General Information
  • Infection from various Plasmodium species parasites due to bite from the Anopheles mosquito
  • CDC reported 1,864 cases in the U.S. in 2010
  • P. falciparum (58%), P. vivax (19%), P. ovale (2%), P. malariae (2%), unreported/unknown (18%)
  • P. falciparum invades RBCs and causes the most severe and lethal illness as the RBCs sequester in microvasculature causing damage to brain, kidney, lung
  • Incubation period of 8-25 days for P. falciparum
Clinical Presentation
  • Headache, confusion, dizziness, diarrhea, vomiting, chills and fever at regular intervals
  • Severe malaria: hypoglycemia, thrombocytopenia, metabolic acidosis, jaundice, encephalopathy, coma, seziure, severe anemia, hyperparasitemia (>5% per CDC), renal failure
  • Diagnosis made by examination of peripheral smear. Repeat smears every 12 hours for total of 3 sets to detect parasitemia that may lag behind clinical presentation
Prophylaxis (malaria endemic regions with chloroquine resistance)
  • Atovaquone/proguanil, mefloquine, doxycycline primaquine
  • Insecticide-treated bed netting, screens, DEET
  • Uncomplicated and unknown chloroquine resistance state: Atovaquone-proguanil, Artemether-lumefantrine, Quinine sulfate + doyxcycline/tetracycline/clindamycin, Mefloquine
  • Severe malaria: IV quinidine + doxycycline/tetracycline/clindamycin; monitor for QT prolongation and QRS widening, hypotension; Artemisinin-containing combination therapy if quinidine is unavailable
  • Consider exchange transfusion for parasitemia > 10%, coma, ARDS, kidney failure
  • Drugs safe for pregnancy: chloroquine, quinine, quinidine, clindamycin, mefloquine