[Severe and Complicated Malaria]

Severe and complicated malaria. About 15% of the 4500 to 5000 cases of malaria occurring each year in France will prove to be severe malaria. Severe forms of malaria mainly involve P. falciparum. Cerebral malaria is the complication, peculiar to P. falciparum, most often fatal, but other forms of damage can occur -multi-organ failure- making severe malaria a parasitic systemic disease with a high rate of mortality. Mortality is strongly correlated with neurological involvement, circulatory shock, respiratory distress, metabolic acidosis, and hyperlactataemia at the time of diagnosis. In addition to the parasitological diagnosis, the biological assessment aims to highlight the existence of biological criteria of gravity. The treatment of severe malaria will be started urgently as soon as the diagnosis is known. The specific treatment of severe malaria is based now on intravenous artesunate for the child, the adult and the pregnant woman. Multi organ failure should be treated in intensive care unit. Mortality in France is less than 5%. Sequelae are possible. In about 15% of patients, an episode of delayed haemolytic anemia may occur after treatment with artesunate -10 days to 3 weeks after the end of treatment-; it must be detected by weekly research on the occurrence of haemolytic anemia in parallel with parasitological monitoring.