Imported Plasmodium falciparum malaria. What is the relevance of severity criteria defined by the WHO?

Severe and complicated falciparum malaria was defined according to symptoms presented by young children or semi-immune adults in tropical areas. This definition of severe and complicated malaria seems less relevant when appli ed to imported malaria in nonimmune adults. The main conclusions drawn by t he authors on severe imported malaria in ICU, after reviewing the internati onal literature and using their personal experience, are: - the 'complete' definition (ten stricto sensu defining criteria, other man ifestations, risk population) allows initial assessment of severity and a g ood triage of patients; - the ten defining criteria adequately point out patients with a high morta lity risk; - in adults, the more relevant criteria are metabolic acidosis, shock, pulm onary edema, coma, and to a lesser degree, renal failure. Spontaneous bleed ing/DIC, severe anemia, hypoglycemia, and recurrent convulsions are uncommo n and less relevant Hemoglobinuria is not relevant at all; - in children, the more relevant defining criteria seem to be metabolic aci dosis, coma, recurrent convulsions, and hypoglycemia. (C) 1999 Editions sci entifiques et medicales Elsevier SAS.