In all patients, clinical diagnosis of severe/complicated malaria should be made in a patient with:
- fever (history of fever or axillary temperature³ 38.5°C) PLUS
- any "sign of severe/complicated malaria" from the list below.
In young children, a clinical diagnosis of severe/complicated malaria can also be made if there is;
- fever (history of fever or axillary temperature ³ 38.5°C) PLUS
- any "general danger sign in young children" from the list "Signs of Severe/complicated malaria”.
Signs of Severe/Complicated Malaria
Malaria is considered as severe if a patient has any one or combination of the following clinical manifestations and laboratory findings:
- Altered consciousness (change of behaviour, confusion, delirium, coma persisting for over 30 minutes after convulsion).
- Repeated generalised convulsions (fits) – 2 or more within 24 hours.
- Difficulty in breathing or pulmonary oedema.
- Spontaneous unexplained heavy bleeding (Disseminated Intravascular Coagulation).
- Marked jaundice (yellowish colouration of the eyes).
- Prostration i.e. generalised weakness, such that the patient cannot walk or sit without assistance.
- Hyperpyrexia (axillary temperature ³ 38.5°C).
- Inability to take fluids or anything orally.
- Repeated profuse vomiting.
- Circulatory collapse or shock (cold limbs, weak rapid pulse) (systolic BP of less than 80mmHg in adults and less than 50mmHg in children.
- Severe normocytic anaemia (severe anaemia; haematocrit <15% or Hb <5g/dl).
- Signs of hypoglycemia (sweating, pupillary dilation, abnormal breathing, coldness, blood sugar- <40mg/dl. or 2.2mmol/L).
- Renal Impairement -Signs of renal failure (passing very little urine)-Serum creatinine >265umol/l.
- Signs of haemoglobinuria (dark or cola-colored urine).
- Hyperparasitaemia (250,000 parasites/microlitre).