Plasmodium falciparum Malarial Sepsis in the Multiparous African American Patient with Prompt ICU Management

Abstract

Background: Malarial infection in pregnancy is uncommon in the United States but morbidity and mortality can be striking. “Severe” malarial infections in pregnancy are even rarer, with only eight reported cases in 2010. Primiparous women are at the greatest risk for significant parasitemia. Case Presentation: A 33-year-old Nigerian G4P3003 at 34 and 2 weeks gestational age presents with a five day history of fevers, frontal headache, weakness, and diarrhea in setting of recent immigration to America. She was septic in the emergency room, with marked splenomegaly, thrombocytopenia, and electrolyte disturbances, requiring medical intensive care unit stabilization and treatment for Plasmodium falciparum malaria sepsis. After stabilization, continuous electronic fetal monitoring revealed multiple prolonged decelerations requiring delivery for fetal indications. Conclusion: Malarial infection in pregnancy, although rare, is often caused by the most virulent species, Plasmodium falciparum, and decompensation can occur quickly more commonly in first pregnancies. “Severe” malarial infections in pregnancy with documentation through the postpartum course are exceedingly rare in the United States.