From the Guidelines
Malaria typically presents with symptoms such as paroxysmal fever, chills, high fever, and sweating, which can occur every 24-72 hours depending on the Plasmodium species, and can lead to severe complications if not promptly treated. The symptoms of malaria usually appear 10-15 days after being bitten by an infected mosquito. Other common symptoms include headache, muscle aches, fatigue, nausea, vomiting, and abdominal pain. Some patients may develop jaundice due to hemolysis of red blood cells. Severe malaria, particularly caused by Plasmodium falciparum, can lead to serious complications including cerebral malaria (confusion, seizures, coma), severe anemia, acute respiratory distress syndrome, kidney failure, and hypoglycemia, as seen in a case report of a 43-year-old Italian woman who was diagnosed with severe P. falciparum malaria after traveling to Uganda without taking malaria chemoprophylaxis 1.
Common Symptoms of Malaria
- Paroxysmal fever
- Chills
- High fever
- Sweating
- Headache
- Muscle aches
- Fatigue
- Nausea
- Vomiting
- Abdominal pain
- Jaundice
Severe Complications of Malaria
- Cerebral malaria (confusion, seizures, coma)
- Severe anemia
- Acute respiratory distress syndrome
- Kidney failure
- Hypoglycemia
According to the World Health Organization (WHO) criteria, severe malaria is characterized by impaired consciousness, multiple convulsions, prostration, bleeding, and acute renal failure, among other symptoms, and requires immediate medical attention for proper diagnosis and treatment 1. The most recent guidelines for managing adult patients with malaria in non-endemic settings recommend the use of intravenous artesunate for patients with severe malaria, particularly those with high parasitaemia values or evidence of end-organ damage 1.
Diagnosis and Treatment of Malaria
- Peripheral blood smear to confirm the presence of Plasmodium species
- Laboratory tests to assess the severity of the disease, such as blood gas examination and plasma lactate levels
- Intravenous artesunate for patients with severe malaria
- Admission to the intensive care unit for patients with severe malaria or evidence of end-organ damage.
From the Research
Signs and Symptoms of Malaria
The provided studies do not directly address the signs and symptoms of malaria. However, they discuss the treatment and efficacy of various antimalarial drugs, which can be related to the symptoms and management of the disease.
- The studies focus on the treatment of uncomplicated Plasmodium falciparum malaria using artemisinin-based combination therapies (ACTs) such as artemether-lumefantrine and dihydroartemisinin-piperaquine 2, 3, 4, 5.
- They report on the efficacy and safety of these treatments, including the occurrence of adverse events and the presence of molecular markers associated with artemisinin and partner drug resistance 3, 4.
- One study mentions the potential for asymptomatic liver enzyme abnormalities in patients treated with artemisinin-based therapy, but notes that these abnormalities seem to be harmless, asymptomatic, and self-limited 2.
- Another study discusses the use of primaquine in combination with ACTs to reduce the transmission of Plasmodium falciparum and limit the spread of artemisinin partial resistance 6.
Treatment Efficacy and Safety
The studies provide information on the efficacy and safety of various antimalarial treatments, including:
- Artemether-lumefantrine: reported to have a high cure rate, but with some cases of recrudescence and adverse events 4, 5.
- Dihydroartemisinin-piperaquine: shown to be highly effective and safe for the treatment of uncomplicated malaria 4.
- Primaquine: found to be safe and efficacious for reducing P. falciparum transmission when used in combination with ACTs 6.
Patient Factors and Treatment Response
The studies highlight the importance of patient factors, such as age and weight, in determining treatment response and the risk of treatment failure: