Review Article Severe Malaria
Severe Malaria
Keywords:
Plasmodium falciparum, Plasmodium vivax, severe malaria, artesunate, artemisinin, quinine, malaria and pregnancyAbstract
Tropical infections accounts for 20–30% of ICU admissions in the tropics. Plasmodium falciparum is responsible for most of the cases, though recently P vivax is increasingly found to be implicated in severe malaria. Cerebral malaria is more common among children, the severe malaria in adults presents with multi organ failure such as thrombocytopenia, acute respiratory distress syndrome, acute kidney failure, coagulopathy, encephalopathy and features of liver injury. A secondary bacterial infection in this clinical setting is not uncommon and may contribute to poor outcome. Several metabolic anomalies such as lactic acidosis, hyponatremia and hypoglycemia may be invariably seen. Aggressive Intensive care management namely fluid resuscitation, immediate appropriate drug therapy, correction of metabolic irregularities, vasopressors along with blood and component therapy determines favourable outcomes. Quinine which was the mainstay of therapy over many decades has now been replaced with more effective and safer Artesunate or Artemisinin centered combination therapy.
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