MANAGING SEVERE MALARIA IN AN INTENSIVE CARE UNIT CONTRAINDICATIONS AND COMPLICATIONS OF TREATMENT WITH QUININE

A total of 24 patients were included in the study, 18 (75%) males, all adults with
an average age of 41,3 ± 13,3 years. We consider that 15 (62,5%) patients had developed
partial immunity as considered in persons living in an endemic area for more than
six months. All cases were imported from endemic countries in Africa. No patients
underwent prophylaxis for malaria. The mean time between onset of the symptoms and
hospital admission was 4,3 ± 2,2 days. Parasitemia, quantified in all but 2 patients,
was, on average, 18,5% ± 15,2 (from 2 to 60%), wherein 18 (81,8%) patients developed
parasitemia greater than 5%. Severe malaria, as defined by the WHO, was observed in
22 (91,7%) of the patients, 15 of whom (68,2%) had 4 or more criteria. The mean Apache
II score at admission was 16,8 ± 7,7 (from 1 to 33) and the SOFA score was 11,4 ±
6,1 (from 4 to 24), either without correlation with the observed intra-hospitalar
mortality rate (8,3%; n = 2). Overall, 20 (83,3%) of the patients were treated with
intravenous quinine, being the loading dose between 750 and 1750mg. The mean time
between the onset of therapeutic and parasitemia 1% was 2,3 ± 1,2 days (from 0,25
to 4). The most common adverse effects of quinine, besides the expectable cinchonism,
was mild hypoglycaemia (50%; n = 12). Three (12,5%) patients needed aminergic support
after initiating quinine. Also 3 patients (12,5%) developed non-severe arrhythmia.