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Infection. 2013 Aug;41(4):821-6. doi: 10.1007/s15010-013-0452-9. Epub 2013 Apr 2.

Acute acalculous cholecystitis in malaria: a review of seven cases from an adult cohort.

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Infectious Disease Service, Intensive Care Unit; Nephrology Research and Development Unit (FCT-725), and Porto Medical School, Serviço Doenças Infecciosas, Centro Hospitalar de S. João, Alameda Professor Hernâni Monteiro, 4202-451, Porto, Portugal.



Acute acalculous cholecystitis (AAC) is an uncommon condition related to serious clinical conditions, such as surgery, trauma, burn injuries and sepsis. The diagnosis of AAC remains challenging to make, since it generally occurs as a secondary event in acutely ill patients with another disease. Imaging evaluation is crucial, and well-known criteria are accepted for the diagnosis. To our knowledge, only case reports of AAC related to 12 malaria adult patients have been published. In this series, seven cases of AAC from a cohort of 42 adult patients with severe imported falciparum malaria [according to the World Health Organization (WHO) criteria] are presented. The aim is to report the cases and look for malaria conditions that may affect the incidence of this unusual malaria complication.


Ultrasonography revealed gallbladder with wall thickening in all patients, plus other(s) major criteria. Each patient presented five to nine WHO severe malaria criteria: all had hyperparasitaemia and hyperbilirubinaemia. All patients developed renal failure, six pulmonary oedema/acute respiratory distress syndrome (ARDS) (five were mechanically ventilated) and five shock. Treatment was non-operative in five patients, cutaneous cholecystostomy was done in two and the outcome was favourable in all.


Patients with AAC have significantly more commonly five or more criteria of severe malaria: renal insufficiency, pulmonary oedema/ARDS, parasitaemia higher than 30 %, nosocomial infection and a prolonged intensive care unit (ICU) stay. Increased awareness for this unusual and potentially severe complication of malaria is needed.

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