Severe falciparum malaria.

Falciparum malaria affect all ages with multiple-systemic complications which varies in different age group. We studied 242 children with complicated Falciparum malaria with a median age of 6.5 years to look for occurrence of different complications in younger and older age groups and overall mortality picture. Unarousable coma (40.5%), severe anemia (26.03%), repeated seizures (46.2%) and hepatopathy (32.2%) were commonest complications. Under five children had higher risk of development of cerebral malaria (P<0.01), severe anemia (P<0.05) and seizures (P<0.001); whereas above five children had higher risk of acute renal failure (P<0.05) and malarial hepatopathy (P<0.02). Over all mortality was 9.9%, cerebral malaria being the commonest cause (6.6%). Multi-system involvement was seen in 58.4% cases of death. Children having pulmonary edema, shock and cerebral malaria had high case fatality rate.

Complicated falciparum malaria.

We studied 50 cases of complicated falciparum malaria in order to evaluate the different clinical presentations. Thirty five had cerebral malaria while 15 presented with extracerebral features including diarrhea and vomiting (n = 6), hepatitis (n = 4), acute renal failure (n = 3), and gastrointestinal bleeding (n = 2). These cases were treated with quinine. Mortality was higher in extracerebral form (33.3%) as compared to cerebral malaria (22%). Our study suggests that even though cerebral malaria remains the single most important cause of high mortality in complicated falciparum malaria, extracerebral presentation of falciparum malaria is equally life threatening and should be viewed seriously.