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Abstract

Malaria represents a medical emergency because it may rapidly progress to complications and death without prompt and appropriate treatment. Severe malaria is almost exclusively caused by Plasmodium falciparum. The incidence of imported malaria is increasing and the case fatality rate remains high despite progress in intensive care and antimalarial treatment. Clinical deterioration usually appears 3-7 days after onset of fever. Complications involve the nervous, respiratory, renal, and/or hematopoietic systems. Metabolic acidosis and hypoglycemia are common systemic complications. Intravenous quinine and quinidine are the most widely used drugs in the initial treatment of severe falciparum malaria, whereas artemisinin derivatives are currently recommended for quinine-resistant cases. As soon as the patient is clinically stable and able to swallow, oral treatment should be given. The intravascular volume should be maintained at the lowest level sufficient for adequate systemic perfusion to prevent development of acute respiratory distress syndrome. Renal replacement therapy should be initiated early. Exchange blood transfusion has been suggested for the treatment of patients with severe malaria and high parasitemia. For early diagnosis, it is paramount to consider malaria in every febrile patient with a history of travel in an area endemic for malaria.

Re-Emergence of Malaria in Malaysia: A Review Article

“…Severe malaria often leads to poor clinical outcomes. The case fatality rate in travelers with severe malaria caused by P. falciparum can be higher than 20% [30]. The criteria for severe malaria established by WHO (revised in 2000) which are used to assist clinical and epidemiological studies are as follows: impaired consciousness (Glasgow Coma Score < 11 in adults or Blantyre coma score < 3 in children), acidosis (base deficit of >8 meq/l or plasma bicarbonate of <15 mM or lactate > 5 mM), hypoglycaemia (plasma glucose < 2.2 mM), severe malarial anaemia (haemoglobin concentration < 5 g/dl with parasite count > 10,000/µl), renal impairment (serum creatinine > 265 µM or blood urea > 20 mM), jaundice (serum bilirubin > 50 µM), pulmonary oedema (Radiologically confirmed, or oxygen saturation < 92% on room air with a respiratory rate > 30/min), significant bleeding, shock and hyperparasitaemia (P. falciparum parasitaemia > 10%) [31].…”

“…Several factors contribute to the poor prognosis of severe malaria such as the infecting malaria parasite species, the degree of abnormality, the number of systems affected, coexisting medical conditions, no antimalarial prophylaxis, delay in treatment, age, gender (especially when associated with pregnancy) and background immunity (nonimmune status) [30] [31]. P. knowlesi infections lead to the highest mortality rate, followed by those caused by P. falciparum [31].…”

Evaluación in vivo de la actividad antimalárica de 25 plantas provenientes de una Reserva de Conservación Biológica de Costa Rica

“…Además, el P. vivax es considerado tradicionalmente como una especie menos patógena, comparándola con el P. falciparum, ampliamente conocida por la severidad de los cuadros clínicos que causa, los cuales llevan a la muerte en un porcentaje elevado de las personas infectadas (Tramputz et al 2003, Mackintosk et al 2004. Sin embargo en este sentido es conveniente hacer notar que de acuerdo con los estudios recientes en un grupo de personas parasitadas con P. vivax, se llegó a determinar que esta especie eventualmente puede causar problemas tan severos como los que se presentan en las infecciones con P. falciparum (Anstey et al 2009).…”

“…Los mayores problemas son causados por el Plasmodium falciparum en África (Tramputz et al 2003, Batista et al 2009, Kakkilaya 2008 y otros lugares del mundo ya que esta especie es la más patógena (Mackintosh et al 2004). El P. vivax es otro agente de la malaria presente tanto fuera como dentro de África y que es encontrado con bastante regularidad en América (Wells et al 2010).…”

“…En Costa Rica, se han realizado varios estudios buscando productos naturales antiparasitarios (Castro et al 1996, Chinchilla et al 1998, 2001, 2003. Precisamente, en una investigación conjunta con el Instituto Nacional de Biodiversidad (INBio), estudiando extractos de insectos, se encontraron en algunos de ellos componentes activos antimaláricos (Chinchilla et al 2008) cuyo origen podrían ser las plantas hospederas de los artrópodos encontrados positivos.…”