Post injury malaria

Surgeons from Congo and the jungles of SE Asia know  well that postoperative malaria Falciparum is a common and dangerous complication to injury and surgery. Interestingly, the complication is not at all discussed in any textbook in trauma, and there are no publications available since the British Army reported difficulties during World War II. Since 2001 TCF and partners have systematically studied the problem. This is what we learned:

A common complication affecting 600 mill. people

Where malaria Falciparum is endemic, 2/3 of trauma victims develop symptomatic malaria within a few days after surgery. The more severe injury, the higher is the risk of post-injury malaria. In malaria- endemic areas where people are repeatedly infected, asymptomatic malaria infections are common due to acquired semi-immunity to the parasites. It seems that post-injury immuno-depression breaks the defenses and lets the parasites explode. The finding is relevant for 600 million people living with poverty and endemic Falciparum wordwide.

Surgery is dangerous

Malaria, extended surgery and major trauma all adds to the injury hit.

Our studies demonstrate that protracted trauma surgery is a heavier risk factor than trauma severity in semi-immune Falciparum carriers, see ROC curve. This is in accordance with the double-hit hypothesis: extensive surgery in patients with poor physiological capacity contributes to post-injury stress and enhances immuno-depression.

Adds to the burden of trauma

It seems that post-injury relapse of Falciparum further deranges an immuno system already out of balance. Patients with postoperative malaria have 2 – 3 times increased risk of postoperative bacterial wound infections. Also wounds heal slower and recovery times increase.

Antimalarials as trauma first aid

TMC and partners have just concluded a historical study of post-injury malaria prevention in Cambodia. The trauma paramedics use rapid tests to all victims in-field to identify Falciparum carriers. Test-positives get the first does of artesunate as part of the life support protocol. The results of the study are pending.

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