PT  - JOURNAL ARTICLE
AU  - Justine Lanneaux
AU  - Stéphane Dauger
AU  - Luu-Ly Pham
AU  - Jérôme Naudin
AU  - Albert Faye
AU  - Yves Gillet
AU  - Emmanuelle Bosdure
AU  - Ricardo Carbajal
AU  - François Dubos
AU  - Renaud Vialet
AU  - Gérard Chéron
AU  - François Angoulvant
TI  - Retrospective study of imported falciparum malaria in French paediatric intensive care units
AID  - 10.1136/archdischild-2015-309665
DP  - 2016 Nov 01
TA  - Archives of Disease in Childhood
PG  - 1004--1009
VI  - 101
IP  - 11
4099  - http://adc.bmj.com/content/101/11/1004.short
4100  - http://adc.bmj.com/content/101/11/1004.full
SO  - Arch Dis Child2016 Nov 01; 101
AB  - 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.