Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Residence in or travel to an endemic area (fever in the returning traveler) Cyclic paroxysms of fever, chills, and intense sweating Headache, backache, cough, abdominal pain, nausea, vomiting, diarrhea Splenomegaly, anemia Can progress to coma, seizures Malaria parasites in peripheral blood smear +++ General Considerations ++ Human malaria is caused by five Plasmodium species Plasmodium vivax (most common) Plasmodium falciparum (most virulent) Plasmodium ovale (similar to P vivax) Plasmodium malariae Plasmodium knowlesi (a primate parasite recognized as a cause of malaria in humans) The female Anopheles mosquito transmits the parasites In early stages of infection, asynchronous erythrocytic cycles of hemolysis commonly cause daily fevers Eventually, synchronous erythrocytic cycles begin as parasites rupture the infected cells at more regular 48- or 72-hour intervals Survival is associated with a progressive decrease in intensity of cycles Relapses years later may occur from persistent hepatic infection, which occurs in P vivax and P ovale infections +++ Demographics ++ Causes approximately 1 million deaths each year, over 80% of which occur in children younger than 5 years of age in sub-Saharan Africa Global efforts toward prevention and treatment have led to declining mortality and morbidity Approximately 1500 imported cases are diagnosed in the United States each year; local transmission may occasionally take place from imported cases +++ Clinical Findings +++ Symptoms and Signs ++ Fever and vomiting are the most common presenting symptoms in children Common presenting symptoms in infants Recurrent fever Irritability Poor feeding Vomiting Jaundice Splenomegaly Rash is usually absent Classic symptoms in older children Fever with chills Rigors Headache Backache Myalgia Fatigue Signs of severe malaria in children include Altered mental status Seizures Respiratory distress Hypoglycemia Acidosis Parasitemia > 5% Fever may be cyclic (every 48 hours for all but P malariae infection, in which it occurs every 72 hours) or irregular (most commonly observed with P falciparum) Infection during pregnancy often causes intrauterine growth restriction or premature delivery but rarely true fetal infection Physical examination in patients with uncomplicated cases may show only mild splenomegaly and anemia +++ Differential Diagnosis ++ Clinical features may not reliably distinguish malaria from other infections in children, so a high index of suspicion in patients with exposure in endemic areas is necessary Differential diagnosis of fever in a returning traveler should be based on diseases endemic to the region of travel and may include Typhoid fever Tuberculosis Rickettsial disease Brucellosis Leptospirosis Yellow fever Dengue fever Chikungunya Borreliosis However, other common causes of fever, such as influenza, Mycoplasma pneumoniae or enteroviral infection, and serious bacterial causes such as occult sinusitis, meningitis, pneumonia, or bacteremia should be considered Malaria may also coexist with other diseases +++ Diagnosis ++ One or more of the five ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.