Abstract
This study analyses the intensive care treatment of 48 patients admitted to the Intensive Care Unit (ICU) at the Infectious Diseases Clinical Hospital No. 2, Moscow, Russia, between 2007 and 2019, with a severe and complicated form of P. falciparum malaria (B50.8 ICD 10). Objective. The aim of this study was to improve the intensive care treatment for severe and complicated P. falciparum malaria. The treatment strategy implemented was aimed at preventing ischaemia-reperfusion injury to organs, as well as haemorrhagic complications. The ICU Case Management Protocol set up indications for transferring patients to the ICU which provide preventive (prior to the development of renal failure) application of extracorporeal hemocorrection methods (continuous venous-venous hemodiafiltration and plasmapheresis in a plasma exchange mode) and mechanical ventilation under a medically induced coma, given impaired consciousness as the initial symptom of patients. Results. Successful treatment outcome in a majority of the patients (93.8%), shorter ICU length of stay (6.67 ± 1.9 days as compared to 94 ± 1.6 before introduction of the protocol), a median parasite clearance time of 37.50 hours (95% CI 36.21–38.18), and a reduced mortality rate from 29.1% to 6.25% support the efficacy of the ICU protocol in managing severe and complicated P. falciparum malaria.
Highlights
Imported cases of P. falciparum malaria from high endemic countries in Africa, Southeast Asia, and in the recent years from South America are recorded annually in the Russian Federation [1].Review of data on susceptibility of mosquitoes in the USSR to imported strains of malaria parasites revealed that local Anopheles mosquitoes are nonsusceptible to P. falciparum [2]. is fact confirms the absence of autochthonous P. falciparum transmission by local mosquitoes for over 40 years. ere were 1086 confirmed cases of P. falciparum malaria in the Russian Federation between 2000 and 2019, of which 44 patients died (4%)
We analyzed the management of 48 patients with severe and complicated P. falciparum malaria admitted to the Intensive Care Unit (ICU) at the Infectious Diseases Clinical Hospital No 2, Moscow city, in the period from 2007 to 2019. ese patients had been managed with a protocol for severe and complicated P. falciparum malaria which was developed at the ICU. e ICU Management Protocol for severe and complicated P. falciparum malaria consists of modern methods of extracorporeal hemocorrection and mechanical ventilation under a medically induced coma
We present a case of severe P. falciparum malaria managed under the ICU Management Protocol for severe and complicated P. falciparum malaria: A 49-year-old man presented to our hospital at the ICU on March 30, 2020, with persistent fever and fatigue for 10 days
Summary
Imported cases of P. falciparum malaria from high endemic countries in Africa, Southeast Asia, and in the recent years from South America are recorded annually in the Russian Federation [1].Review of data on susceptibility of mosquitoes in the USSR to imported strains of malaria parasites revealed that local Anopheles mosquitoes are nonsusceptible to P. falciparum [2]. is fact confirms the absence of autochthonous P. falciparum transmission by local mosquitoes for over 40 years. ere were 1086 confirmed cases of P. falciparum malaria in the Russian Federation between 2000 and 2019, of which 44 patients died (4%). Imported cases of P. falciparum malaria from high endemic countries in Africa, Southeast Asia, and in the recent years from South America are recorded annually in the Russian Federation [1]. Ere were 1086 confirmed cases of P. falciparum malaria in the Russian Federation between 2000 and 2019, of which 44 patients died (4%). Factors found to be associated with severe and complicated P. falciparum malaria were absence of chemoprophylaxis by travellers to endemic regions, lack of information on travel history, healthcare delay, and management and diagnostic errors. Medical practitioners implement conventional antimalarial medication without considering the risk of a drug-resistant P. falciparum in endemic regions where travellers may have visited [3], which further delays treatment. Most of the patients with imported P. falciparum malaria are nonimmune Russian citizens (travellers) which explains the rapid development of severe and complicated forms of the disease. Most of the patients with imported P. falciparum malaria are nonimmune Russian citizens (travellers) which explains the rapid development of severe and complicated forms of the disease. e aim of this study was to improve the intensive care treatment for patients with severe and complicated R. falciparum malaria so as to prevent fatal outcomes
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