Severe complicated Plasmodium falciparum malaria. Current aspects in French Guyana.

The incidence of severe Plasmodium falciparum malaria is increasing in French Guyana. Mortality in multivisceral forms remains high despite appropriate intensive care and antimalarial drug therapy. The epidemiology, clinical features, treatment, outcome, and prognosis of severe P. falciparum malaria were studied in 71 patients. Mean age was 29.6 years. All ethnic groups were affected. Most cases occurred along the Maroni and Oyapock rivers that flow along the borders of French Guyana. Mean number of WHO criteria at admission was 2.03. Mortality was 21.3%. Multiple organ failure is usually ascribable to drug resistance (isolates showed type III in vivo and in vitro resistance to quinine) and to a delay in the initiation of therapy. Studies aimed at developing new therapeutic approaches are urgently needed.