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Appendices

The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.

Section 3. Summaries of Infectious Diseases

Malaria

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: The classic symptoms of malaria are high fever with chills, rigor, sweats, and headache, which may be paroxysmal. If appropriate treatment is not administered, fever and paroxysms may occur in a cyclic pattern. Depending on the infecting species, fever appears every other or every third day. Other manifestations can include nausea, vomiting, diarrhea, cough, arthralgia, and abdominal and back pain. Anemia and thrombocytopenia are common, and pallor and jaundice caused by hemolysis may occur. Hepatosplenomegaly may be present.

Infection by Plasmodium falciparum potentially is fatal and most commonly manifests as a febrile nonspecific influenza-like illness without localizing signs. With more severe disease, however, P falciparum infection may manifest as one of the following clinical syndromes:

  • Cerebral malaria, which may have variable neurologic manifestations, including seizures, signs of increased intracranial pressure, confusion, and progression to stupor, coma, and death

  • Hypoglycemia, sometimes associated with quinine treatment, requiring urgent correction

  • Noncardiogenic pulmonary edema, which is difficult to manage and may be fatal (rare in children)

  • Renal failure caused by acute tubular necrosis (rare in children younger than 8 years of age)

  • Respiratory failure and metabolic acidosis, without pulmonary edema

  • Severe anemia attributable to high parasitemia and consequent hemolysis

  • Vascular collapse and shock associated with hypothermia and adrenal insufficiency

Individuals with asplenia who become infected are at high risk of death.

Syndromes primarily associated with Plasmodium vivax and Plasmodium ovale infection are as follows:

  • Anemia attributable to acute parasitemia

  • Hypersplenism with danger of late splenic rupture

  • Relapse, for as long as 3 to 5 years after the primary infection, attributable to latent hepatic stages

Syndromes associated with Plasmodium malariae infection include:


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  • Villamor, E., Mbise, R., Spiegelman, D., Hertzmark, E., Fataki, M., Peterson, K. E., Ndossi, G., Fawzi, W. W. (2002). Vitamin A Supplements Ameliorate the Adverse Effect of HIV-1, Malaria, and Diarrheal Infections on Child Growth. Pediatrics 109: e6-6 [Abstract] [Full Version]  
  • Ahlfors, C. E., Herbsman, O. (2003). Unbound Bilirubin in a Term Newborn With Kernicterus. Pediatrics 111: 1110-1112 [Full Version]  
  • Barennes, H., Valea, I., Nagot, N., Van de Perre, P., Pussard, E. (2005). Sublingual Sugar Administration as an Alternative to Intravenous Dextrose Administration to Correct Hypoglycemia Among Children in the Tropics. Pediatrics 116: e648-e653 [Abstract] [Full Version]  
  • Verhoef, H., West, C. E., Veenemans, J., Beguin, Y., Kok, F. J. (2002). Stunting May Determine the Severity of Malaria-Associated Anemia in African Children. Pediatrics 110: e48-48 [Abstract] [Full Version]  
  • Boctor, F. N. (2005). Red Blood Cell Exchange Transfusion as an Adjunct Treatment for Severe Pediatric Falciparum Malaria, Using Automated or Manual Procedures. Pediatrics 116: e592-e595 [Abstract] [Full Version]  
  • Worley, C. W., Worley, K. A., Kumar, P. L. (2000). Infectious Disease Challenges in Immigrants From Tropical Countries. Pediatrics 106: 3e-3 [Abstract] [Full Version]  
  • Berkley, J. A., Versteeg, A. C., Mwangi, I., Lowe, B. S., Newton, C. R. J. C. (2004). Indicators of Acute Bacterial Meningitis in Children at a Rural Kenyan District Hospital. Pediatrics 114: e713-e719 [Abstract] [Full Version]  
  • Raju, T. N.K. (2006). Hot Brains: Manipulating Body Heat to Save the Brain. Pediatrics 117: e320-e321 [Full Version]  
  • Stiehm, E. R. (2006). Disease Versus Disease: How One Disease May Ameliorate Another. Pediatrics 117: 184-191 [Abstract] [Full Version]