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Severe malaria in African adults living in a seasonal endemic area

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Abstract

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 TNFα 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 TNFα, IL-6 and IL-2SR correlated positively with each other. TNFα 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.

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References

  1. Molyneux ME, Taylor TE, Wirima JJ, Borgstein A (1989) Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. Q J Med 71:441–459

    Google Scholar 

  2. Lichtman AR, Mohrcken S, Engelbrecht M, Bilgalke M (1990) Pathophysiology of severe forms of falciparum malaria. Crit Care Med 18:666–668

    Google Scholar 

  3. Salord F, Allaouchiche B, Gaussorgues P, Boibieux A, Sirodot M, Gerard-Boncompain M, Biron F, Peyramond D, Robert D (1991) Severe falciparum malaria (21 cases). Intensive Care Med 17: 449–454

    Google Scholar 

  4. Ho M, Webster HK (1989) Immunology of human malaria. A cellular perpective. Parasite Immunol 11:105–116

    Google Scholar 

  5. Peyron F, Vuillez JP, Barbe G, Boudin C, Picot S, Ambroise-Thomas P (1990) Plasma levels of tumor necrosis factor during a longitudinal survey in an endemic area of malaria. Acta Tropica 47:47–51

    Google Scholar 

  6. World Health Organization (1990) Severe and complicated malaria. Trans R Soc Trop Med Hyg 84 [Suppl]:1–65

    Google Scholar 

  7. Warrell DA, Looareesuwan S, Warrell MJ, Kasemsarn P, Intaraprasert R, Bunnag D, Harinasuta T (1982) Dexamethasone proves deleterious in cerebral malaria. A double-blind trial in 100 comatose patients. N Engl J Med 306:313–319

    Google Scholar 

  8. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ system failure. Ann Surg 202:685–692

    Google Scholar 

  9. Facer CA (1980) Direct antiglobulin reactions in Gambian children withPlasmodium falciparum. III. Expression of IgG subclass determinants and genetic markers and association with anaemia. Clin Exp Immunol 41:81–90

    Google Scholar 

  10. Nardin EH, Nussenzweig RS, McGregor IA, Bryan JH (1979) Antibodies to sporozoïtes; their frequent occurence in individuals living in an area of hyperendemic malaria. Science 206:597–599

    Google Scholar 

  11. Brasseur P, Ballet JJ, Druilhe P (1990) Impairment ofPlasmodium falciparum specific antibody response in severe malaria. J Clin Microbiol 228:265–268

    Google Scholar 

  12. Greenwood B, Marsh K, Snow R (1991) Why do some African children develop severe malaria? Parasitol Today 7:277–281

    Google Scholar 

  13. Clair B, Wolff M, Bedos JP, Regnier B, Lebras J, Vachon F (1990) Accès pernicieux palustre de l'adulte. Experience actuelle de la clinique de réanimation des maladies infectieuses de l'hôpital Claude Bernard. Med Trop 50:69–73

    Google Scholar 

  14. Mac Pherson GG, Warrell MJ, White NJ, Looareesuwan S, Warrell DA (1985) Human cerebral malaria. Quantitative ultrastructural analysis of parasitized erythrocyte sequestration. Am J Pathol 119:385–401

    Google Scholar 

  15. De Silva HJ, Goonetilleke AKE, Senaratna N, Ramesh N, Jayawickrama US (1988) Skeletal muscle necrosis in severe falciparum malaria. Br Med J 296:1039

    Google Scholar 

  16. Lewis DJM (1987) Hypophosphataemia: a feature of malaria? Br Med J 295:416–417

    Google Scholar 

  17. Saïssy JM, Diatta B, Raux O, Gohard R, Kempf J (1990) Hypophosphorémie au cours du neuropaludisme. Presse Méd 19:1053

    Google Scholar 

  18. Clark IA, Chaudhri G, Cowden WB (1989) Roles of tumor necrosis factor in the illness and pathology of malaria. Trans R Soc Trop Med Hyg 83:436–440

    Google Scholar 

  19. Tracey KJ, Beutler B, Lowry SF, Merryweather J, Wolpe S, Milsark IW, Hariri RJ, Fahey TJ, Zentella A, Albert JD, Shires GT, Cerami A (1986) Shock and tissue injury induced by recombinant human cachectin. Science 234:470–474

    Google Scholar 

  20. Miller KD, Greenberg AE, Campbell CC (1989) Treatment of severe malaria in the United States with a continuous infusion of quinidine gluconate and exchange transfusion. N Engl J Med 321:65–70

    Google Scholar 

  21. Grau GE, Taylor TE, Molyneux ME, Wirima JJ, Vassali P, Hommel M, Lambert PH (1989) Tumor necrosis factor and disease severity in children with falciparum malaria. N Engl J Med 320:1586–1591

    Google Scholar 

  22. Shaffer N, Grau GE, Hedberg K, Davachi F, Lyamba B, Hightower AW, Breman JG, Nguyen-Dinh P (1991) Tumor necrosis factor and severe malaria. J Infect Dis 163:96–101

    Google Scholar 

  23. Kwiatkowski D, Hill AVS, Sambou I, Twumasi P, Castracane J, Manogue KR, Cerami A, Brewster DR, Greenwood BM (1990) TNF concentration in fatal cerebral, non-fatal cerebral, and uncomplicatedPlasmodium falciparum malaria. Lancet II:1201–1204

    Google Scholar 

  24. Molyneux ME, Taylor TE, Wirima JJ, Grau GE (1991) Tumor necrosis factor, interleukin-6 and malaria. Lancet I:1098

    Google Scholar 

  25. Kern P, Hemmer CJ, Van Damme J, Gruss HJ, Dietrich M (1989) Elevated tumor necrosis factor alpha and interleukin-6 serum levels as markers for complicated Plasmodium falciparum malaria. Am J Med 87:139–143

    Google Scholar 

  26. Reske-Kunz AB, Osawoa H, Josimovic-Alasevic O, Rude E, Diamantstein T (1987) Soluble interleukin-2 receptors are released by long term-cultured insulin-specific T cells transiently after contact with antigen. J Immunol 138:192–196

    Google Scholar 

  27. Kremsner PG, Zotter GM, Feldmeier H, Graninger W, Rocha RM, Jansen-Rosseck R, Bienzle U (1990) Immune response in patients during and after Plasmodium falciparum infection. J Infect Dis 161:1025–1028

    Google Scholar 

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Authors and Affiliations

  1. Service de Réanimation et de Soins Intensifs, Hôpital Principal, Dakar, Sénégal

    J. M. Saïssy, M. Vitris, B. Diatta & J. Kempf

  2. Unité d'Immunologie, Institut Pasteur, Dakar, Sénégal

    F. Adam & J. L. Sarthou

Authors
  1. J. M. Saïssy
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  2. M. Vitris
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  3. B. Diatta
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  4. J. Kempf
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  5. F. Adam
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  6. J. L. Sarthou
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Saïssy, J.M., Vitris, M., Diatta, B. et al. Severe malaria in African adults living in a seasonal endemic area. Intensive Care Med 20, 437–441 (1994). https://doi.org/10.1007/BF01710655

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  • DOI: https://doi.org/10.1007/BF01710655

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