Manifestations | Definitions |
Impaired consciousness | Glasgow coma score <11 in adults or Blantyre coma score <3 in children; inability to swallow |
Prostration | Generalized weakness so that a person is unable to sit, stand, or walk without assistance |
Multiple convulsions | More than two episodes within 24 hours |
Acidosis | A base deficit of >8 mEq/L, a plasma bicarbonate level of <15 mmol/L, or venous plasma lactate ≥5 mmol/L. Clinical indicators of acidosis include rapid, deep, labored breathing. |
Hypoglycemia | Blood or plasma glucose <40 mg/dL (<2.2 mmol/L) for children ≥5 years and adults; blood or plasma glucose <54 mg/dL (<3 mmol/L) for children <5 years |
Severe anemia | Hemoglobin concentration ≤5 g/dL or hematocrit ≤15% in children <12 years of age (<7 g/dL and <20%, respectively, in adults) with parasite count >10,000 parasites/uL |
Renal impairment | Plasma or serum creatinine >3 mg/dL (265 umol/L) or blood urea >20 mmol/L |
Jaundice | Plasma or serum bilirubin >50 umol/L (3 mg/dL) with one of the following: - Plasmodium falciparum parasite count >2.5% parasitemia
- Plasmodium knowlesi parasite count >20,000 parasites/uL
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Pulmonary edema | Radiographically confirmed or oxygen saturation <92% on room air with respiratory rate >30/minute, often with chest indrawing and crepitation on auscultation |
Significant bleeding | Including recurrent or prolonged bleeding (from the nose, gums, or venipuncture sites), hematemesis, or melena |
Shock | Compensated shock is defined as capillary refill ≥3 seconds or temperature gradient on leg (mid to proximal limb), but no hypotension. Decompensated shock is defined as systolic blood pressure <70 mmHg in children or <80 mmHg in adults, with evidence of impaired perfusion (cool peripheries or prolonged capillary refill). |
Hyperparasitemia | P. falciparum: - In non-immune travelers: parasitemia ≥5%[3]
- All patients: parasitemia >10%
P. knowlesi: - Parasite density >100,000 parasites/uL
Plasmodium vivax: - No established parasite density thresholds
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