UMEM Educational Pearls

Title: Malaria Basics

Category: International EM

Keywords: malaria, Plasmodium, falciparum, quinine, international, fever (PubMed Search)

Posted: 11/21/2012 by Andrea Tenner, MD (Updated: 11/12/2024)
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General information
- Organism: 5 Plasmodium species (P. falciparum, P. vivax, P. ovale, P. malariae, P. knowlesi)
  - P. falciparum is responsible for most severe disease.
  - P. vivax and P. ovale are responsible for recrudescent disease.
- Transmission via the female Anopheles mosquito, which bites at night or in the early morning.
- Endemic in Asia, Africa, Central America, and South America

Clinical presentation
- Initially, the patient presents with an acute febrile illness: fever, chills, headache, nausea, lethargy, and upper respiratory symptoms.
- Infection with P. falciparum can further progress to severe organ dysfunction.
- The disease course is unpredictable in the non-immune individual.

Diagnosis
- Thick and thin peripheral blood smears demonstrating organism
  - Thick smear – confirms Plasmodium parasites
  - Thin smear – allows speciation of Plasmodium parasites
- Hyperparasitemia is associated with increased mortality

Treatment
- P. falciparum or species unidentified
  - For severe malaria, IV quinine (quinidine if quinine not available)
  - IV artusenate is available from the CDC as a quinidine/quinine alternative.
  - DO NOT USE Chloroquine for severe malaria
- Patients with evidence of complicated malaria (>3% parasitemia, signs of organ dysfunction, alterations in mental status) should be admitted to an ICU.

University of Maryland Section for Global Emergency Health

Author: Emilie J.B. Calvello, MD, MPH

References

Center for Disease Control. (2012). Malaria. Retrieved November 9, 2012, from http://www.cdc.gov/MALARIA/

Wattal, C. et al. Infectious disease emergencies in returning travelers: special referece to malaria, dengue and chikungunya. Med Clin North Am. 2012 Nov; 96(6): 1225 – 55.