Severe Malaria in a Spanish Tertiary Hospital: A Descriptive Study

Background: In recent years there has been an increasing in number of tropical stays in children. They are related to tourism, migration and international adoption. Malaria in one of the main diseases that should be ruled out in this kind of patients. Children under 5 years old have an increased risk of severe illness. In fact, malaria is the fourth cause of children mortality worldwide. Therefore, we should study malaria and its treatment, specially its features in children and its severe form.

Objective: The aim of the present study was to describe epidemiological, clinical, analytical, microbiological, radiological and treatment characteristics of patients with severe malaria in a tertiary Spanish hospital.

Methods: We performed a case series study. It included 12 patients who suffered from severe malaria and were admitted from 2004 to 2018.

Results: The average age of patients was 4 years old. Eight patients were female. Four patients were transferred from other hospitals and two by the airport sanitary services.

All severe cases were caused by Plasmodium falciparum. All patients contracted the disease in west Africa. Seven of the them lived there and travelled to Spain. The other five patients travelled from Spain to visit relatives. Eight patients (75%) got malaria in Equatorial Guinea. Just one received prophylaxis with mefloquine.

Fever and digestive symptoms were the most frequent. One patient, treated with intravenous quinine, suffered black water fever. Table shows main features. Five patients showed a parasitaemia equal or higher than 5%. The highest parasitaemia detected was 12%. Intravenous quinine plus clindamycin and intravenous artesunate were the most frequently used initial treatments. None of the patients presented sequelae related to malaria or died.

Conclusion: Malaria should be suspected in every patient with fever traveling from endemic countries. Most children with severe malaria had parasitaemia under 10%. These patients present severe complications and must be initially treated in critical care settings.