Polyneuropathy in a Critically Ill Patient with Severe Malaria and Multiorganic Dysfunction
Keywords:
Polyneuropathies, Malaria, Patients.Abstract
Introduction: a critically ill patient´s polyneuropathy is a acute sensory-motor axonal neuropathy that occurs in 60-80% of severely ill patients, often it could be subclinical or unimportant, but it should be suspected in all patients after 2-to-3-week stay in intensive care who starts 2-5 days after admission to the intensive care unit of the Girassol Clinic (People´s Republic of Angola) or from the beginning of the systemic inflammatory response. The course of the disease is monophasic and self-limiting. It may present itself with variable intensity tetraparesis, hypotonia, muscular hypotrophy, with or without sensory disorders (distal hypoesthesia, paresthesia), with rare involvement of cranial nerves.Case presentation: a 28-year-old patient was admitted to the Intensive Care Unit of Girassol Clinic (People´s Republic of Angola) with a diagnosis of severe malaria with multiorganic dysfunction, while prolonged mechanical ventilation is presented. After seven days of evolution, tetraparesis appeared, which is an acute respiratory failure. Its timely detection and empirical treatment, combined with immunoglobulins and plasmapheresis, permitted a total recovery.
Conclusions: a critically ill patient´s polyneuropathy as in the presented case of a patient with critical malaria, should be detected in all patients with sensory-motor alterations, above all in the recovery stage. It is important the differentiating diagnosis regarding Guillain Barre. The treatment is based on sepsis proper management with multiorganic dysfunction syndrome, hyperglycemia control, and favoring factors as the most effective measure to avoid it.
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