Imported Plasmodium falciparum malaria.: What is the relevance of severity criteria defined by the WHO?

Severe and complicated falciparum malaria was defined according to symptoms presented by young children or semi-immune adults in tropical areas. This definition of severe and complicated malaria seems less relevant when applied to imported malaria in nonimmune adults. The main conclusions drawn by the authors on severe imported malaria in ICU, after reviewing the international literature and using their personal experience, are: - the 'complete' definition (ten stricto sensu defining criteria, other manifestations, risk population) allows initial assessment of severity and a good triage of patients; - the ten defining criteria adequately point out patients with a high mortality risk; - in adults, the more relevant criteria are metabolic acidosis, shock, pulmonary edema, coma, and to a lesser degree, renal failure. Spontaneous bleeding/DIC, severe anemia, hypoglycemia, and recurrent convulsions are uncommon and less relevant Hemoglobinuria is not relevant at all; - in children, the more relevant defining criteria seem to be metabolic acidosis, coma, recurrent convulsions, and hypoglycemia. (C) 1999 Editions scientifiques et medicales Elsevier SAS.