Article Sidebar
Published:
May 25, 2017Article Details
Copyright remains in the Author’s name. The work is licensed under a Creative Commons Attribution - Noncommercial Works License. Authors are required to complete and sign an Author Agreement form that outlines Author and Publisher rights and terms of publication. The Agreement form should be uploaded along with other submissions files and any submission will be considered incomplete without it [forthcoming].
Material submitted for publication in the SAMJ is accepted provided it has not been published or submitted for publication elsewhere. Please inform the editorial team if the main findings of your paper have been presented at a conference and published in abstract form, to avoid copyright infringement. The SAMJ does not hold itself responsible for statements made by the authors.
Previously published images
If an image/figure has been previously published, permission to reproduce or alter it must be obtained by the authors from the original publisher and the figure legend must give full credit to the original source. This credit should be accompanied by a letter indicating that permission to reproduce the image has been granted to the author/s. This letter should be uploaded as a supplementary file during submission.
Main Article Content
Severe and complicated malaria in KwaZulu-Natal
Abstract
Design. Retrospective case series.
Setting. King Edward VIII Hospital, Durban, Natal, a referral centre.
Patients. One hundred and forty-three consecutive patients (88 males, 55 females; median age 25 years, range 2 - 86 years) admitted with a microscopic diagnosis of Plasmodium falciparum malaria from 1984 to 1991 .
Main outcome measures. A univariate analysis comparing survival and death for categorical and continuous data for various complications was perlormed using the t-test or x2-test (or Fisher's exact test in the case of small cell sizes). Variables that showed significance on univariat,e analysis (P < 0.1) were used in a multivariate analysis to determine which contributed independently to survival or death.
Results. The case tatality rate was 11.1% (15/135) and the commonest complications were hyperparasitaemia (30%), renal tailure (17%), acidaemia (14%), jaundice (10.4%) and cerebral malaria (6%). The commonest complications in patients who died were renal failure (10 patients), cerebral malaria (7), hyperparasitaemia (6) and severe anaemia (5). Multivariate analysis using a logistic
regression model showed a high parasite load and cerebral malaria (relative risks of 11.9 and 51.8 respectively) and high urea levels to be the significant predictors of poor outcome (95% confidence intervals 1.53 - 91 .9, 2.74 - 100.0 and 1.01 - 1.09, respectively).
Conclusions. Patients with high parasite densities, cerebral involvement and renal dysfunction need urgent attention with parenteral chemotherapy, intravenous fluid
replacement and early referral to a tertiary hospital with facilities for intensive monitoring and supportive treatment.
