SEVERE MALARIA IN AFRICAN ADULTS LIVING IN A SEASONAL ENDEMIC AREA

Objective: This study investigates severe malaria in african adults li ving in a seasonal endemic area. Design: A prospective study of all ad ults admitted with severe malaria over 2 consecutive seasons: October 1990 till January 1991 and October 1991 till January 1992. Setting: IC U (15 beds) of Hopital Principal, Dakar, Senegal. Patients: 23 patient s: 14 men and 9 women with a mean age of 30+/-3 years were included in the study; all fulfilled the 1990 WHO criteria for severe malaria. Re sults: At admission, 12 patients were comatose (Glasgow Coma Scale < 1 0), 7 had generalized convulsions. Parasitaemia was 135+/-52 x 10(9)/1 . Biological indications of severity were as follows: hypophosphataemi a < 0.8 mmol/l in 14 cases, serum creatine phosphokinase > 500 IU/l in 15 cases; and PaO2 < 70 mmHg in 5 cases. Serum TNFalpha levels, measu red in 16 cases, were increased at 298.4+/- 63.5 pg/ml, serum levels o f IL-6 and IL-2SR were also elevated: 609.5+/-304.2 pg/ml and 297.6 +/ -35.6 pg/ml respectively. Circulating IgM and IgG antibodies were foun d in 14 out of 16 patients. Serum levels of TNFalpha, IL-6 and IL-2 SR correlated positively with each other. TNFalpha and IL-2SR were also positively correlated to parasitaemia. Intravenous therapy with quinin e at loading dose was favorable in 19 patients. Four patients died dur ing the study, 3 from multiple organ failure. Conclusions: This work d emonstrated that severe malaria in a seasonal endemic area displays or iginal clinical features with a high rate of either cerebral malaria o r multiple organ failure.