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Malária

Last reviewed: 16 Aug 2025
Last updated: 17 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco para contrair malária
  • presença de fatores de risco para a doença grave
  • febre, ou história de febre
Full details

Other diagnostic factors

  • cefaleia
  • fraqueza
  • mialgia
  • artralgia
  • anorexia
  • diarreia
  • convulsões
  • náuseas e vômitos
  • dor abdominal
  • palidez
  • hepatoesplenomegalia
  • icterícia
  • nível alterado de consciência
  • hipotensão
  • sangramento
  • anuria/oligúria
  • taquipneia
Full details

Risk factors

  • viagem para uma área endêmica
  • quimioprofilaxia inadequada ou ausente
  • mosquiteiro de leito tratado com inseticida usado em área endêmica
  • baixa imunidade do hospedeiro (doença grave)
  • gestação (doença grave)
  • idade <5 anos (doença grave)
  • imunocomprometimento (doença grave)
  • idade avançada (doença grave)
  • desnutrição (doença grave)
  • administração de ferro (crianças)
Full details

Diagnostic investigations

1st investigations to order

  • esfregaços sanguíneos delgados e espessos corados por Giemsa
  • testes diagnósticos rápidos (TDRs)
  • Hemograma completo
  • coagulograma
  • eletrólitos, ureia e creatinina séricos
  • testes séricos da função hepática
  • glicemia sérica
  • urinálise
  • gasometria arterial
Full details

Investigations to consider

  • reação em cadeia da polimerase do sangue para malária
  • radiografia torácica
  • hemocultura
  • urocultura
  • cultura de escarro
  • punção lombar
  • teste de HIV
  • reação em cadeia da polimerase de swabs nasofaríngeos para gripe (influenza) ou COVID-19
  • tomografia computadorizada (TC) do crânio
Full details

Emerging tests

  • ensaio de amplificação circular isotérmica

Treatment algorithm

ACUTE

doença grave (ou incapacidade de tomar medicamentos por via oral inicialmente): todas as espécies de Plasmodium

Plasmodium falciparum (ou espécies desconhecidas): doença não complicada

Plasmodium ovale: doença não complicada

Plasmodium vivax: doença não complicada

Plasmodium malariae ou Plasmodium knowlesi: doença não complicada

ONGOING

Plasmodium falciparum: infecção recorrente

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 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. 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

Clinical Research 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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

World Health Organization. WHO guidelines for malaria. Nov 2024 [internet publication].Full text

Centers for Disease Control and Prevention. Clinical guidance: malaria diagnosis & treatment in the U.S. Jun 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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