Severe imported malaria: a case report

Purpose

Malaria is still considered a major global health problem. The severity form of the disease is caused mainly by P. falciparum and may occur together with cerebral, kidney, pulmonary, hematologic, circulatory and hepatic complications. This report is about a patient with a case of severe imported malaria.

Case report

A 30-year-old male, mulatto, Philippine, sailor, from a ship arriving from Nigeria, with a history of abdominal pain on the right hypochondrium, jaundice, fever, and a decrease in consciousness. Laboratory tests on admission showed hyperbilirubinemia at a level of 50 mg/dl, severe metabolic acidosis, thrombocytopenia, creatinine levels of 5.6 mg/dl and leukocytosis with deviation through metamyelocytes. The APACHE II score was 37, with a death estimated risk of 88%. During the patient's stay at the hospital, P. falciparum malaria was diagnosed through the thick drop test. Even with the adequate antimalaria therapy, the patient's condition evolved to an acute renal failure requiring hemodialysis, acute respiratory distress syndrome, septic shock, and a hematological disorder, forming a multiple organ dysfunction syndrome. After being discharged from the hospital, the patient did not present any cerebral, pulmonary or kidney sequel.

Discussion

From the criteria described in the medical literature to define critical malaria, the patient fulfilled the following: acute renal failure, acute respiratory distress syndrome, metabolic acidosis, altered level of consciousness, macroscopic hemoglobinuria, hyperparasitism and hyperbilirubinemia, related to a lethality rate of over 10% depending on early treatment and available resources. Severe malaria requires fast diagnosis allied to quick access to an intensive care treatment, since any delay increases the morbidity – mortality of the disease.