Guidelines
Malaria Clinical Pearls

Malaria Clinical Pearls

General Considerations

Malaria is a medical emergency

Untreated Plasmodium falciparum malaria rapidly progresses, and is often fatal if untreated

Suspect in any febrile traveler and consider in fever of unknown origin with travel history

  • High parasitemia (≥ 5%)
  • Impaired consciousness/coma
  • Seizures
  • Circulatory collapse/shock
  • Acute respiratory distress syndrome
  • Acidosis
  • Acute kidney injury
  • Disseminated intravascular coagulation (DIC)
  • Severe anemia (Hgb < 7 g/dL)
  • Jaundice (accompanied by ≥ 1 other sign)

Symptomatic parasitemia without signs of severity or evidence of organ dysfunction

Microbiology

Diagnosis

  • “Gold standard” for laboratory confirmation of malaria
  • A blood specimen collected from a patient is spread as a thick and thin blood smear and Giemsa stained
    • Thin smear (at Scripps): screen for presence of parasites and determine parasitemia
    • Thick smear (at Scripps): determine species and degree of parasitemia
  • In Epic, order “blood parasites (malaria)”
  • Repeat blood smears every 12 hours for total of 3 sets to detect parasitemia that may lag behind clinical presentation
  • % parasitemia should be released on smear result: if not, contact local pathology to request (assists with treatment decisions)

Prophylaxis

Choice of prophylaxis depends on area of travel, click here for current CDC recommendations

More Information

  1. CDC Malaria Recommendations. www.cdc.gov
  2. WHO Guidelines for malaria, 14 March 2023. Geneva: World Health Organization; 2023 (WHO/UCN/GMP/2023.01). License: CC BY-NC-SA 3.0 IGO.