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- W2032342011 abstract "Introduction. – Le paludisme grave d'importation est peu étudié. Nous avons analysé rétrospectivement les cas de paludisme grave admis au centre hospitalier universitaire de Montpellier. Matériel et méthode. – Tous les patients âgés de plus de 15 ans admis en réanimation avec un frottis sanguin positif à Plasmodium falciparum entre octobre 1997 et avril 2004 ont été inclus. Les principales données épidémiologiques, les motifs d'admission, la prise en charge et l'évolution ont été étudiés. Résultats. – Trente-deux patients ont été inclus soit 9 % des accès à P. falciparum diagnostiqués dans la même période. L'âge moyen était de 44 ans. Tous les patients avaient séjourné en Afrique subsaharienne et 25 étaient non-immuns. La chimioprophylaxie était absente ou inadéquate dans 94 % des cas. Le délai moyen entre le début des symptômes et le traitement était de six jours. La parasitémie moyenne initiale était de 15 %. Les motifs d'admission en réanimation étaient des troubles de conscience dans 69 %, une insuffisance rénale aiguë dans 19 % et une hyperparasitémie isolée dans 19 % des cas. Tous les patients sauf un recevaient un traitement par quinine intraveineuse avec une dose de charge dans 34 % des cas. Sept patients (22 %) avaient une co-infection bactérienne communautaire et six (19 %) des infections nosocomiales. Le taux de mortalité était de 16 %. Les causes de décès étaient l'état de choc réfractaire, l'œdème cérébral, le syndrome de détresse respiratoire aiguë. Conclusion. – La mortalité des formes graves du paludisme reste élevée. L'amélioration de la chimioprophylaxie et la précocité du diagnostic pourraient permettre de la baisser significativement. Introduction. – Few studies have focused on severe imported malaria in patients admitted to intensive care units. We, therefore, undertook a retrospective study in the University Hospital of Montpellier. Material and methods. – All patients, more than 15 years-old with falciparum malaria who were admitted to intensive care units between October 1997 and April 2004 were included. Main epidemiological features, criteria of admission, treatment and outcome were investigated. Results. – Thirty-two patients were included, representing 9% of falciparum malaria cases diagnosed in the same period. The mean age was 44 years. All patients acquired falciparum malaria in sub-Sahara Africa and 25 patients were nonimmune. Chemoprophylaxis was absent or inadequate in 94%. The mean time from symptom onset and treatment initiation was 6 days. Mean parasitemia on admission was 15%. Criteria of admission were impaired consciousness in 69%, acute renal failure in 19% and isolated high parasitemia in 19% of the cases. All, but one received quinine therapy and a loading dose was performed in 34%. Seven patients (22%) had community-acquired coinfections and six (19%) had nosocomial infections. Mortality was 16%. Causes of death were refractory shock, cerebral edema, and acute respiratory distress syndrome. Conclusion. – Severe imported malaria remains associated with a bad outcome. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly this mortality." @default.
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- W2032342011 date "2004-12-01" @default.
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- W2032342011 title "Paludisme grave d'importation chez l'adulte : étude rétrospective de 32 cas admis en réanimation" @default.
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- W2032342011 doi "https://doi.org/10.1016/j.patbio.2004.07.017" @default.
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