Research

Early treatment of imported falciparum malaria in the intermediate and intensive care unit setting: an 8-year single-center retrospective study

Lukas Schwake¹ , Judith Pamela Streit¹ , Lutz Edler² , Jens Encke¹ , Wolfgang Stremmel¹ and Thomas Junghanss³

¹Department of Internal Medicine IV (Gastroenterology, Infectious Diseases and Intensive Care Medicine), University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany

²Department of Biostatistics, German Cancer Research Center, Im Neuenheimer Feld, D-69120 Heidelberg, Germany

³Section of Clinical Tropical Medicine, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany

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Critical Care 2008, 12:R22doi:10.1186/cc6796

Published:	22 February 2008

Abstract

Introduction

Imported falciparum malaria is characterized by a broad spectrum of potentially life-threatening complications that may arise even after initiation of appropriate antimalarial drug therapy. Hence, at Heidelberg University Hospital, all patients with newly diagnosed falciparum malaria are initially treated in the intermediate care unit (IMC) or intensive care unit (ICU). The present study was undertaken to evaluate critically the benefit of this strategy, which includes daily consultation with senior specialists in tropical medicine.

Methods

We conducted a retrospective cohort study at the 14-bed combined IMC/ICU of a 1,685-bed university hospital. A cohort of 122 patients with imported falciparum malaria admitted from 1 January 1996 to 31 December 2003 was included.

Results

Thirty-four patients (27.9%) developed complications, defined according to the current World Health Organization classification. Most patients (80.3%) studied did not take the recommended chemoprophylaxis against malaria. The majority of patients (89.3% [n = 109]) could be adequately treated in the IMC. Life-threatening complications requiring ICU support occurred in 13 patients (10.7%). All complications were successfully managed. Fifty-five patients (45.1%) fulfilling recently published criteria for outpatient treatment had an excellent therapeutic response and did not require ICU support.

Conclusion

This retrospective evaluation demonstrated favourable therapeutic results in hospitalized patients with imported falciparum malaria. Both initial treatment in the medical IMC/ICU and close collaboration between intensivists and specialists in tropical medicine may improve disease outcome among affected patients. Prospective studies are needed to confirm these preliminary findings.