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Diagnosis of malaria

Heidi Hopkins, MD
Section Editor
Johanna Daily, MD, MSc
Deputy Editor
Elinor L Baron, MD, DTMH


Prompt and accurate diagnosis of malaria is critical for implementation of appropriate treatment to reduce associated morbidity and mortality. Accurate detection of malaria is also important for epidemiological screening and surveillance to inform malaria control strategies, for research purposes in testing efficacy of antimalarial drugs and vaccines, and for blood bank screening.

Characteristics of a useful malaria diagnostic tool include the ability to definitively establish presence or absence of infection, determine which species of malaria is/are present, quantify parasitemia (ie, parasites per microliter of blood or percent red blood cells infected), detect low-level parasitemia, and allow monitoring of response to antimalarial therapy (including detection of recrudescence or relapse). Thus far, there is no single malaria diagnostic tool that meets all of these criteria. Test characteristics that are important for diagnosis vary depending on the epidemiology of infection and goals for control in the region where the test is used.

Tools for diagnosis of malaria and the goals of malaria diagnosis in various settings will be reviewed here. Issues related to epidemiology, pathogenesis, clinical manifestations, treatment, and prevention of malaria are presented separately. (See separate topic reviews.)


In general, malaria should be suspected in the setting of fever (temperature ≥37.5°C) and relevant epidemiologic exposure (residence in or travel to an area where malaria is endemic) [1]. In malaria-endemic areas with stable transmission and during high-transmission season in areas with seasonal malaria, malaria should also be suspected in children with palmar pallor or hemoglobin concentration <8 g/dL.

The diagnosis of malaria is established in the setting of symptoms consistent with malaria and a positive malaria diagnostic test.


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