In this paper, the ICU admission was based on the presence of at least a life-threatening organ dysfunction, haemodynamic instability, as well as high parasitaemia, which often precedes clinical deterioration. Delay in diagnosis of malaria has been associated with a worse prognosis [24, 25] , but this was not found in this review, where 49% of the patients had the symptoms for more than a week before diagnosis, without any correlation with a worse prognosis. It is difficult to explain the reasons why. The validity of the variable (duration of symptoms) may be questioned because the time since arrival to diagnosis was statistically significant for the risk of death. A delay in diagnosis can be caused by patient ignorance about the potential severity of malaria, auto medication for fever with antipyretics before seeking medical attention or the doctor's delay in considering the diagnosis, only overcome with proper training and experience. In this review, the case fatality rate was 15.2% (nine patients) and factors statistically associated with death were time since arrival to diagnosis (p = 0.027), SAPS II score (p < 0.001), cerebral malaria (p = 0.019), acute renal failure (p < 0.001), ARDS (p < 0.001), hypoglycaemia (p = 0.02), DIC or spontaneous bleeding (p = 0.007) and acidaemia (p < 0.001) ( Table 2) ; the need for renal replacement (p = 0.027) and invasive ventilation (p = 0.027) was significantly more frequent in those who died. These data are in agreement with literature review, where the fatality rate is higher in cerebral malaria and acute respiratory distress syndrome (ARDS). Two of the patients were put on ECMO, used as a rescue therapy [26] [27] [28] . They had been working in Angola and Mozambique for some years, had parasitaemia 2% and 3% respectively and severe ARDS and multiorganic dysfunction. One of them survived and recovered without respiratory sequelae, the other died in refractory shock. These cases show the importance of a clinical surveillance of all patients, because the evolution is sometimes unfavourable in cases that initially seemed benign. The patient on mefloquine chemoprophylaxis that died had a parasitaemia of 30% and a fulminant evolution. Unfortunately he was not autopsied and it was impossible to investigate if it was a problem of resistance to mefloquine.