Severe malaria in an infant

We report on a five month-old infant from Cameroon, who was admitted becaus e of febrile gastroenteritis after living in Germany for two weeks. Since t he patient was somnolent, had a parasitaemia of Plasmodium falciparum of 23 0 000/mu l, a haemoglobin concentration of 5.3 g/dl and a thrombocytopenia, a complicated falciparum malaria was diagnosed. Treatment was started imme diatedly with intravenous 20 mg quinine/kg bw as a loading dose, followed b y 10 mg/kg bw every 12 hours, combined with intravenous clindamycin 10 mg/k g bw bd. Red blood cells were transfused once. The parasitaemia dropped to 2000 trophozoites/mu l within 48 hours. No asexual stages were detectable f rom the third day of treatment on. Weekly controls for the following four w eeks remained negative. The mortality rate of complicated malaria is 50% in the first year of life, which can be reduced by early treatment. We presen t this case to draw attention to therapeutic options in infants.