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 REPORT
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.

Keywords: Case Reports; Malaria; Prone Position; Pulmonary Edema