• It is a serious complication of Plasmodium
• Manifests as diffuse symmetric
• Common in children and non immune adults.
• Despite treatment fatality rate is ~20%.
• Long term sequelae is rare with appropriate
• Usually develops after several days after
patient has become ill, but may develop
• Occurs with parasitaemia >5%.
Late schizonts secretes protein on the on surface
Proteins cause aggregation of non infected RBCs
and capillary endothelium in brain
Anoxia, ischemia and haemorrhage
• Decreased level of consciousness
- Severity ranges from drowsiness and severe
head ache to delirium, hallucinations, or
• Fever of 106-108oF
• Contracted or unequal pupils, retinal
haemorrhages, papilloedema, discrete spots of
retinal calcification may be seen.
• Muscle tone may be either increased or
• Abdominal and cremasteric reflexes absent.
• Plantar reflex may be flexor or extensor.
• Cortical blindness
• Cerebral palsy
• Lumbar puncture
- Increased pressure and proteins
- Minimal or no pleocytosis
- Normal glucose.
• EEG findings are non specific.
• Intravenous artesunate is the treatment of
choice for sever P. falciparum malaria.
• Artesunate 2.4mg/kg bw i.v or i.m. given.
• Is a common complication of severe
P. falciparum malaria.
• Results from deposition of haemoglobin in
renal tubules decreased renal blood flow
acute tubular necrosis ARF
• Blackwater fever is a clinical syndrome which
consists of severe haemolysis,
haemoglobinuria and renal failure.
• Renal failure requires either peritoneal dialysis
Non cardiogenic pulmonary oedema
• It is a complication of severe
P. falciparum malaria may occur with P. vivax
• Mortality is >80%.
• Pathogenesis of respiratory distress is unclear.
• It is aggravated by over hydration with IV
• An important and common complication of
• Associated with poor prognosis.
• Hypoglycemia occurs due to failure of hepatic
• Quinine and quinidine also aggravates
• Important cause of death from severe malaria.
• Occurs due to anaerobic glycolysis in tissues
sequesterated by parasites interfere with
microcirculation, hypovolemia, lactate
production by parasites and failure of hepatic
and renal lactate clearance.
- accelerated destruction of RBCs by spleen
- ineffective erythropoiesis
• <5% patients may have significant bleeding
due to DIC.
Relative incidence of severe
complications of Falciparum malaria
Pregnant Women Children
Anemia + ++ +++
Convulsions + + +++
Hypoglycemia + +++ +++
Jaundice +++ +++ +
Renal failure +++ +++ -
Pulmonary oedema ++ +++ +
Chronic complications of malaria
• Tropical splenomegaly (Hyperreactive
Malarial Splenomegaly) :
• Chronic or repeated malarial infections
normochromic, normocytic anemia; and in
certain situations, splenomegaly
Quartan Malarial Nephropathy
• Rarely seen in chronic or repeated infections
with P. malariae.
• Histology shows focal or segmental
glomerulonephritis with splitting of capillary
• It usually responds poorly to treatment with
either antimalarial agents or glucocorticoids
and cytotoxic drugs.
• Nelson’s Textbook of Paediatrics, 18th Edition.
• Harrison’s Principles of Internal Medicine, 17th
• Guidelines for the treatment of Malaria,
Second edition, WHO 2010.