Severe and complicated malaria in KwaZulu-Natal
AbstractObjective. To describe severe and complicated malaria, including the common complications. causes of death and predictors of poor outcome.
Design. Retrospective case series.
Setting. King Edward VIII Hospital, Durban, Natal, a referral centre.
Patients. One hundred and forty-three consecutive patients (88 males, 55 females; median age 25 years, range 2 - 86 years) admitted with a microscopic diagnosis of Plasmodium falciparum malaria from 1984 to 1991 .
Main outcome measures. A univariate analysis comparing survival and death for categorical and continuous data for various complications was perlormed using the t-test or x2-test (or Fisher's exact test in the case of small cell sizes). Variables that showed significance on univariat,e analysis (P < 0.1) were used in a multivariate analysis to determine which contributed independently to survival or death.
Results. The case tatality rate was 11.1% (15/135) and the commonest complications were hyperparasitaemia (30%), renal tailure (17%), acidaemia (14%), jaundice (10.4%) and cerebral malaria (6%). The commonest complications in patients who died were renal failure (10 patients), cerebral malaria (7), hyperparasitaemia (6) and severe anaemia (5). Multivariate analysis using a logistic
regression model showed a high parasite load and cerebral malaria (relative risks of 11.9 and 51.8 respectively) and high urea levels to be the significant predictors of poor outcome (95% confidence intervals 1.53 - 91 .9, 2.74 - 100.0 and 1.01 - 1.09, respectively).
Conclusions. Patients with high parasite densities, cerebral involvement and renal dysfunction need urgent attention with parenteral chemotherapy, intravenous fluid
replacement and early referral to a tertiary hospital with facilities for intensive monitoring and supportive treatment.
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