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
- anuria/oliguria
Risk factors
- travel to endemic area
- inadequate or absent chemoprophylaxis
- insecticide-treated bed net not used in endemic area
- settled migrants returning from travel to endemic area of origin
- low host immunity (for severe disease)
- pregnancy (for severe disease)
- age <5 years (for severe disease)
- immunocompromise (for severe disease)
- older age (for 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
Ron Behrens, MD, FRCP
Honorary Consultant in Tropical and Travel Medicine
Hospitals for Tropical Diseases
Professor emeritus
London School of Hygiene and Tropical Medicine
London
UK
Disclosures
RB has acted as a paid expert to the courts on malaria prophylaxis. RB has received fees on the Travel Health advisory board for Emergent BioSolutions. RB had 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.
Acknowledgements
Dr Ron Behrens would like to gratefully acknowledge Mariyam Mirfenderesky, Dr Signe Maj Sorensen, Dr Joanna Allen, Dr Simon Warren, and Dr Behzad Nadjm, previous contributors to this topic.
Disclosures
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.
Differentials
- Dengue fever
- Zika virus infection
- Chikungunya virus
More DifferentialsGuidelines
- WHO Guidelines for malaria
- Malaria prevention guidelines for travellers from the UK
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