A decade with Falciparum Malaria in the ICU

Aims and introduction

To study and compare the various treatment modalities and the attendant complications of Falciparum Malaria with or without concomitant Vivax in the intensive care unit.

Method

Retrospective study between 1993 and 1995 and prospective study from 1996 to 2002 of patients having severe malaria warranting intensive care management.

Results

A total of 173 patients; 107 survived and 66 died (61% survival, 38% mortality) (Fig. 1).

Figure 1

Conclusions

Quinine has given good and consistent results (10 mg/kg up to 600 mg, thrice daily for 5–10 days) and can cure all stages of Falciparum and other plasmodia. The treatment must be initiated with Quinine only in patients sick enough to need the ICU.

Parasites may have developed resistance to a multidrug regimen. It is also very much in evidence in the study that if the Quinine is given after Mefloquine the results are not really encouraging, besides having an unacceptable rate of side effects due to its long half-life.

Artisunate 120 mg bolus followed by 60 mg daily IV × 5 days given with Quinine yielded good results. This is perhaps the best that can presently be offered to patients with shock/MOF.

Artesunate or Arthemether alone although effective are probably insufficient to treat severely complicated patients.

Cinchonism and hypoglycemia were easily manageable. Most importantly, prolonged QTc was not encountered in any patient.

Patients who came to the ICU in multiorgan failure did not do well with whatever interventions. We must do a planned study on these patients and the blood exchange transfusion therapy must be tried to salvage these patients.

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