Approach to the Patient With Malaria

Baird, J. Kevin; Nelwan, Erni J.; Taylor, W. Robert

Nearly 3 billion people live at risk of malaria across most of the tropics, subtropics, and even some temperate zones. Millions visit these areas, and each year thousands appear in hospitals with posttravel acute malaria. That diagnosis should be managed as a medical emergency. Illness may deteriorate rapidly without prompt diagnosis and effective treatment. Among five species of Plasmodium responsible for human malaria, Plasmodium falciparum most often deteriorates rapidly, but all species potentially threaten life. Malignant and benign species of malaria parasites is a dangerous fallacy. Clinical malaria mimics other common tropical infections and the diagnosis requires laboratory confirmation, but malaria-like symptoms in a patient exposed to risk should be presumed to be malaria until proven otherwise. Intravenous or intramuscular artesunate is used for severe malaria of any species in any patient, including all trimesters of pregnancy. Primaquine is administered with vivax or ovale malarias after affirming glucose-6-phosphate dehydrogenase (G6PD)–normal status.