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Treatment of severe malaria

Terrie E Taylor, DO
Section Editor
Johanna Daily, MD, MSc
Deputy Editor
Elinor L Baron, MD, DTMH


Malaria is endemic throughout large areas of the tropics. Of the approximately 3 billion people living in more than 100 countries who are exposed to malaria, more than 240 million develop symptomatic infection annually [1]. Most of these infections are attributable to Plasmodium falciparum (90 percent), but Plasmodium vivax and Plasmodium knowlesi can also cause severe disease [2,3]. Approximately 863,000 deaths are caused by malaria each year; over 80 percent of the deaths occur among children in sub-Saharan Africa.

Severe malaria is acute malaria with signs of organ dysfunction and/or high level of parasitemia [4]. (See 'Definition' below.)

In endemic areas, young children and pregnant women are at high risk for severe malaria. Older children and adults develop partial immunity after repeated infections; therefore, these groups are at lower risk for severe disease. Travelers to areas where malaria is endemic generally have no previous exposure to malaria parasites and so are at high risk for severe disease.

Management of patients with severe malaria presents a broad array of clinical challenges given the complex pathophysiology of the infection involving multiple organ systems. These challenges are increased in endemic areas where access to diagnostic and therapeutic tools may be limited. Nevertheless, it is possible to provide excellent care for these patients.

The approach to treatment of severe malaria will be reviewed here. Issues related to management in both endemic and nonendemic areas will be addressed. Issues related to treatment of nonsevere malaria are discussed separately. (See "Treatment of uncomplicated falciparum malaria in nonpregnant adults and children" and "Prevention and treatment of malaria in pregnant women".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 17, 2017.
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