Table 1

Total admissions in the ICU:        96

Quinine group:    40 patients

Non Quinine group:        56 patients

Survived        34          Died      06

Survived        20          Died        36

All Started with Quinine 10 mg/kg

Started either with Chloroquine, Sulfadoxine-

(up to max 600 mg thrice a day for 5-10 days)

Pyremethamine, Mefloquine with or without

IV Fluids esp. Dextrose

Halofantrine, Doxycycline, Norfloxacin

Antibiotics esp. Doxycycline

Artemesnin derivatives and others

Other parameters like Mechanical ventilatory support, Blood transfusions, Positive Ionotropes were used indiscriminately for all patients, as the

situation demanded

Complications:

Complications:

CNS - Drowsy, altered sensorium responded

CNS - Disorientation, Unconsciousness,

well by the 3rd dose of Quinine

coma, death

Respiratory- Reversible with prompt treatment

Respiratory - Respiratory Failure, ARDS

and others recovered well after mechanical ventilaton

Renal Failure: High Creatinine due to microvascular

Renal Failure - High creatinine, Anuria, ATN

ischemia returned to baseline over a period of time

DIC, Shock, Multi organ failure were not encountered

Hepatic failure, Multi Organ Failure, Hemolysis, Circulatory failure, DIC

Death

Ominous signs of Falciparum

1) Peripheral smear: due to invasion of young RBCs and sequestration in tissues, a large number of parasites may be invisible on the smear,

thereby giving false assurance of a "low parasite index".

2) Premunition: in holo and hyperendemic areas, due to some degree of acquired immunity, patients are largely asymptomatic early on. It is almost

always late when symptoms manifest overtly.

3) Cerebral Malaria is a "diffuse symmetrical encephalopathy" and therefore sparing mild neck rigidity, signs of meningeal irritation are largely

absent. Mild delerium, obtundation, convulsions etc. are to be taken seriously.

4) Pregnant women are spared gross parasitemia for a long time due to heavy "parasitisation of the placenta".