Severe malaria in Parirenyatwa Hospital, Harare Intensive Care Unit: a case record review of 16 cases

Abstract

Background: Zimbabwe has reported a decrease in malaria admissions and mortality rates by 64% and 71% respectively between 2003 and 2012, suggesting the country is on track to achieve a decrease in admission rates by 50-75% and mortality rates by >75% by 2015. The aim of this study is to review the Intensive Care Unit (ICU) outcomes of the malaria patients admitted into Parirenyatwa Group of Hospitals (PGHs) adult  ICU and to determine whether the Multiple Organ Dysfunction Score can be applied to a small set of patients with severe malaria in our unit.

Materials and Methods: A retrospective case record review of patients admitted in ICU with a diagnosis of malaria at PGH general adult ICU. Demographic data, clinical data, laboratory data and data on interventions in ICU were collected. Multiple Organ Dysfunction Score (MODS), Malaria Prediction Score (MPS) and Malaria Score for Adults (MSA) were applied for all patients.

Results: Sixteen (16) malaria patients were included in the study and all were adults with an age range of 18-68 and 10 (62.5%) were female. Parasitaemia on admission was quantified in 8/16 (50%) patients were 2 patients had parasitaemia greater than 5% and 6 had parasitaemia less than 5%. The complications included unarousable coma 12 (75%), persistent seizures 6 (37.5%), circulation collapse 3 (18.8%), Moderate to severe ARDS 4 (25%), renal impairment 7 (44%), severe metabolic acidosis 8 (50%), severe anaemia 8 (50%), severe thrombocytopaenia 4 (25%), hyperbilirubinaemia 9 (56%) and hypoglycaemia 2 (12.5%). The case fatality rate was 50%. Death was associated with a shorter duration of ICU stay and higher MODS scores.

Conclusion: Although antimalarial therapies are the mainstay of malaria treatment, ICU admission and interventions remain pivotal in reducing morbidity and mortality in severe malaria. The MODS score is a good predictor of mortality in a small number of malaria patients; however specific scores should be studied.