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Retrospective study of imported falciparum malaria in French paediatric intensive care units
  1. Justine Lanneaux1,
  2. Stéphane Dauger1,
  3. Luu-Ly Pham2,
  4. Jérôme Naudin1,
  5. Albert Faye3,
  6. Yves Gillet4,
  7. Emmanuelle Bosdure5,
  8. Ricardo Carbajal6,
  9. François Dubos7,
  10. Renaud Vialet8,
  11. Gérard Chéron9,
  12. François Angoulvant9,10
  1. 1Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  2. 2Paediatric Emergency Department, AP-HP, Hôpital Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France
  3. 3Department of General Paediatrics, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  4. 4Paediatric Emergency Department, HCL, HFME Lyon, Université de Lyon 1, Lyon, France
  5. 5Department of Paediatrics, APHM, CHU Timone Enfants, Marseille, France
  6. 6Paediatric Emergency Department, AP-HP, Hôpital Armand Trousseau, Université Pierre et Marie Curie Paris 6, Paris, France
  7. 7Paediatric Emergency and Infectious Diseases Departments, Université de Lille, Hôpital R. Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France
  8. 8Paediatric Intensive Care Department, APHM, CHU Nord, Marseille, France
  9. 9Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
  10. 10Clinical Epidemiology Unit ECEVE, INSERM UMR 1123, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  1. Correspondence to Dr François Angoulvant, Service des Urgences Pédiatriques, Hôpital Necker-Enfants malades, 149 Rue de Sèvres, Paris 75015, France; francois.angoulvant{at}


Objective The World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country.

Design Retrospective case-control study.

Setting Eight French university hospitals, from 2006 to 2012.

Patients Children with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110).

Main outcome measures Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis.

Results Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3 (46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001).

Conclusions The WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3 could be used as additional criteria to identify children needing high level of care.

  • Infectious Diseases
  • Intensive Care
  • Parasitology
  • malaria

Statistics from


  • Contributors Study concept and design: JL, SD, FA; data acquisition: JL, L-LP, JN, AF, YG, EB, GC, RC, FD, RV; data analysis and interpretation: JL, SD, L-LP, JN, AF, YG, EB, GC, RC, FD, RV, FA; drafting of the manuscript: JL, SD, FA; revision of the manuscript: JL, SD, L-LP, JN, AF, YG, EB, GC, RC, FD, RV, FA; statistical analysis: JL, SD, FD, GC, FA; FA had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None declared.

  • Ethics approval Comité de Protection des Personnes, Ile de France XI.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on request from

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