Managing malaria in the intensive care unit

Abstract

The number of people travelling to malaria-endemic countries continues to increase, and malaria remains the commonest cause of serious imported infection in non-endemic areas. Severe malaria, mostly caused by Plasmodium falciparum, often requires intensive care unit (ICU) admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. The mortality from imported malaria remains significant. This article reviews the manifestations, complications and principles of management of severe malaria as relevant to critical care clinicians, incorporating recent studies of anti-malarial and adjunctive treatment. Effective management of severe malaria includes prompt diagnosis and early institution of effective anti-malarial therapy, recognition of complications, and appropriate supportive management in an ICU. All cases should be discussed with a specialist unit and transfer of the patient considered.

Keywords: ARDS; ICU; imported infections; malaria.

Fig 1

Countries and areas with risk of malaria transmission. Map from WHO International Travel and Health Programme, http://www.who.int/ith/en/. Reproduced with permission of the World Health Organisation.

Fig 2

Life cycle of Plasmodium. Image from the Centers for Disease Control and Prevention (www.cdc.gov). Image produced by CDC — DPDx/Alexander J. da Silva, Melanie Moser.

Fig 3

Health Protection Agency and British Infection Associated Algorithm for Initial Assessment and Management of Malaria in Adults. © Crown copyright. Reproduced with permission of Public Health England.