What are the complications of Malaria (Plasmodium infection)?

From the Guidelines

Malaria complications can be severe and life-threatening if not promptly treated, and the most effective approach to managing them is to use artemisinin-based combination therapies (ACTs) for uncomplicated cases or intravenous artesunate for severe malaria, as recommended by the WHO and supported by recent studies 1. The most serious complications of malaria include cerebral malaria, severe anemia, acute respiratory distress syndrome, kidney failure, hypoglycemia, and metabolic acidosis. Pregnant women face additional risks including maternal death, miscarriage, stillbirth, and low birth weight babies. Children under five are particularly vulnerable to cerebral malaria and severe anemia. These complications typically develop when Plasmodium falciparum parasites multiply rapidly in the bloodstream, causing infected red blood cells to block small blood vessels and reduce oxygen delivery to vital organs. Some key points to consider in managing malaria complications include:

• The use of intravenous artesunate as a first-line treatment for severe malaria, as recommended by the WHO 1.
• The importance of monitoring patients with severe malaria for complications such as post-artesunate delayed haemolysis (PADH) 1.
• The need for supportive care, including blood transfusions, oxygen therapy, anticonvulsants, and management of metabolic abnormalities, in addition to antimalarial treatment 1.
• The importance of prevention through mosquito control measures, chemoprophylaxis for travelers, and seeking immediate medical attention at the first signs of malaria 1. Overall, prompt and effective treatment of malaria complications is critical to preventing morbidity and mortality, and healthcare providers should be aware of the latest recommendations and guidelines for managing these complications.

From the FDA Drug Label

Atovaquone and proguanil hydrochloride has not been evaluated for the treatment of cerebral malaria or other severe manifestations of complicated malaria, including hyperparasitemia, pulmonary edema, or renal failure. Falciparum malaria carries a higher risk of death and serious complications in pregnant women than in the general population. Maternal death and fetal loss are both known complications of falciparum malaria in pregnancy

Malaria Complications:

• Cerebral malaria
• Hyperparasitemia
• Pulmonary edema
• Renal failure
• Maternal death and fetal loss in pregnant women with falciparum malaria The use of atovaquone and proguanil hydrochloride is not recommended for the treatment of severe malaria or its complications. Patients with severe malaria should be treated with other appropriate antimalarial therapy. 2

From the Research

Malaria Complications

• Malaria is a serious disease that can lead to severe complications, including vital organ involvement, shock, pulmonary edema, significant bleeding, seizures, impaired consciousness, and laboratory abnormalities such as kidney impairment, acidosis, anemia, or high parasitemia 3.
• Severe malaria, defined as vital organ involvement, occurred in approximately 14% of patients in the US, and an estimated 0.3% of those receiving a diagnosis of malaria in the US died 3.
• The most common complications of malaria include:
  • Coma
  • Convulsions
  • Metabolic acidosis
  • Hypoglycaemia
  • Fluid and electrolyte disturbances
  • Renal failure
  • Secondary infections
  • Bleeding disorders
  • Anaemia 4
• The priority for treatment of complicated and severe disease is the parenteral administration of adequate, safe doses of an appropriate antimalarial, in the setting of the highest possible level of clinical care 4.

Treatment of Severe Malaria

• Intravenous artesunate is first-line therapy for severe malaria 3, 5.
• Artesunate has been shown to be more effective than quinine in treating severe malaria, with a reduction in mortality of 34.7% (95% confidence interval: 18.5-47.6%) 6.
• The World Health Organization recommends injectable artesunate as the first-line treatment for severe malaria 5.
• Combined intravenous treatment with artesunate and quinine has been found to be efficacious, safe, and well-tolerated in treating severe malaria 7.

Prevention and Management

• Prevention and treatment of malaria depend on the species and the drug sensitivity of parasites from the region of acquisition 3.
• Chemoprophylaxis and selection should be based on patient characteristics and preferences 3.
• Supportive management of complications, such as mechanical ventilation and renal replacement, has also played an important role in reducing mortality of severe malaria 4.