Severe malaria in African adults living in a seasonal endemic area

Objective This study investigates severe malaria in african adults living in a seasonal endemic area.Design: A prospective study of all adults admitted with severe malaria over 2 consecutive seasons: October 1990 till January 1991 and October 1991 till January 1992.Setting ICU (15 beds) of Hôpital Principal, Dakar, Sénégal.Patients 23 patients: 14 men and 9 women with a mean age of 30±3 years were included in the study; all fulfilled the 1990 WHO criteria for severe malaria.Results At admission, 12 patients were comatose (Glasgow Coma Scale<10), 7 had generalized convulsions. Parasitaemia was 135±52×10⁹/l. Biological indications of severity were as follows: hypophosphataemia <0.8 mmol/l in 14 cases, serum creatine phosphokinase >500 IU/l in 15 cases; and PaO₂<70 mmHg in 5 cases. Serum TNF levels, measured in 16 cases, were increased at 298.4±63.5 pg/ml, serum levels of IL-6 and IL-2SR were also elevated: 609.5±304.2 pg/ml and 297.6±35.6 pg/ml respectively. Circulating IgM and IgG antibodies were found in 14 out of 16 patients. Serum levels of TNF, IL-6 and IL-2SR correlated positively with each other. TNF and IL-2SR were also positively correlated to parasitaemia. Intravenous therapy with quinine at loading dose was favorable in 19 patients. Four patients died during the study, 3 from multiple organ failure.Conclusions: This work demonstrated that severe malaria in a seasonal endemic area displays original clinical features with a high rate of either cerebral malaria or multiple organ failure.