Assessment of malaria severity

Malaria is classified as uncomplicated or severe/complicated. Therapy for malaria is based on severity of illness.

Determine the parasite count in all patients with P. falciparum malaria, regardless of clinical presentation or severity.

Uncomplicated malaria is defined as symptomatic malaria and a positive parasitological test result (microscopy or rapid diagnostic test), without features of severe malaria. It is treated with oral therapy, if tolerated (see Treatment of uncomplicated malaria).

Severe malaria is indicated by one or more of the following features:

• a blood parasite count more than 100 000/microlitre (more than 2% of red blood cells parasitised)
• impaired consciousness
• jaundice
• oliguria
• respiratory distress
• severe anaemia
• hypoglycaemia
• vomiting
• clinical acidosis or metabolic acidosis on blood biochemistry
• acute kidney injury.

Urgently treat patients who have severe malaria with intravenous therapy—see Treatment of severe malaria.