#EMConf: Malaria Review



Transmitted by female Anopheles mosquito 

Plasmodium: falciparum, vivax, ovale, malariae, knowlesi, simium 

Where in the World - Central and South America, Caribbean, Sub-Saharan Africa, India, Middle East, Southeast Asia, Oceania 

P. falciparum MC Africa 

P. vivax MC in indian subcontinent


Mosquito feeds → injects sporozoites host’s bloodstream → liver → hepatocytes rupture → invade erythrocytes → RBC lyse, invades uninfected RBCs or sexual reprod → mosquito feeds on host ingest gametocytes 

P. vivax and P. ovale hypnozoites remain dormant in hepatocytes, can be reactivated months to years later


Incubation period 7-35 days, usually 2 weeks 


Uncomplicated infection - fever, chills, malaise, fatigue, headache, cough, N/V/D, abdominal pain, myalgias, anemia, thrombocytopenia

Fever intervals every 2-3 days assoc with RBC rupture 

Severe infection - prostration, AMS, seizure, respiratory distress, pulmonary edema, jaundice, severe anemia, acute renal failure, shock, acidosis, hypoglycemia, parasitemia >5% 


Diagnosis by thick and thin blood smear 



Uncomplicated P. falciparum (likely chloroquine resistant):  

Artemisinin combination therapies are drugs of choice 

Artemether-lumefantrine (CoArtem) 3 day treatment 

Atovaquone-proguanil for 3 days 


Uncomplicated P.Vivax, P. malariae, P. ovale or P. knowlesi 

Chloroquine/hydroxychloroquine or artemisinin combo therapy 


Note - Vivax and ovale need additional treatment to eradicate hypnozoites from liver 

Primaquine phosphate for 2 weeks 

Need to check for G6PD deficiency - at risk of hemolysis


Severe infection:

IV artesunate (available from the CDC) for 7 days but w/ goal to transition to PO asap



Avoid dusk to dawn, long sleeved and light colored clothing, repellents (ex DEET), insecticide treated nets

Chemoprophylaxis available for travelers - need to start prior to travel, continue during the trip and after return home



Molyneaux M. "Malaria." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016.


Griffith KS, Lewis LS, Mali S, Parise ME. Treatment of Malaria in the United States: A Systematic Review. JAMA. 2007;297(20):2264–2277. doi:https://doi-org.ezproxy.rowan.edu/10.1001/jama.297.20.2264

Plewes K, Leopold SJ, Kingston H, Dondrop AM. Malaria: what’s new in the management of malaria?. Infect Dis Clin North Am. 2019 Mar;33(1):39-60. doi: 10.1016/j.idc.2018.10.002.