Management of Severe Malaria : A Practical Handbook - Second Edition (WHO

Management of Severe Malaria : A Practical Handbook - Second Edition (WHO - OMS, 2000, 78 p.)

		(introduction...)
		Table 1 Antimalarial chemotherapy of severe falciparum malaria
		Preface
		Introduction
		Severe falciparum malaria
		General management
		Clinical features and management of complications in adults
		Special clinical features of severe malaria and management of common complications in children
		Special clinical features and management of severe malaria in pregnancy
		Diagnosis of malaria
		Prognostic indicators
		Common errors in diagnosis and management
		Selected further reading
		Annex 1. Notes on antimalarial drugs
		Annex 2. The Glasgow coma scale
		Annex 3. A coma scale for children
		Annex 4. Cannulating the femoral vein
		Annex 5. Setting up an intra-osseous infusion in children
		Annex 6. Measurement of central venous pressure
		Summary of the management of severe falciparum malaria
		Back cover

Introduction

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.

Uncomplicated malaria

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.

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.