Multiorgan failure in a case of severe plasmodium vivax malaria

Abstract

Malaria is a parasitic disease that affects humans and represents a public health issue in more than 91 countries. While mortality in uncomplicated infection is close to 0.1%, in severe malaria it increases gradually and is mainly associated with multiorgan failure with greater pulmonary involvement. We report the case of a patient living in an endemic area (Beni) with severe Plasmodium vivax malaria. He developed acute respiratory distress syndrome, the most severe clinical form with high mortality despite an adequate therapeutic approach. Due to the aggressiveness of the pathology and its pathophysiological complexity, it is difficult to reach a specific diagnosis, so many differential diagnoses are analyzed. Despite this, an early diagnosis was made by microscopic methods (thick drop). Initially the evolution was torpid until the development of multiorgan failure with pulmonary, renal, hepatic and coagulation disorders, for which reason it was decided to transfer him from the department of Beni to our intensive care unit. He was managed in our critical unit with specific antimalarial medication, in addition to protective ventilatory support measures for 14 days in intermittent prone position, hemodynamic management with vasoactive agents, renal replacement therapy, transfusion of hemocomponents and others. He had a satisfactory evolution and was discharged 18 days after admission. Multidisciplinary management was conducted with the intensive care, infectology, pneumology, cardiology and nephrology units because it is a rare critical condition reported in the literature.