Major clinical and laboratory features of severe malaria
| Major features of severe or complicated falciparum malaria in adults. |
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| Cerebral involvement: impaired consciousness, seizures and neurological signs |
| Pulmonary oedema and acute respiratory distress syndrome (ARDS) |
| Renal impairment (oliguria <0.4 mL/kg bodyweight per hour or creatinine >265 mmol/L) |
| Metabolic and lactic acidosis (pH <7.3) |
| Hypoglycemia (<2.2 mmol/L) |
| Anaemia (haemoglobin ≤80 g/L) |
| Spontaneous bleeding/disseminated intravascular coagulation |
| Hypovolaemia/shock (blood pressure <90/60 mmHg) |
| Haemoglobinuria (without glucose-6-phosphate dehydrogenase deficiency) |
| Parasitaemia >10% (In the UK a parastitaemia of >2% or ≤2% with schizonts present indicates potentially severe malaria, and is an indication for parenteral treatment) |
| Malaria can be more severe in pregnancy. Early consultation with a specialist unit should be made, and parenteral therapy should be considered. |