Malaria is caused by Plasmodium parasites, with P. falciparum being the most deadly. Clinical features of malaria include flu-like symptoms such as fever, fatigue, and muscle aches. Fever occurs in periodic paroxysms, with shivering, high fever, and sweating stages. Complications of severe falciparum malaria include cerebral malaria, hypoglycemia, acidosis, anemia, disseminated intravascular coagulation, liver dysfunction, pulmonary edema, and renal impairment. Cerebral malaria is the most important complication and a leading cause of death from malaria.

1. Malaria
Turki M. Alanazi

2. Objective
• Clinical picture of malaria.
• Complication of acute sever malaria.

3. Malaria
• Malaria is caused by Plasmodium parasites.
• P. falciparum is the most prevalent malaria parasite
on the African continent. It is responsible for most
malaria-related deaths globally.
• P. vivax,P.ovale & P.malariae are benign .. Rarely
progress to severe malaria.

4. Clinical features
• Initially ; flue like symptoms
 headache,
 Fatigue.
 abdominal discomfort.
 muscle aches.
 Arthralgia.
 FEVER
 Splenomegaly.
 Mild jaundice.

5. Fever paroxysms
• An abrupt onset of an initial ‘cold stage’ associated with a
dramatic rigor (paroxysm ) in which the patient visibly
shakes.
• An ensuing ‘hot stage’ during which the patient may have a
temperature >40°C, be restless and excitable, and vomit or
convulse.
• Finally, the sweating stage, during which the patient's
temperature returns to normal (defervesces) and sleep may
ensue.
• Such a paroxysm can last 6-10 h.• A prolonged asymptomatic period may follow lasting ;
• 38-42 h in the case of p.vivax and p.ovale malaria (‘tertian’
fever)
• 62-66 h in P. malariae infections (‘quartan’ fever).

6. • paroxysms associated
with synchrony of
merozoite release
• between paroxysms
temper-ature is normal
and patient feels well
• falciparum may not
exhibit classic paroxysms
(continuous fever)

8. Complication of Acute Sever
Falciparum Malaria

9. WHO criteria for sever falciparum
malariaOne or more of the following clinical or laboratory features

10. 1- Cerebral malaria (CM):
• ‘unrousable coma in the presence of peripheral
parasitaemia where other causes of encephalopathy
have been excluded'.
▫ Febrile convulsion in children , hypoglycemia.
• Most important complication of flaciparum malaria.
• Mortality rates of 20% among adults and 15%among
children.
• Focal deficits are uncommon
• Retinal hemorrhages may be observed ;30 to 40
percent of cases.

11. 2- Hypoglycemia
• Hypoglycemia is a common complication of severe malaria,
although the usual signs (sweating, tachycardia, neurologic
impairment) are difficult to distinguish from systemic
symptoms due to severe malaria.
• Hypoglycemia occurs as a result of the following
factors:
I. Diminished hepatic gluconeogenesis
II. Depletion of liver glycogen stores
III. Increase in the consumption of glucose by the host (and, to
a much lesser extent, the parasite)
IV. Quinine-induced hyperinsulinemia
• Hypoglycemia is associated with a poor prognosis, particularly
in children and pregnant women.

12. 3- Acidosis
• Acidosis is an important cause of death from severe
malaria; it is caused by several factors, including:
▫ Anaerobic glycolysis in host tissues where sequestered
parasites interfere with microcirculatory flow
▫ Parasite lactate production
▫ Hypovolemia
▫ Insufficient hepatic and renal lactate clearance
• The prognosis of severe acidosis is poor.

13. 4- Hematological abnormalities
• Anemia in the setting of malaria occurs as a result of
the following factors: ( common in children )
 Hemolysis of parasitized red cells
 Increased splenic sequestration and clearance of
erythrocytes with diminished deformability
 Cytokine suppression of hematopoiesis
 Shortened erythrocyte survival
 Repeated infections and ineffective treatments
• Disseminated intravascular coagulation (DIC)

14. 5-LIVER DYSFUNCTION
• Mild hemolytic jaundice is common in malaria.
• Severe jaundice is associated with P. falciparum
infections; is more common among adults than
among children;
• Results from
▫ hemolysis,
▫ hepatocyte injury
▫ cholestasis.
• When accompanied by other vital-organ dysfunction
(often renal impairment), liver dysfunction carries a
poor prognosis.

15. • 6- NONCARDIOGENIC PULMONARY EDEM A;
 Adults w ith severe falciparum malaria may develop
noncardiogenic pulmonary edema even after several days
of antimalarial therapy .
 Pathogenesis unclear.
• 7- RENAL IMPAIRM ENT
 Renal impairment is common among adults w ith severe
falciparum malaria but rare among children.
 Pathogenesis unclear.

19. References