|
Indicators of severe malaria and poor prognosis |
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| Manifestation |
Features |
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| Initial World Health Organization criteria from 1990 [11] |
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| Cerebral malaria |
Unrousable coma not attributable to any other cause, with a Glasgow Coma Scale score ≤ 9. Coma should persist for at least 30 min after a generalized convulsion |
| Severe anemia |
Hematocrit <15% or hemoglobin < 50 g/l in the presence of parasite count >10 000/μl |
| Renal failure |
Urine output <400 ml/24 hours in adults (<12 ml/kg/24 hours in children) and a serum creatinine>265 μmol/l (> 3.0 mg/dl) despite adequate volume repletion |
| Pulmonary edema and acute respiratory distress syndrome |
The acute lung injury score is calculated on the basis of radiographic densities, severity of hypoxemia, and positive end-expiratory pressure [26] |
| Hypoglycemia |
Whole blood glucose concentration <2.2 mmol/l (<40 mg/dl) |
| Circulatory collapse (algid malaria) |
Systolic blood pressure <70 mmHg in patients > 5 years of age (< 50 mmHg in children aged 1–5 years), with cold clammy skin or a core-skin temperature difference >10°C |
| Abnormal bleeding and/or disseminated intravascular coagulation |
Spontaneous bleeding from gums, nose, gastrointestinal tract, or laboratory evidence of disseminated intravascular coagulation |
| Repeated generalized convulsions |
≥ 3 convulsions observed within 24 hours |
| Acidemia/acidosis |
Arterial pH <7.25 or acidosis (plasma bicarbonate <15 mmol/l) |
| Macroscopic hemoglobinuria |
Hemolysis not secondary to glucose-6-phosphate dehydrogenase deficiency |
| Added World Health Organization criteria from 2000 [12] |
|
| Impaired consciousness |
Rousable mental condition |
| Prostration or weakness |
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| Hyperparasitemia |
> 5% parasitized erythrocytes or > 250 000 parasites/μl (in nonimmune individuals) |
| Hyperpyrexia |
Core body temperature >40°C |
| Hyperbilirubinemia |
Total bilirubin >43 μmol/l (> 2.5 mg/dl) |
Trampuz et al. Critical Care 2003 7:315 doi:10.1186/cc2183 |
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