[Multiple organ failure in Plasmodium falciparum malaria]

Area of Science:

• Infectious Diseases
• Tropical Medicine
• Critical Care Medicine

Background:

• Malaria remains a significant global health threat, particularly Plasmodium falciparum, with potential for severe complications in travelers.
• Inadequate malaria prophylaxis during travel to endemic areas increases the risk of contracting the disease upon return.

Observation:

• A 44-year-old traveler developed severe Plasmodium falciparum malaria with high parasitemia (22%) and multi-organ dysfunction, including cerebral, hepatic, renal, and hematologic compromise.
• The patient presented with hyperpyrexia, obtundation, hypotension, jaundice, hemorrhage, acute kidney injury, disseminated intravascular coagulation, and metabolic acidosis.
• Despite initial chloroquine treatment failure, aggressive management in the intensive care unit, including quinine, sulfadoxine-pyrimethamine, clindamycin, exchange transfusion, mechanical ventilation, and hemodialysis, was initiated.

Findings:

• The patient required extensive supportive care, including mechanical ventilation for 16 days and hemodialysis for 11 days, alongside blood product transfusions and management of seizures.
• Nosocomial infections with Escherichia coli, Staphylococcus, and Pseudomonas aeruginosa complicated the recovery, necessitating broad-spectrum antibiotic treatment.
• Complete clinical recovery was achieved, underscoring the importance of prompt and comprehensive intensive care management for severe malaria.

Implications:

• This case highlights the critical need for adherence to malaria prophylaxis guidelines for travelers to endemic regions.
• Effective management of severe Plasmodium falciparum malaria necessitates a multidisciplinary approach within an intensive care setting.
• The case underscores the challenges and successful outcomes achievable with advanced medical interventions in life-threatening malaria cases.