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Review
, 7 (4), 315-23

Clinical Review: Severe Malaria

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Review

Clinical Review: Severe Malaria

Andrej Trampuz et al. Crit Care.

Abstract

Malaria represents a medical emergency because it may rapidly progress to complications and death without prompt and appropriate treatment. Severe malaria is almost exclusively caused by Plasmodium falciparum. The incidence of imported malaria is increasing and the case fatality rate remains high despite progress in intensive care and antimalarial treatment. Clinical deterioration usually appears 3-7 days after onset of fever. Complications involve the nervous, respiratory, renal, and/or hematopoietic systems. Metabolic acidosis and hypoglycemia are common systemic complications. Intravenous quinine and quinidine are the most widely used drugs in the initial treatment of severe falciparum malaria, whereas artemisinin derivatives are currently recommended for quinine-resistant cases. As soon as the patient is clinically stable and able to swallow, oral treatment should be given. The intravascular volume should be maintained at the lowest level sufficient for adequate systemic perfusion to prevent development of acute respiratory distress syndrome. Renal replacement therapy should be initiated early. Exchange blood transfusion has been suggested for the treatment of patients with severe malaria and high parasitemia. For early diagnosis, it is paramount to consider malaria in every febrile patient with a history of travel in an area endemic for malaria.

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References

    1. Muentener P, Schlagenhauf P, Steffen R. Imported malaria (1985–95): trends and perspectives. Bull World Health Organ. 1999;77:560–566. - PMC - PubMed
    1. Sachs J, Malaney P. The economic and social burden of malaria. Nature. 2002;415:680–685. doi: 10.1038/415680a. - DOI - PubMed
    1. Kain KC, Keystone JS. Malaria in travelers. Epidemiology, disease, and prevention. Infect Dis Clin North Am. 1998;12:267–284. - PubMed
    1. Kain KC, Harrington MA, Tennyson S, Keystone JS. Imported malaria: prospective analysis of problems in diagnosis and management. Clin Infect Dis. 1998;27:142–149. - PubMed
    1. Garcia LS. Malaria and babesiosis. In: Garcia LS, editor. Diagnostic Medical Parasitology. Washington, DC: American Society for Microbiology; 2001. pp. 159–204.

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