Abstract
IntroductionImported falciparum malaria is characterized by a broad spectrum of potentially life-threatening complications that may arise even after initiation of appropriate antimalarial drug therapy. Hence, at Heidelberg University Hospital, all patients with newly diagnosed falciparum malaria are initially treated in the intermediate care unit (IMC) or intensive care unit (ICU). The present study was undertaken to evaluate critically the benefit of this strategy, which includes daily consultation with senior specialists in tropical medicine.MethodsWe conducted a retrospective cohort study at the 14-bed combined IMC/ICU of a 1,685-bed university hospital. A cohort of 122 patients with imported falciparum malaria admitted from 1 January 1996 to 31 December 2003 was included.ResultsThirty-four patients (27.9%) developed complications, defined according to the current World Health Organization classification. Most patients (80.3%) studied did not take the recommended chemoprophylaxis against malaria. The majority of patients (89.3% [n = 109]) could be adequately treated in the IMC. Life-threatening complications requiring ICU support occurred in 13 patients (10.7%). All complications were successfully managed. Fifty-five patients (45.1%) fulfilling recently published criteria for outpatient treatment had an excellent therapeutic response and did not require ICU support.ConclusionThis retrospective evaluation demonstrated favourable therapeutic results in hospitalized patients with imported falciparum malaria. Both initial treatment in the medical IMC/ICU and close collaboration between intensivists and specialists in tropical medicine may improve disease outcome among affected patients. Prospective studies are needed to confirm these preliminary findings.
Highlights
Imported falciparum malaria is characterized by a broad spectrum of potentially life-threatening complications that may arise even after initiation of appropriate antimalarial drug therapy
Study population and design We evaluated all patients with imported falciparum malaria admitted to the combined medical intermediate care unit (IMC)/intensive care unit (ICU) of Heidelberg University Hospital, Heidelberg, Germany, between 1 January 1996 and 31 December 2003, in a single-centre retrospective observational study
Patient characteristics Between January 1996 and December 2003, a total of 165 patients with malaria were admitted to the medical IMC/ICU
Summary
Imported falciparum malaria is characterized by a broad spectrum of potentially life-threatening complications that may arise even after initiation of appropriate antimalarial drug therapy. At Heidelberg University Hospital, all patients with newly diagnosed falciparum malaria are initially treated in the intermediate care unit (IMC) or intensive care unit (ICU). Severe or complicated falciparum malaria is characterized by a broad spectrum of life-threatening complications, in particular acute respiratory distress syndrome, renal failure, circulatory shock and coma [3,4,5,6,7,8]. Despite improvements in intensive care management, the case fatality rate for complicated malaria in the intensive care unit (ICU) is still high and may reach up to 40% [9,10,11,12]. Unfavourable outcomes are at least partly attributable to delayed initiation of appropriate
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