Two Cases of Malaria-Associated Acute Respiratory Distress Syndrome and Severe Pulmonary Complications From Plasmodium falciparum in Tanzania

Objective: Unusual clinical course Background:Malaria remains a major cause of morbidity and mortality in tropical regions.Severe Plasmodium falciparum malaria can be complicated by malaria-associated acute respiratory distress syndrome (MA-ARDS), which has a high mortality rate, particularly in resource-limited settings where extracorporeal membrane oxygenation (ECMO) is unavailable.Clinicians in this setting must rely on the most readily available conventional methods to benefit patients and optimize treatment outcomes. Case Reports:We describe 2 patients in Tanzania with severe Plasmodium falciparum malaria complicated by life-threatening pulmonary complications.Case 1 was a 6-year-old boy with severe malaria and multiorgan dysfunction who developed acute hypoxemic respiratory failure with diffuse pulmonary infiltrates requiring mechanical ventilation.He received intravenous artesunate, lung-protective ventilation, and prolonged prone positioning (up to 18 hours/day for 3 consecutive days), with gradual improvement and successful extubation on ICU day 6.Case 2 was a 39-year-old man referred after 1 week of treatment for severe malaria who developed MA-ARDS with bilateral pleural effusions, shock requiring norepinephrine, and acute kidney injury requiring hemodialysis; early mechanical ventilation with prone positioning improved oxygenation and supported recovery.These cases describe 2 patients who developed severe Plasmodium falciparum malaria resulting in MA-ARDS and were treated with favorable outcomes, regardless of the differences in their ages, by optimizing lung supportive ventilation and prone position, which significantly improved their conditions. Conclusions:These cases emphasize that early recognition of MA-ARDS and implementation of evidence-based supportive strategies, particularly lung-protective ventilation and prone positioning, may improve outcomes in severe malaria when advanced therapies such as ECMO are not available.