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

  • Hypoglycemia
  • Anemia
  • Encephalopathy
  • Seizure
  • Renal failure
  • Metabolic acidosis
  • Jaundice
  • Pulmonary edema
  • Significant bleeding
  • Shock
  • Hyperparasitemia (in the absence of other clear causes)

Symptomatic parasitemia without signs of severity or evidence of organ dysfunction



  • “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
    • Thick smear: screen for presence of parasites and determine parasitemia
    • Thin smear: determine species and degree of parasitemia
  • Repeat blood smear every 12 hours for total of 3 sets to detect parasitemia that may lag behind clinical presentation



Choice of prophylaxis depends on area of travel, see CDC map for most current recommendations

More Information

  1. CDC Malaria Recommendations.
  2. Bartlett JG et al. Johns Hopkins ABX Guide: Diagnosis and Treatment of Infectious Diseases (3rd Ed.). 2011.
  3. WHO Guidelines for malaria, 13 July 2021. Geneva: World Health Organization; 2021 (WHO/UCN/GMP/2021.01Rev.1)