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ICU TopicsInfection / global health

ICU · Infection / global health

Tropical & Global Infections — Malaria, Dengue, TB, Influenza & COVID

Also known as Severe malaria · Falciparum malaria · Artesunate · Cerebral malaria · AQUAMAT · SEAQUAMAT · Exchange transfusion malaria · Dengue · Dengue shock syndrome · Dengue NS1 antigen · Melioidosis · Burkholderia pseudomallei · Severe enteric fever · Typhoid · Intestinal perforation typhoid · Scrub typhus · Orientia tsutsugamushi · Murine typhus · Doxycycline · Leprosy · Severe tuberculosis · Miliary TB · TB meningitis · RIPE therapy · Severe influenza · Severe COVID-19 · Dexamethasone COVID

The tropical and the global infections in the ICU: the severe malaria (the Plasmodium falciparum — the cerebral, the ARDS, the AKI, the severe anaemia, the hypoglycaemia, the hyperparasitaemia; the IV artesunate the WHO first-line, the superior to the quinine, the AQUAMAT and the SEAQUAMAT the mortality benefit; the blood smear or the RDT), the dengue (the plasma leak — the pleural effusion, the ascites, the haemoconcentration; the dengue shock syndrome; the cautious the fluids in the leak phase; the NS1 antigen; the warning signs; the paracetamol NOT the NSAIDs; the platelets or the FFP for the bleeding), the melioidosis (the Burkholderia pseudomallei — the pneumonia, the liver and the spleen abscess; the ceftazidime or the meropenem the inten…

high41 referencesUpdated 18 Aug 202627 min readSource-verified · Sept 2026

Checked against its sources on 3 Sept 2026

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The tropical and global infections share one rule: ask the two questions — exposure geography with incubation window, and the time-critical empiric agent. Severe falciparum malaria gets IV artesunate 2.4 mg/kg at 0, 12, and 24 hours then daily — superior to quinine (AQUAMAT: 22.5 per cent relative mortality reduction; SEAQUAMAT: 34.7 per cent); a smear-pending returned traveller gets empirical artesunate within the hour. Dengue drives a plasma leak at defervescence, so resuscitate cautiously in the leak phase (the WHO Ringer-lactate regimen with a stepwise taper) and avoid overload. Melioidosis (Burkholderia pseudomallei) is the great mimicker — never discard an oxidase-positive Gram-negative from a soil-exposed diabetic as a contaminant; give IV ceftazidime or a carbapenem for at least 10 to 14 days, then oral TMP-SMX for at least 12 weeks. Scrub typhus — find the eschar, then treat without waiting for serology. TB meningitis gets RIPE plus dexamethasone. Severe COVID-19 gets dexamethasone (6 mg once daily for up to 10 days) when hypoxic.[2][3][6][18][14][13]

Meet the patient

A 42-year-old non-immune businessman returned from Papua New Guinea nine days ago. He presents with three days of high fever, rigors, and progressive confusion. GCS 9. The thick blood smear shows Plasmodium falciparum ring forms at 14 per cent parasitaemia. He is hypoxic, hypoglycaemic, and in renal failure.[1]

The single highest-yield fact in tropical medicine is what happens next: he gets IV artesunate within the hour, before the parasitology is complete, because the AQUAMAT and SEAQUAMAT trials proved artesunate cuts mortality by roughly a third versus quinine. The returned traveller with fever is malaria until proven otherwise, and the smear does not delay the cure.[1][4]

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References41ShowHide
  1. [1]Karnad DR, Nor MBM, Richards GA, et al. Intensive care in severe malaria: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine. Journal of critical care, 2018.PMID 29132978
  2. [2]Dondorp AM, Fanello CI, Hendriksen IC, et al. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet, 2010.PMID 21062666
  3. [3]Dondorp A, Nosten F, Stepniewska K, et al. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial (SEAQUAMAT). Lancet, 2005.PMID 16125588
  4. [4]White NJ, Pukrittayakamee S, Hien TT, et al. Malaria. Lancet, 2014.PMID 23953767
  5. [5]Simmons CP, Farrar JJ, Nguyen VV, Wills B. Dengue. New England Journal of Medicine, 2012.PMID 22494122
  6. [6]Wills BA, Nguyen MD, Ha TL, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. New England Journal of Medicine, 2005.PMID 16135832
  7. [7]Wiersinga WJ, Virk HS, Torres AG, et al. Melioidosis. Nature Reviews Disease Primers, 2018.PMID 29388572
  8. [8]Limmathurotsakul D, Golding N, Dance DA, et al. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nature Microbiology, 2016.PMID 27571754
  9. [9]Savelkoel J, Dance DAB, Currie BJ, et al. A call to action: time to recognise melioidosis as a neglected tropical disease. Lancet Infectious Diseases, 2022.PMID 34953519
  10. [10]Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. New England Journal of Medicine, 2002.PMID 12456854
  11. [11]GBD 2017 Typhoid and Paratyphoid Collaborators. The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Infectious Diseases, 2019.PMID 30792131
  12. [12]Maude RJ, Beare NA, Abu Sayeed A, et al. The spectrum of retinopathy in adults with Plasmodium falciparum malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene, 2009.PMID 19344925
  13. [13]RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. New England Journal of Medicine, 2021.PMID 32678530
  14. [14]Thwaites GE, Nguyen DB, Nguyen HD, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. New England Journal of Medicine, 2004.PMID 15496623
  15. [15]Stepniewska K, White NJ, Barnes KI, et al. Safety of single-dose primaquine as a Plasmodium falciparum gametocytocide: a systematic review and meta-analysis of individual patient data. BMC Medicine, 2022.PMID 36109733
  16. [16]Chetchotisakd P, Chierakul W, Anunnatsiri S, et al. Trimethoprim-sulfamethoxazole versus trimethoprim-sulfamethoxazole plus doxycycline as oral eradicative treatment for melioidosis (MERTH): a multicentre, double-blind, non-inferiority, randomised controlled trial. Lancet, 2014.PMID 24284287
  17. [17]Chierakul W, Anunnatsiri S, Chaowagul W, et al. Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim-sulfamethoxazole for the treatment of severe melioidosis. Clinical Infectious Diseases, 2005.PMID 16163628
  18. [18]Meumann EM, Chetchotisakd P, Wuthiekanun V, et al. Treatment of Melioidosis. Infectious Disease Clinics of North America, 2026.PMID 41571490
  19. [19]Anunnatsiri S, Chetchotisakd P, Wanitchanon T, et al. A Comparison Between 12 Versus 20 Weeks of Trimethoprim-sulfamethoxazole as Oral Eradication Treatment for Melioidosis: An Open-label, Pragmatic, Multicenter, Non-inferiority, Randomized Controlled Trial. Clinical Infectious Diseases, 2021.PMID 32725199
  20. [20]Hoffman SL, Punjabi NH, Kumala S, et al. Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. New England Journal of Medicine, 1984.PMID 6361558
  21. [21]Chatham-Stephens K, Medalla F, Hughes M, et al. Emergence of Extensively Drug-Resistant Salmonella Typhi Infections Among Travelers to or from Pakistan - United States, 2016-2018. MMWR Morbidity and Mortality Weekly Report, 2019.PMID 30629573
  22. [22]Manesh A, Boehme T, Peto L, et al. Typhoid and paratyphoid fever: a clinical seminar. Journal of Travel Medicine, 2021.PMID 33550411
  23. [23]Antillon M, Warren JL, Crawford FW, et al. The Relationship Between Blood Sample Volume and Diagnostic Sensitivity of Blood Culture for Typhoid and Paratyphoid Fever: A Systematic Review and Meta-Analysis. Journal of Infectious Diseases, 2018.PMID 30307563
  24. [24]Arora P, Peto L, Cho NH, et al. Comparative accuracy of typhoid diagnostic tools: A Bayesian latent-class network analysis. PLoS Neglected Tropical Diseases, 2019.PMID 31067228
  25. [25]Varghese GM, Dayanand D, Gunasekaran K, et al. Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus. New England Journal of Medicine, 2023.PMID 36856615
  26. [26]Taylor AJ, Paris DH, Newton PN. A Systematic Review of Mortality from Untreated Scrub Typhus (Orientia tsutsugamushi). PLoS Neglected Tropical Diseases, 2015.PMID 26274584
  27. [27]Somasetia DH, Setiati TE, Sjahrodji AT, et al. Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety. Critical Care, 2014.PMID 25189175
  28. [28]Htun TP, Zaw NN, Pang J. Clinical signs and symptoms associated with WHO severe dengue classification: a systematic review and meta-analysis. Emerging Microbes and Infections, 2021.PMID 34036893
  29. [29]Fuchs I, Golan A, Peto L, et al. NS1 antigen testing for the diagnosis of dengue in returned Israeli travelers. Journal of Medical Virology, 2014.PMID 24390973
  30. [30]Flannery AH, Goncalves AB. Oseltamivir Dosing in Critically Ill Patients With Severe Influenza. Annals of Pharmacotherapy, 2014.PMID 24816209
  31. [31]White NJ. Melioidosis. Lancet, 2003.PMID 12767750
  32. [32]Bruneel F, Tubach F, Corne P, et al. Severe imported falciparum malaria: a cohort study in 400 critically ill adults. PLoS One, 2010.PMID 20949045
  33. [33]Harris P, Price S, Senthuran S, et al. Automated erythrocytapheresis for severe falciparum malaria. Internal Medicine Journal, 2011.PMID 21265962
  34. [34]Browne AJ, Kashef Hamadani BH, Kumaran EA, et al. Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis. BMC Medicine, 2020.PMID 31898501
  35. [35]Smith CS, Noordeen SK, Richardus JH, et al. Multidrug therapy for leprosy: a game changer on the path to elimination. Lancet Infectious Diseases, 2017.PMID 28693853
  36. [36]Kumar A, Girdhar A, Girdhar BK. Six months fixed duration multidrug therapy in paucibacillary leprosy: risk of relapse and disability in Agra PB cohort study. BMJ Open, 2012.PMID 22893667
  37. [37]Khalid H, Bashir S, Farooq U, et al. Clinical outcomes, environmental exposure factors, and antibiotic resistance patterns of extensively drug-resistant (XDR) typhoid fever in Pakistan: A prospective observational study. Therapeutic Advances in Infectious Disease, 2026.PMID 42602150
  38. [38]Bay P, Cottagnoud P, Bittel P, et al. How to manage antivirals in critically ill patients with influenza? Clinical Microbiology and Infection, 2025.PMID 40204233
  39. [39]Das BK, Pradhan S, Sahu KK. Management of Hyperparasitaemia in Severe Malaria: A Sea Change With the Availability of Artesunate. Cureus, 2024.PMID 38659513
  40. [40]Sridharan S, Princess IB, Ramakrishnan N. Melioidosis in Critical Care: A Review. Indian Journal of Critical Care Medicine, 2021.PMID 34345132
  41. [41]Howes M, Kaestli M, Mayo M, Currie BJ. Melioidosis and Activation from Latency: The "Time Bomb" Has Not Occurred. American Journal of Tropical Medicine and Hygiene, 2024.PMID 38806042

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