Parasitic infection by Plasmodium species (vivax, falciparum, malariae, ovale, knowlesi) transmitted by Anopheles mosquito.
History taking
- • Cyclical fever with chills/rigors, headache, vomiting, sweating
- • Travel/residence in endemic area, prior malaria, mosquito exposure
Examination
- • Pallor, jaundice, splenomegaly, hepatomegaly
- • Look for severe malaria signs
Red flags
- • Severe malaria (P. falciparum): impaired consciousness, seizures, ARDS, oliguria, jaundice, hypoglycaemia, anaemia
- • Pregnancy with malaria
- • Parasitaemia >2%
Differential diagnosis
- • Dengue, typhoid, leptospirosis, viral fever, sepsis
- • Other haemolytic anaemias
Recommended investigations
- • Peripheral smear (thick & thin) — gold standard, species & parasitaemia
- • Rapid diagnostic test (HRP2 for Pf; pLDH for Pv)
- • CBC, LFT, RFT, glucose, urinalysis
- • PCR if mixed/low parasitaemia
Diagnosis
- • Positive smear or RDT
Initial treatment / management
- • Uncomplicated P. vivax: Chloroquine 3 d + Primaquine 0.25 mg/kg x 14 d (after G6PD test)
- • Uncomplicated P. falciparum: ACT (Artesunate-SP or AL) x 3 d + single-dose Primaquine 0.75 mg/kg
- • Severe malaria: IV Artesunate 2.4 mg/kg at 0, 12, 24 h then daily; switch to oral ACT once stable
Prescription examples
- • Tab Chloroquine 600 mg base PO stat, then 300 mg at 6, 24, 48 h
- • Tab Primaquine 15 mg PO OD x 14 d (P. vivax, after G6PD)
- • Inj Artesunate 2.4 mg/kg IV at 0, 12, 24 h then daily (severe malaria)
- • Tab Paracetamol 500–1000 mg PO 6 hourly
Follow-up advice
- • Recheck smear in 48–72 h
- • P. vivax: prevent relapse with full primaquine course
Patient counselling
- • Mosquito prevention (LLINs, repellent)
- • Complete full course; primaquine for vivax
- • G6PD test before primaquine; avoid pregnancy
Referral criteria
- • Severe/complicated malaria, pregnancy
- • Treatment failure, mixed infection
Clinical pearls
- • Negative smear once does NOT exclude malaria — repeat every 6–12 h x 48 h
- • IV artesunate is the drug of choice for all severe malaria
- • Always test for hypoglycaemia in severe falciparum
References
- • WHO Guidelines for the Treatment of Malaria 2023
- • NVBDCP National Drug Policy on Malaria 2013 (India)
Educational outpatient guide — verify against local guidelines before clinical use.
