| Element | Comment |
|---|---|
| Clinical features | Prodromal symptoms of malaise, headache, myalgia, anorexia and mild fever. Paroxysms of fever lasting 8–12h but classical cyclical fever patterns rarely present in early infection. Dry cough, abdominal discomfort, diarrhoea and vomiting common. Moderate tender hepatosplenomegaly (without lymphadenopathy). Jaundice may occur. |
| Cerebral malaria | Reduced conscious level. Focal or generalized fits. Abnormal neurological signs may be present (including opisthotonos, extensor posturing of decorticate or decerebrate pattern, sustained posturing of limbs, conjugate deviation of the eyes, nystagmus, dysconjugate eye movements, bruxism, extensor plantar responses, generalized flaccidity). Retinal haemorrhages common (papilloedema may be present but is unusual). Abnormal patterns of breathing common (including irregular periods of apnoea and hyperventilation). Tachypnoea may be due to acidosis or adult respiratory distress syndrome. |
| Blood results | Neutropenia Thrombocytopenia Low pH, raised lactate Haemolysis and anaemia Hypoxaemia Hypoglycaemia Renal failure Disseminated intravascular coagulation Abnormal transaminases Hyperbilirubinaemia and sometimes hyperbilirubinuria |
| Diagnosis | Microscopy of Giemsa-stained thick and thin blood films and rapid diagnostic tests (RDT) for malaria. RDT and thick films are more sensitive for detection of malaria and the thin film allows species identification and quantification of the percentage of parasitized red cells. |
| Treatment | Supportive management as for severe sepsis; early admission to high dependency or intensive care facility. Chemotherapy: see Table 33.4. Seek advice from an infectious disease or tropical physician. |
| Management of complications | See Table 33.5. |