Severe imported falciparum malaria: a cohort study in 400 critically ill adults.
<h4>Background</h4>Large studies on severe imported malaria in non-endemic industrialized countries are lacking. We sought to describe the clinical spectrum of severe imported malaria in French adults and to identify risk factors for mortality at admission to the intensive care unit.<...
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2010
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oai:doaj.org-article:1b69f95a352c4d6c8333fd16da7bda442021-11-18T07:03:32ZSevere imported falciparum malaria: a cohort study in 400 critically ill adults.1932-620310.1371/journal.pone.0013236https://doaj.org/article/1b69f95a352c4d6c8333fd16da7bda442010-10-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20949045/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Large studies on severe imported malaria in non-endemic industrialized countries are lacking. We sought to describe the clinical spectrum of severe imported malaria in French adults and to identify risk factors for mortality at admission to the intensive care unit.<h4>Methodology and principal findings</h4>Retrospective review of severe Plasmodium falciparum malaria episodes according to the 2000 World Health Organization definition and requiring admission to the intensive care unit. Data were collected from medical charts using standardised case-report forms, in 45 French intensive care units in 2000-2006. Risk factors for in-hospital mortality were identified by univariate and multivariate analyses. Data from 400 adults admitted to the intensive care unit were analysed, representing the largest series of severe imported malaria to date. Median age was 45 years; 60% of patients were white, 96% acquired the disease in sub-Saharan Africa, and 65% had not taken antimalarial chemoprophylaxis. Curative quinine treatment was used in 97% of patients. Intensive care unit mortality was 10.5% (42 deaths). By multivariate analysis, three variables at intensive care unit admission were independently associated with hospital death: older age (per 10-year increment, odds ratio [OR], 1.72; 95% confidence interval [95%CI], 1.28-2.32; P = 0.0004), Glasgow Coma Scale score (per 1-point decrease, OR, 1.32; 95%CI, 1.20-1.45; P<0.0001), and higher parasitemia (per 5% increment, OR, 1.41; 95%CI, 1.22-1.62; P<0.0001).<h4>Conclusions and significance</h4>In a large population of adults treated in a non-endemic industrialized country, severe malaria still carried a high mortality rate. Our data, including predictors of death, can probably be generalized to other non-endemic countries where high-quality healthcare is available.Fabrice BruneelFlorence TubachPhilippe CorneBruno MegarbaneJean-Paul MiraEric PeytelChristophe CamusFrederique SchortgenElie AzoulayYves CohenHugues GeorgesAgnes MeybeckHerve HyvernatJean-Louis TrouilletEric FrenoyLaurent NicoletCarine RoyRemy DurandJacques Le BrasMichel WolffSevere Imported Malaria in Adults (SIMA) Study GroupPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 10, p e13236 (2010) |
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Medicine R Science Q Fabrice Bruneel Florence Tubach Philippe Corne Bruno Megarbane Jean-Paul Mira Eric Peytel Christophe Camus Frederique Schortgen Elie Azoulay Yves Cohen Hugues Georges Agnes Meybeck Herve Hyvernat Jean-Louis Trouillet Eric Frenoy Laurent Nicolet Carine Roy Remy Durand Jacques Le Bras Michel Wolff Severe Imported Malaria in Adults (SIMA) Study Group Severe imported falciparum malaria: a cohort study in 400 critically ill adults. |
| description |
<h4>Background</h4>Large studies on severe imported malaria in non-endemic industrialized countries are lacking. We sought to describe the clinical spectrum of severe imported malaria in French adults and to identify risk factors for mortality at admission to the intensive care unit.<h4>Methodology and principal findings</h4>Retrospective review of severe Plasmodium falciparum malaria episodes according to the 2000 World Health Organization definition and requiring admission to the intensive care unit. Data were collected from medical charts using standardised case-report forms, in 45 French intensive care units in 2000-2006. Risk factors for in-hospital mortality were identified by univariate and multivariate analyses. Data from 400 adults admitted to the intensive care unit were analysed, representing the largest series of severe imported malaria to date. Median age was 45 years; 60% of patients were white, 96% acquired the disease in sub-Saharan Africa, and 65% had not taken antimalarial chemoprophylaxis. Curative quinine treatment was used in 97% of patients. Intensive care unit mortality was 10.5% (42 deaths). By multivariate analysis, three variables at intensive care unit admission were independently associated with hospital death: older age (per 10-year increment, odds ratio [OR], 1.72; 95% confidence interval [95%CI], 1.28-2.32; P = 0.0004), Glasgow Coma Scale score (per 1-point decrease, OR, 1.32; 95%CI, 1.20-1.45; P<0.0001), and higher parasitemia (per 5% increment, OR, 1.41; 95%CI, 1.22-1.62; P<0.0001).<h4>Conclusions and significance</h4>In a large population of adults treated in a non-endemic industrialized country, severe malaria still carried a high mortality rate. Our data, including predictors of death, can probably be generalized to other non-endemic countries where high-quality healthcare is available. |
| format |
article |
| author |
Fabrice Bruneel Florence Tubach Philippe Corne Bruno Megarbane Jean-Paul Mira Eric Peytel Christophe Camus Frederique Schortgen Elie Azoulay Yves Cohen Hugues Georges Agnes Meybeck Herve Hyvernat Jean-Louis Trouillet Eric Frenoy Laurent Nicolet Carine Roy Remy Durand Jacques Le Bras Michel Wolff Severe Imported Malaria in Adults (SIMA) Study Group |
| author_facet |
Fabrice Bruneel Florence Tubach Philippe Corne Bruno Megarbane Jean-Paul Mira Eric Peytel Christophe Camus Frederique Schortgen Elie Azoulay Yves Cohen Hugues Georges Agnes Meybeck Herve Hyvernat Jean-Louis Trouillet Eric Frenoy Laurent Nicolet Carine Roy Remy Durand Jacques Le Bras Michel Wolff Severe Imported Malaria in Adults (SIMA) Study Group |
| author_sort |
Fabrice Bruneel |
| title |
Severe imported falciparum malaria: a cohort study in 400 critically ill adults. |
| title_short |
Severe imported falciparum malaria: a cohort study in 400 critically ill adults. |
| title_full |
Severe imported falciparum malaria: a cohort study in 400 critically ill adults. |
| title_fullStr |
Severe imported falciparum malaria: a cohort study in 400 critically ill adults. |
| title_full_unstemmed |
Severe imported falciparum malaria: a cohort study in 400 critically ill adults. |
| title_sort |
severe imported falciparum malaria: a cohort study in 400 critically ill adults. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2010 |
| url |
https://doaj.org/article/1b69f95a352c4d6c8333fd16da7bda44 |
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