First Things First (assess & treat for the following)

• CDC Malaria Hotline: (770) 488-7788 M-F 8 am – 4:30 pm EST
  • (770) 488-7100 after hours, weekends, and holidays
  • Ask to page the malaria person on call
  • http://www.cdc.gov… 

• Worldwide impact of malaria
  • Cases/year: ~300-500 million
  • Deaths/year: ~750,000-2 million

• Epidemiology
  • 40% population lives in areas of malaria transmission (parts of Africa, Asia, the Middle East, Central and South America, Hispaniola, and Oceania)
  • Imported malaria
  • Non-immune population infected – travelers and migrants
  • Majority of deaths due to Plasmodium falciparum infection
    • Produces life-threatening complication in ~1% of cases

• Severe malaria
  
  • No formal definition
• World Health Organization (WHO) Criteria and Suggested Expert Guidelines
  • Cerebral malaria
    
    • Coma – GCS ≤11 not attributable other causes
    • Coma persists 30 minutes after generalized seizure.
    • Exclusion of other causes – bacterial meningitis, cerebral hemorrhage, etc.
  • Severe anemia
    • Hct < 15% OR Hgb < 5 gm/dL, presence of parasite count >10,000/ml
  • Renal failure
    • Adult: urine output < 400 ml/24 hr and serum creatine >2.65 mg/dl
  • Pulmonary edema and ARDS
  • Hypoglycemia (whole blood glucose < 40 mg/dl or 2.2 mmol/L)
  • Circulatory collapse/shock
    • Adults: SBP < 70 mmHg
    • Pediatrics: SBP < 50 mmHg
  • Coagulation
    • DIC
    • Spontaneous bleeding
  • Acidemia/acidosis
    
    • Arterial pH < 7.25
    • Plasma bicarbonate < 15 mmol/L
  • Macroscopic hemoglobinuria
    • Hemolysis after exclusion of glucose-6-phosphate dehydrogenase deficiency
  • Impaired consciousness
  • Hyperpyrexia – core temperature >40C
  • Hepatic
    • Total bilirubin >2.5 mg/dl
    • Lactate >5 mmol/L
    • Increased transaminases
  • Hyperparasitemia
    • Parasite index >5%
    • Nonimmune individuals >250,000 parasites/ul