Affiliations: Paediatric Infectious Diseases Unit, St. Mary's
Hospital London, London, UK | Great Ormond Street Hospital for Children, London, UK
Note: [] Correspondence: Dr. Marc Tebruegge, DTM&H, DLSHTM,
MRCPCH, MSc, MD, Specialist Registrar in Paediatric Infectious Diseases,
Paediatric Infectious Diseases Unit, St. Mary's Hospital London, London, UK.
E-mail: [email protected]
Abstract: We report the case of a 12-year-old girl who had returned to the UK
from Nigeria two days prior to presenting with fever and breathing
difficulties. She had high-grade pyrexia, was mildly dehydrated and lethargic
but there were no abnormal findings on auscultation. Initially she required
5l/min of oxygen to maintain adequate oxygenation. The chest X-ray showed
bilateral shadowing consistent with pulmonary edema and early acute respiratory
distress syndrome (ARDS). The patient was admitted to pediatric intensive care
unit and intubated six hours later due to increasing oxygen requirement and
deteriorating level of consciousness. Thin blood films revealed Plasmodium
falciparum infection with high-grade parasitemia (13%. commenced on
intravenous quinine. No further complications were observed, apart from mild
renal impairment. She made a remarkable recovery, was extubated after four days
of ventilation and discharged without residual problems five days later. Lung
function tests at follow up revealed no abnormalities. Acute lung injury (ALI)
secondary to P. falciparum malaria, which includes pulmonary edema and
ARDS at the severe end of the spectrum, is not uncommon in adults, and has been
reported to occur in up to 30% of malaria patients who require admission to
the intensive care unit. In contrast, ALI is a relatively rare complication in
pediatric patients. Many of these patients with ALI simultaneously develop
other complications of malaria including acute renal failure, hypotension and
cerebral malaria. Adult studies have reported overall mortality rates of
approximately 50% in patients with ALI secondary to malaria; however, the
majority of survivors have no long-term respiratory sequelae.
