Noncardiogenic pulmonary edema and pulmonary fibrosis in falciparum malaria.

Noncardiogenic pulmonary edema is an uncommon but serious complication of falciparum malaria. A case of fatal noncardiogenic pulmonary edema complicating falciparum malaria is presented in which the unfavorable outcome resulted from rapidly developing pulmonary fibrosis, documented through open-lung biopsy. Possible mechanisms of lung injury in falciparum malaria include: impaired perfusion and tissue hypoxia in the pulmonary microcirculation caused by reduced effective circulating volume; abnormal autonomic effects on the lung resulting from reduced blood flow in the central nervous system; immunologic injury to alveolar-capillary structures; and morphologic changes in the surface membranes of infected erythrocytes leading to sequestration of parasitized erythrocytes in vascular beds and pulmonary capillary damage. That pulmonary involvement in falciparum malaria is usually associated with high-grade parasitemia, concurrent cerebral involvement, and delay in institution of antimalarial therapy emphasizes the importance of early diagnosis and treatment.