POSSIBLE PROGNOSTIC-SIGNIFICANCE OF A BRIEF VISE IN PARASITEMIA FOLLOWING QUININE TREATMENT OF SEVERE PLASMODIUM-FALCIPARUM MALARIA

An increase in parasitaemia is not uncommon after initiation of treatm ent for Plasmodium falciparum malaria, but its exact significance is u nknown. The time-course of parasitaemia was assessed retrospectively i n 33 patients with severe imported malaria. In 19 patients (group 1) m ean parasitaemia (+/-SEM) fell promptly after starting quinine treatme nt, from 24.9+/-4.1% on day 0 to 9.7+/-2.3% on day 1 and 1.8+/-0.7% on day 2. In 14 other patients (group 2), parasitaemia did not change si gnificantly or increased, with mean parasitaemia (+/-SEM) Of 9.5+/-2.1 % on day 0, 17.2+/-2.6% on day 1, and 3.7+/-1.8% on day 2. Simplified acute physiology scores on admission (mean +/-SEM) were 17.4+/-1.4 in group 1 and 11.7+/-1.0 in group 2 (P=0.006). The mean number of compli cations of malaria per patient (+/-SEM) was 2.9+/-0.5 in group 1 and 1 .6+/-0.3 in group 2 (P=0.046). Two group 1 patients died. Initially, m ore than 95% of peripheral blood parasites were tiny and small rings i n both groups, and this distribution was unchanged on day 1, suggestin g that the parasitaemia increase in group 2 was not due to release of sequestered mature parasites. In severe falciparum malaria, a rise in parasitaemia after treatment initiation may be of favourable prognosti c significance and should not lead to aggressive therapeutic approache s such as exchange tranfusion.