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Acute lung injury complicating imported Plasmodium falciparum malaria
1Clinique de Réanimation des Maladies Infectieuses, Groupe Hospitalier Bichat-Claude Bernard, Paris, France.
Study Objective:
To characterize adult patients with acute lung injury complicating severe imported Plasmodium falciparum malaria.
Design And Setting:
Retrospective study of patients with severe P falciparum malaria admitted to the medical ICU of a university hospital infectious diseases department.
Patients:
Forty adults with complicated malaria, with (group 1, 12 patients) or without (group 2, 28 patients) acute lung injury.
Results:
Patients with acute lung injury had a higher simplified acute physiology score on admission (24.2 +/- 3.2 vs 13.7 +/- 0.7 in group 2, p < 0.0001) and a longer time interval to adequate antimalarial therapy (8.8 +/- 2.5 vs 4.9 +/- 0.6 days in group 2, p = 0.046). Of the nine group 1 patients given mechanical ventilation, eight had a PaO2/FIO2 < or = 200 mm Hg. Two patients with moderate hypoxemia received oxygen through a nasal tube and one received continuous positive airway pressure via a face mask. Acute renal failure, unrousable coma, metabolic acidosis, and shock were significantly more common among group 1 patients. The number of complications of malaria was significantly higher in patients with acute lung injury (4.7 +/- 0.5 vs 1.6 +/- 0.1 in group 2, p < 0.0001). Five patients, including four with acute lung injury, had evidence of bacterial infection (pneumonia or primary bacteremia) at ICU admission. Four patients with acute lung injury died (33%) vs one patient without acute lung injury (4%, p = 0.022).
Conclusions:
Acute lung injury is more likely to occur in patients with extremely severe, multisystemic P falciparum malaria. In patients with acute lung injury and septic shock, bacterial coinfection should be suspected and treated empirically since it contributes substantially to early mortality.
Insights
Acute lung injury (ALI) is more common in severe Plasmodium falciparum malaria with multiple organ issues. Bacterial coinfection in ALI patients with malaria and septic shock requires prompt treatment to reduce early mortality.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Severe Plasmodium falciparum malaria can lead to acute lung injury (ALI).
- Understanding ALI in malaria is crucial for patient outcomes.
Purpose of the Study:
- To characterize adult patients with ALI complicating severe imported P. falciparum malaria.
- To identify factors associated with ALI in severe malaria patients.
Main Methods:
- Retrospective study of 40 adult patients with severe P. falciparum malaria.
- Patients were divided into two groups: with (n=12) and without (n=28) ALI.
- Data collected included severity scores, time to treatment, complications, and mortality.
Main Results:
- Patients with ALI had higher severity scores and delayed antimalarial therapy.
- ALI patients experienced more complications, including acute renal failure, coma, acidosis, and shock.
- Bacterial coinfection was present in 4/12 ALI patients.
- Mortality was significantly higher in the ALI group (33% vs 4%).
Conclusions:
- ALI is associated with extremely severe, multisystemic P. falciparum malaria.
- Bacterial coinfection should be suspected and empirically treated in malaria patients with ALI and septic shock.
- Prompt treatment of bacterial coinfection is vital for reducing early mortality in these critical patients.