MULTIORGANIC FAILURE IN PLASMODIUM-FALCIP ARUM MALARIA

A 44-year-old spanish woman travelled in Kenya without doing correct m alarial prophylaxis. Upon her return to Spain, she suffered from Plasm odium falciparum malaria. She was initially treated with chloroquine f or three days, but her state worsened and she was admitted to our inte nsive care unit. On admission, parasitaemia was 22%. She had hyperpyre xia, obtundation, hypotension, tachycardia, tachypnoea, jaundice, dige stive haemorrage, petechiae in her soles, oliguria with elevation of s erum uraemia and creatinine, anaemia, thrombocytopaenia, hypoproteinae mia, hyponatraemia, hypocalcaemia, metabolic acidosis and paramethers of disseminated intravascular coagulation. She was given quinine, sulf adoxine-pyrimethamine and clindamycin, An exchange transfusion was per formed, during which an acute pulmonary oedema appeared, initially wit h high pulmonary artery wedge pressure. She required mechanical ventil ation for 16 days and haemodialysis for 11 days. She remained in coma and had seizures which required diazepam, phenitoin and thiopentone. S he received a total amount of 22 units of packed erythrocites, 55 of p latelets and 15 of plasma. After the first week, she had nosocomial in fection due to Escherichia coli, Staphylococcus and Pseudomonas aerugi nosa and was treated with the corresponding antibiotics. She cured com pletely. This case report gives us the possibility of discussing on fr equent problems in the prevention and treatment of malaria, and on the treatment of severe, life-threatening malaria in the setting of the i ntensive care unit.