Shock complicating severe falciparum malaria in European adults

Objective: To study adult patients with severe falciparum malaria who developed shock. Design: Retrospective study from 1987 to 1993. Setting: Medical intensive care unit in a university hospital. Patients: 13 patients admitted with severe falciparum malaria who developed shock. All received intravenous quinine. Measurements and results: The mean Simplified Acute Physiology Score II was 59.5 +/- 7.1, 2.6 +/- 0.4 criteria defining severe disease were present on admission in 12 patients; and initial parasitemia was 21 +/- 6 %, Twelve patients received inotropic drugs. Pulmonary artery catheterization showed the following results in 7 patients: mean arterial pressure 57 +/- 4 mmHg; pulmonary artery occlusion pressure 11 +/- 1 mmHg; cardiac index 5.5 +/- 0.91 . min(-1) . m(-1); and systemic vascular resistance index 783 +/- 122 dyne . s . cm(-5) m(-2). Seven patients had evidence of bacterial infection at the time of shock. Of the 7 deaths (50 %), 5 were due to shock, with documented bacterial infection in all patients and persistent parasitemia in 4. Conclusions: Shock complicating severe falciparum malaria in adults is associated with peripheral vasodilation and carries a poor prognosis. In falciparum malaria with shock, bacterial coinfection should be suspected immediately and treated empirically with broad-spectrum anti biotics. Nevertheless, Plasmodium falciparum may contribute directly or indirectly to the onset of shock.