Malaria infection
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors for acquiring malaria
- presence of risk factors for severe disease
- fever or history of fever
Other diagnostic factors
- headache
- weakness
- myalgia
- arthralgia
- anorexia
- diarrhoea
- seizures
- nausea and vomiting
- abdominal pain
- pallor
- hepatosplenomegaly
- jaundice
- altered level of consciousness
- hypotension
- bleeding
- anuria/oliguria
- tachypnoea
Risk factors
- travel to endemic area
- inadequate or absent chemoprophylaxis
- insecticide-treated bed net not used in endemic area
- low host immunity (severe disease)
- pregnancy (severe disease)
- age <5 years (severe disease)
- immunocompromise (severe disease)
- older age (severe disease)
- iron administration (children)
Diagnostic investigations
1st investigations to order
- Giemsa-stained thick and thin blood smears
- rapid diagnostic tests (RDTs)
- FBC
- clotting profile
- serum electrolytes, urea and creatinine
- serum LFTs
- serum blood glucose
- urinalysis
- arterial blood gas
Investigations to consider
- polymerase chain reaction (PCR) blood for malaria
- chest x-ray
- blood culture
- urine culture
- sputum culture
- lumbar puncture
- HIV test
- PCR nasopharyngeal swabs for influenza
- CT head
Emerging tests
- loop-mediated isothermal amplification
Treatment algorithm
Plasmodium falciparum: uncomplicated disease, able to take oral medication initially
Plasmodium falciparum: severe disease or unable to take oral medication initially
Plasmodium ovale
Plasmodium vivax
Plasmodium malariae or Plasmodium knowlesi
Plasmodium falciparum: recurrent infection
Contributors
Authors
Elizabeth Ashley, MB BS, FRCP, FRCPath
Director
Institution Lao-Oxford-Mahosot Hospital - Wellcome Trust Research Unit
Vientiane
Laos
Honorary Consultant in Infectious Diseases and Microbiology
Oxford University Hospitals NHS Foundation Trust
Professor of Tropical Medicine
University of Oxford
Oxford
UK
Disclosures
EA has active grants from a number of organisations; however, none of them are for malaria projects. EA is an associate editor of Malaria Journal, an academic editor for PLOS Medicine, and is on the Lancet Infectious Diseases International Advisory Board. EA is on the council of the International Society for Infectious Diseases and was paid by Pfizer to chair a grants committee on antimicrobial stewardship (unrelated to malaria). The Institution Lao-Oxford-Mahosot Hospital - Wellcome Trust Research Unit receives core funding from the Wellcome Trust. EA is an author of a number of references cited in this topic.
Arjun Chandna, BA MRCP AFHEA
Wellcome Trust Doctoral Training Fellow
Centre for Tropical Medicine and Global Health
University of Oxford
Oxford
Specialty Registrar in Infectious Diseases and Medical Microbiology
University College London Hospitals NHS Trust
London
UK
Disclosures
None.
Acknowledgements
Dr Elizabeth Ashley and Dr Arjun Chandna would like to gratefully acknowledge Professor Ron Behrens, Mariyam Mirfenderesky, Dr Signe Maj Sorensen, Dr Joanna Allen, Dr Simon Warren, and Dr Behzad Nadjm, previous contributors to this topic.
Disclosures
RB acted as a paid expert to the courts on malaria prophylaxis. RB received fees on the Travel Health advisory board for Emergent BioSolutions. RB prepared education material for the Royal College of Physicians and Surgeons of Glasgow. RB is an author of a number of references cited in this topic. MM, SMS, JA, and SW declare that they have no competing interests. BN is an author of a reference cited in this topic.
Peer reviewers
Blaise Genton, MD
Professor
Head of the Travel Clinic
Consultant of Tropical and Travel Medicine
University Hospital
Project Leader
Swiss Tropical and Public Health Institute
Basel
Switzerland
Disclosures
BG has received a research grant from Novartis Pharma to assess the impact of the introduction of artemether-lumefantrine (Novartis) as first-line treatment for uncomplicated malaria on mortality of children under 5 years old in 2 districts in Tanzania and travel grants from Novartis Pharma to present the results of the study above. BG is an author of a reference cited in this topic.
David Sullivan, MD
Associate Professor
Malaria Research Institute and Department of Molecular Microbiology and Immunology
Johns Hopkins Bloomberg School of Public Health
Baltimore
MD
Disclosures
DS has received royalties from antigen provision for a diagnostic test to Inverness. DS with Johns Hopkins University has patents on diagnostic tests that do not require blood.
Walther H. Wernsdorfer, MD
Professor
Institute of Specific Prophylaxis and Tropical Medicine
Medical University of Vienna
Vienna
Austria
Disclosures
WHW declares that he has no competing interests.
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