treatment of severe malaria

Background. Malaria represents a medical emergency as it may rapidly progress to complication and death without a prompt and appropriate treatment. Severe malaria is almost exclusively caused by Plasmodium falciparum. The incidence of imported malaria in developed countries has been increasing and the case-fatality rate remains high despite progress in intensive care management and antimalarial treatment. Clinical deterioration usually appears 3 to 7 days after onset of fever. Complications involve the nervous, respiratory, renal and/or hematopoietic system. Acidosis and hypoglycemia are also common.

Conclusions. Intravenous quinine is the most widely used drug in the initial treatment of severe falciparum malaria whereas artemisinin derivatives are currently in developed countries recommended only for quinine-resistant cases. As soon as the patient is clinically stable and can swallow, oral treatment should be given. The intravascular volume should be maintained at the lowest level sufficient for adequate systemic perfusion to prevent development of acute respiratory distress syndrome. Renal replacement therapy in acute renal failure should be initiated early. Exchange blood transfusion has been suggested for the treatment of patients with severe malaria and hyperparasitemia. For the early diagnosis, it is of paramount importance to consider malaria in every febrile patient with a history of travel within an endemic area for the last years.