Common Features of Malaria in Children vs Adults
Key Age-Related Differences in Clinical Presentation
Children under 5 years present predominantly with severe anemia and respiratory distress, while older children and adults more commonly develop prostration, impaired consciousness, and cerebral malaria. 1
Pediatric-Specific Features (Children <5 years)
Severe anemia is the hallmark of pediatric malaria, occurring in approximately 68% of severe cases and representing the most frequent manifestation in young children. 2 Children under 18 months are particularly vulnerable to anemia. 2
Respiratory distress is the second most common severe manifestation in children under 5 years (29-31% of cases), typically associated with underlying metabolic acidosis (base deficit >8 mmol/l) and compensated shock. 3, 1, 2
Prostration occurs in approximately 45% of children under 5 years with severe malaria. 1
Seizures and convulsions are common in pediatric malaria, often accompanied by abnormal neurological signs and opisthotonic posturing. 3
Hypoglycemia (blood sugar <3 mmol/l) is a frequent life-threatening complication that may precipitate seizures or coma. 3
Non-specific presentations are typical, with symptoms mimicking gastroenteritis, meningitis/encephalitis, or pneumonia, including fever, vomiting, diarrhea, cough, headache, and malaise. 4, 5, 6
Cerebral malaria (strictly defined) is relatively uncommon in young children (3.4% in one highland study), though impaired consciousness occurs in approximately 24% of severe cases. 1, 2
Features in Older Children and Adults (≥5 years)
Prostration becomes the dominant manifestation in persons 5 years and older, occurring in 65% of severe malaria cases. 1
Impaired consciousness and cerebral malaria are significantly more common in older children and adults compared to young children (13.6% vs lower rates in under-5s), with cerebral malaria typically occurring in those over 18 months. 1, 2
Severe anemia is less frequent in older age groups (odds ratio 0.2 for those ≥5 years compared to younger children). 1
Respiratory distress is less common in older children and adults compared to young children (15.2% vs 29.4%). 1
Classic fever patterns (tertian and quartan) are rarely observed in children but may be more apparent in adults. 5
Common Features Across All Ages
Fever is the key symptom across all age groups, though patterns vary. 5, 6, 1
Vomiting is a frequent presenting symptom in both children and adults. 1
Hepatosplenomegaly may be present but is often absent, particularly in highland or low-transmission areas. 6, 1
Thrombocytopenia, hypoglycemia, metabolic acidosis, and hyperlactataemia are laboratory features common to severe malaria regardless of age. 5
Critical Prognostic Indicators
The highest mortality occurs with the triad of coma/seizures, hyperlactataemia, and hypoglycemia, with an overall case fatality rate of 9% in pediatric severe malaria. 2 Children with severe malaria have nearly double the risk of post-discharge hospitalization compared to asymptomatic community children (56.6% vs 30.8%), with over 80% of these hospitalizations due to recurrent malaria. 7
Clinical Pitfall
In highland or epidemic-prone areas, severe malaria frequently occurs in persons older than 5 years, and "typical" signs like splenomegaly are often absent, making diagnosis more challenging. 1 The clinical and laboratory features of severe falciparum malaria in children are equally typical for severe sepsis, requiring careful diagnostic evaluation. 5