Volume 72, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Clinical presentation of malaria reflects a continuum from asymptomatic to multi-organ manifestation and death. Severe malaria is defined by the World Health Organization as a qualitative variable. We used the multi-organ dysfunction score (MODS) as a quantitative approach for severity in 29 patients with severe and complicated malaria to test its usefulness in discriminating different severity levels. The MODS on admission was highly correlated with the duration of symptoms after admission (r = 0.73, < 0.001) and the serum level of tumor necrosis factor alpha (r = 0.41, = 0.03). In addition, the simplified MODS, based mainly on clinical findings, was also correlated with liver and renal dysfunction during hospitalization (alanine transaminase, r = 0.42, = 0.02; blood urea nitrogen, r = 0.45, = 0.015). A score ≥ 16 was associated with significantly longer disease duration ( = 0.018). Thus, this score might provide a predictive value for morbidity in malaria.


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  1. White NJ, 2002. Malaria. Cook G, Zumla A, eds. Manson’s Tropical Diseases. Philadelphia: W. B. Saunders, 1205–1297.
  2. Udomsangpetch R, Chivapat S, Viriyavejakul P, Riganti M, Wilairatana P, Pongponratn E, Looaresuwan S, 1997. Involvement of cytokines in the histopathology of cerebral malaria. Am J Trop Med Hyg 57: 501–506. [Google Scholar]
  3. Wilairatana P, Noan NS, Chinprasatsak S, Prodeengam K, Kityaporn D, Looareesuwan S, 1995. Scoring systems for predicting outcomes of critically ill patients in northeastern Thailand. Southeast Asian J Trop Med Public Health 26 : 66–72. [Google Scholar]
  4. Krishnan A, Karnad DR, 2003. Severe falciparum malaria: an important cause of multiple organ failure in Indian intensive care unit patients. Crit Care Med 31 : 2278–2284. [Google Scholar]
  5. WHO, Division of Control of Tropical Diseases, 1990. Severe and complicated malaria. Trans R Soc Trop Med Hyg 84 (Suppl 2): 1S–65S. [Google Scholar]
  6. World Health Organization, 2000. Severe falciparum malaria. Trans R Soc Trop Med Hyg 94: S1–S90. [Google Scholar]
  7. Weiler Th, Baldering HJ, Heinrichs W, Schmitz JE, 1997. Quality assurance in intensive care medicine. Results of a multicenter study in Germany. Anästhesiol Intensivmed Schmerzther 32 : 372–375. [Google Scholar]
  8. Helbok R, Dent W, Nacher M, Treeprasertsuk S, Krudsood S, Wilairatana P, Silachamroon U, Looareesuwan S, Schmutzhard E, 2003. Use of the multi-organ dysfunction score as a tool to discriminate different levels of severity in uncomplicated Plasmodium falciparum malaria. Am J Trop Med Hyg 68: 372–375. [Google Scholar]
  9. Silamut K, White NJ, 1993. The relationship of stage of parasite development to prognosis in falciparum malaria. Trans R Soc Trop Med Hyg 87 : 436–443. [Google Scholar]
  10. Looaresuwan S, Wiairatana P, Mounto W, Chalermrut K, Olliaro P, Andrial M, 1997. A comparative trial of sequential treatments of severe malaria with artesunate suppository followed by mefloquine in Thailand. Am J Trop Med Hyg 57 : 348–353. [Google Scholar]
  11. Oguche S, Omokhodion SI, Adeyemo AA, Olumese PE, 2002. Low plasma bicarbonate predicts poor outcome of cerebral malaria in Nigerian children. West Afr J Med 21 : 276–279. [Google Scholar]
  12. Lopansri BK, Anstey NM, Weinberg JB, Stoddard GJ, Hobbs MR, Levesque MC, Mwaikambo ED, Granger DL, 2003. Low plasma arginine concentrations in children with cerebral malaria and decreased nitric oxide production. Lancet 361 : 676–678. [Google Scholar]
  13. Day NP, Hien TT, Schollaardt T, Loc PP, Chuong LV, Chau TT, Mai NT, Phu NH, Sinh DX, White NJ, Ho M, 1999. The prognostic and pathophysiologic role of pro- and anti-inflammatory cytokines in severe malaria. J Infect Dis 180 : 1288–1297. [Google Scholar]
  14. Knisely MH, Stratman-Thomas WK, Elliot TS, 1941. Observations on circulating blood in the small vessels of internal organs in living Macaca rhesus infected with malaria parasites. Anat Rec 79 : 90. [Google Scholar]
  15. Habte B, 1990. Acute renal failure due to falciparum malaria. Ren Fail 12: 15–19. [Google Scholar]
  16. Trang TT, Phu NH, Vinh H, Hien TT, Cuong BM Chau TT, Mai NT, Waller DJ, White NJ, 1992. Acute renal failure in patients with falciparum malaria. Clin Infect Dis 15 : 874–880. [Google Scholar]
  17. Wilairatana P, Looareesuwan S, Charoenlarp P, 1989. Liver profile changes and complications in jaundiced patients with falciparum malaria. N Engl J Med 320 : 1586–1591. [Google Scholar]

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  • Received : 06 May 2004
  • Accepted : 20 Sep 2004

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