Malaria infection

Last reviewed: 9 Nov 2022
Last updated: 15 Nov 2022

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
More key diagnostic factors

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
Other diagnostic factors

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)
More risk factors

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
More 1st investigations to order

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
More investigations to consider

Emerging tests

  • loop-mediated isothermal amplification

Treatment algorithm

ACUTE

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

ONGOING

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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