|Management of Severe Malaria : A Practical Handbook - Second Edition (WHO - OMS, 2000, 78 p.)|
Severe malaria is caused by Plasmodium falciparum infection and usually occurs as a result of delay in treating an uncomplicated attack of falciparum malaria. Sometimes, however, especially in children, severe malaria may develop very rapidly. Recognizing and promptly treating uncomplicated P. falciparum malaria is therefore of vital importance. Global status of malaria is shown in Fig. 1.
The presentation of uncomplicated P. falciparum malaria is very variable and mimics that of many other diseases. Although fever is common, it is absent in some cases. The fever is initially persistent rather than tertian (spikes of fever on alternate days, Fig. 2). The expectation that P. falciparum malaria should have a tertian fever pattern may lead to the diagnosis of malaria being missed with a consequent delay in treatment. The fever may or may not be accompanied by rigors. True rigors are relatively unusual in acute falciparum malaria.
The patient commonly complains of fever, headache, and aches and pains elsewhere in the body, and occasionally of abdominal pain and diarrhoea. In a young child there may be irritability, refusal to eat and vomiting. On physical examination fever may be the only sign. In some patients the liver and spleen are palpable. This clinical presentation in non-endemic or low-endemic areas may be misdiagnosed as influenza. Unless the condition is diagnosed and treated promptly the clinical picture may deteriorate at an alarming rate and often with catastrophic consequences.
Fig 1. Global status of malaria
The designations employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines represent approximate border lines for which there may not yet be full agreement.
© World Health Organization 1999
Fig. 2. Temperature chart characteristic of P. falciparum malaria
Note: The expectation that P. falciparum malaria should have a tertian (alternate day) fever pattern may lead to the diagnosis of malaria being missed.