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Malária grave em cuidados intensivos pediátricos : revisão casuística
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Introdução: A malária é uma doença infecciosa causada por um parasita do género Plasmodium, com transmissão associada ao mosquito Anopheles. Atualmente em Portugal, apesar de não existir malária indígena, continuam a ser diagnosticados múltiplos casos anualmente, associados a viajantes e imigrantes com origem em países endémicos. A malária grave, definida pela OMS através de um conjunto de critérios clínicos e laboratoriais, é a forma complicada e potencialmente fatal da doença, sendo as crianças um grupo de risco. Neste trabalho procura-se caracterizar os internamentos por malária grave na UCIPed do HSM/CHULN.
Métodos: Estudo retrospetivo com base na consulta dos processos clínicos dos doentes internados em UCIP com malária grave entre janeiro de 2010 e junho de 2020. Foram analisados os dados demográficos, sintomas à apresentação, manifestações clínicas e laboratoriais, tratamento e intervenções. Análise estatística descritiva.
Resultados: Foram incluídos oito doentes, entre os 3 e os 17 anos (mediana de 11,5 anos), todos com estadia recente em África e infeção identificada por P. falciparum. Seis doentes eram residentes em países Africanos, e apenas uma criança realizou quimioprofilaxia. Todos os doentes apresentaram febre, anemia e trombocitopenia, as manifestações mais frequentes. Os principais critérios de gravidade foram a presença de choque, hiperparasitemia, lesão renal aguda, acidose metabólica e icterícia. Todos foram tratados com uma associação de quinino com doxiciclina ou clindamicina. Houve necessidade de ventilação invasiva em duas crianças, suporte aminérgico em quatro, suporte transfusional em cinco e expansão de volume em seis. Ocorreu um óbito.
Discussão: Esta série ilustra a gravidade potencial da malária e morbimortalidade associada. É essencial manter um elevado grau de suspeição para a doença em crianças com estadia em áreas endémicas e instituir terapêutica atempada, incluindo internamento em cuidados intensivos, em casos de malária grave, pela probabilidade de efeitos adversos da terapêutica e necessidade frequente de suporte de órgão.
Introduction: Malaria is an infectious disease caused by a parasite of the Plasmodium genus, commonly transmitted by the Anopheles mosquito. Although malaria isn’t currently indigenous in Portugal, there are still multiple cases of malaria diagnosis yearly, associated with travelers and migrants from endemic countries. Severe malaria, defined by the World Health Organization by a series of clinical and laboratory criteria, is the complicated and life-threatening form of the disease, that disproportionately affects children. This paper aims to characterize the hospitalizations for severe malaria in the Pediatric ICU of HSM/CHULN. Methods: Retrospective study based on a review of the records of patients admitted to a Pediatric ICU with severe malaria, between January 2010 and June 2020. The variables studied included demographic data, presenting symptoms, presentation, laboratory changes, treatment and interventions. Descriptive statistical analysis. Results: Eight patients were included, with ages between 3 and 17 years old (median of 11.5 years), all of them with recent stay in Africa and confirmed infection by P. falciparum. Most patients resided in an African country and only one child received chemoprophylaxis. All patients showed fever, anemia and thrombocytopenia, the most frequent manifestations. The main criteria of severity found were the presence of shock, hyperparasitemia, renal failure, metabolic acidosis and jaundice. All children were treated with an association of quinine and either doxycycline or clindamycin. There was need for invasive ventilation in two children, aminergic support in four, transfusional support in five and fluid expansion in six. One child died. Discussion: This series illustrates the potential severity of malaria and the associated morbimortality. A high degree of suspicion is essential in children who’ve stayed in endemic areas, as well as a timely therapeutic approach, including ICU admittance in severe cases, due to the risk of medication adverse effects and frequent need for organ support.
Introduction: Malaria is an infectious disease caused by a parasite of the Plasmodium genus, commonly transmitted by the Anopheles mosquito. Although malaria isn’t currently indigenous in Portugal, there are still multiple cases of malaria diagnosis yearly, associated with travelers and migrants from endemic countries. Severe malaria, defined by the World Health Organization by a series of clinical and laboratory criteria, is the complicated and life-threatening form of the disease, that disproportionately affects children. This paper aims to characterize the hospitalizations for severe malaria in the Pediatric ICU of HSM/CHULN. Methods: Retrospective study based on a review of the records of patients admitted to a Pediatric ICU with severe malaria, between January 2010 and June 2020. The variables studied included demographic data, presenting symptoms, presentation, laboratory changes, treatment and interventions. Descriptive statistical analysis. Results: Eight patients were included, with ages between 3 and 17 years old (median of 11.5 years), all of them with recent stay in Africa and confirmed infection by P. falciparum. Most patients resided in an African country and only one child received chemoprophylaxis. All patients showed fever, anemia and thrombocytopenia, the most frequent manifestations. The main criteria of severity found were the presence of shock, hyperparasitemia, renal failure, metabolic acidosis and jaundice. All children were treated with an association of quinine and either doxycycline or clindamycin. There was need for invasive ventilation in two children, aminergic support in four, transfusional support in five and fluid expansion in six. One child died. Discussion: This series illustrates the potential severity of malaria and the associated morbimortality. A high degree of suspicion is essential in children who’ve stayed in endemic areas, as well as a timely therapeutic approach, including ICU admittance in severe cases, due to the risk of medication adverse effects and frequent need for organ support.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Malária grave Malária importada Crianças Unidade de cuidados intensivos Pediatria