Describe the approach.
Focused clinical evaluation
Time of travel to regions where malaria is endemic and previous chemoprophylaxis
Evaluate for signs of severe malaria.
Routine laboratory studies: CBC, CMP, LFTs, and coagulation panel to evaluate for organ dysfunction
Parasitological testing: confirms the presence and determines the species of Plasmodia
Microscopic examination of thick and thin blood smears (gold standard) ]
Antigen detection test (more rapid but less sensitive)
List routine laboratory studies with their respective findings.
CBC: Changes in multiple parameters may occur.
Hemolytic anemia: ↓ Hb, ↓ haptoglobin, ↑ LDH, ↑ indirect bilirubin, ↑ reticulocytes
Thrombocytopenia
Leukocytosis or leukopenia are uncommon except in severe disease.
Urinalysis: Hemoglobinuria may occur with intravascular hemolysis.
Describe rapid diagnostic tests (RDTs).
Detects specific malaria antigens
Allows for quick diagnosis if high‑quality microscopy is unavailable or delayed.
Confirm all RDT results via microscopy when available.
Describe the blood smear.
Gold standard test: allows for visualization of parasites within RBCs via microscopy to confirm malaria diagnosis
Thick blood smear: high sensitivity; best initial test
Thin blood smear: lower sensitivity, high specificity; confirmatory test
Allows identification of Plasmodium species
Enables calculation of malaria parasitemia: the percentage of RBCs containing a Plasmodium organism; used to classify severity and monitor response to therapy.
Findings include:
Schuffner granules (fine, brick-red dots) within RBCs infected with P. vivax and P. ovale
Crescent-shaped gametocytes in individuals infected with P. falciparum
Developmental stages plasmodium in RBCs (table).
Malaria can be classified into uncomplicated and severe malaria. Define uncomplicated malaria and list the causative pathogens.
Definition: symptomatic, diagnostically proven malaria without features of severe malaria Etiology: can be caused by all six Plasmodium species
Describe severe Malaria.
Description: potentially fatal manifestation or complication of malaria
Etiology: most commonly a result of falciparum malaria
Pathophysiology: Infected erythrocytes occlude capillaries, which can lead to severe organ dysfunction.
Criteria for severe malaria: ≥ 1 of the following in a patient with proven malaria [16][19][21]
Clinical findings
General: prostration
CNS: hallucinations, confusion, impaired consciousness, seizures, coma
Cardiac: shock (e.g., hypotension, capillary refill time ≥ 3 seconds), heart failure
Pulmonary: respiratory distress, pulmonary edema, ARDS
Renal: flank pain, oliguria, hemoglobinuria, acute kidney injury
Gastrointestinal: jaundice
Hematopoietic: significant bleeding
Laboratory findings
Severe anemia: < 7 g/dL in adults, < 5 g/dL in children
Hypoglycemia: < 40 mg/dL
Acidosis (with or without lactemia): base deficit > 8 meq/L or bicarbonate < 15 meq/L
Hyperlactatemia: lactate > 5 meq/L
Acute kidney injury: creatinine > 3 mg/dL or urea > 20 mmol/L
Hyperbilirubinemia: bilirubin > 3 mg/dL
High malaria parasitemia
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