Severe malaria

Abstract

Severe malaria is a medical emergency. It is a major cause of preventable childhood death in tropical countries. Severe malaria justifies considerable global investment in malaria control and elimination yet, increasingly, international agencies, funders and policy makers are unfamiliar with it, and so it is overlooked. In sub-Saharan Africa, severe malaria is overdiagnosed in clinical practice. Approximately one third of children diagnosed with severe malaria have another condition, usually sepsis, as the cause of their severe illness. But these children have a high mortality, contributing substantially to the number of deaths attributed to ‘severe malaria’. Simple well-established tests, such as examination of the thin blood smear and the full blood count, improve the specificity of diagnosis and provide prognostic information in severe malaria. They should be performed more widely. Early administration of artesunate and broad-spectrum antibiotics to all children with suspected severe malaria would reduce global malaria mortality.

The prognostic and diagnostic value of intraleukocytic malaria pigment in patients with severe falciparum malaria

“…Rapid recognition of the disease and early administration of effective treatment are critical determinants of outcome 2,16,17,25,26 . Delays in diagnosis and the administration of artesunate cost lives 1,2 . In hospitals and health centres a diagnosis of malaria and recognition of the three major clinical components of severe malaria (coma, acidotic breathing, severe anaemia) can be done immediately but, importantly, this does not distinguish malaria as the cause of severe illness, from other causes of severe febrile illness (e.g.…”

“…However today, rapid diagnostic tests (RDTs) are increasingly used to diagnose malaria, even in hospitals, and there is less use of microscopy than in previous years. There are concerns that microscopy proficiency and support are declining in malaria endemic areas 1 , yet microscopy of thin and thick blood films provides important diagnostic and prognostic information which the current rapid tests do not. Blood slide microscopy gives quantitative information which is not vulnerable to technical errors or to mutations in the parasite target genes (e.g.…”

“…Severe malaria is a major cause of preventable childhood death in tropical countries, particularly in sub-Saharan Africa. The continuing large death toll justifies the substantial global investment in malaria control, although relatively little attention has been paid to severe malaria in recent years 1 . Many factors affecting the prognosis of falciparum malaria have been identified in the past from detailed prospective clinical studies [2][3][4][5][6] .…”

“…Unfortunately RDTs do not quantify parasitaemia and they also do not provide other information of prognostic value. However, even small, poorly equipped hospitals usually have a microscope, although the support for, and thus the quality of microscopy vary substantially 1 . Microscopy malaria parasite counts are still often semi-quantitative in reports (although this is no longer recommended), and other potentially valuable information is not assessed or reported.…”

The Phenomenon of the ‘Starry Sky’ on Blood: Lesson Learned From Severe Malaria Falciparum

“…Until nowadays, malaria as a disease entity, still represents a global medical disaster because it can quickly progress to severe complications and resulting in the death of the unfortunate patient [1]. Without early diagnosis, made on the basis of a brief anamnesis, sufficient physical examination as well as supporting examinations (e.g., Parasitology Laboratory examination and other relevant examination), followed by prompt and appropriate treatment, it is unlikely that the patient will survive [1][2][3][4].…”