I. Falciparum Malaria (FM)

• Fever or history of fever within last 48 hours
  and
• Absence of convincing evidence of any other febrile illness
  and
• No features of severe malaria
  and
• High index of suspicion based on time, place and person - (Enquiring about high risk groups - Jhum Cultivator, Forest goers, new arrival, H/0 travel to endemic area, short term travelers)
  and
• Presence of asexual form of Plasmodium falciparum in Blood Slide Examination (BSE) or Rapid Diagnostic Test (RDT) +ve for P.  falciparum

The diagnosis of malaria should be confirmed through RDT or BSE as symptom based clinical diagnosis of malaria may be unreliable.

❖ Fever or history of fever within last 48 hours

and

❖ One or more of the following clinical or lab features of severity:

Clinical features:

❖ Change of behavior, confusion or drowsiness

❖ Altered consciousness or coma (cerebral malaria)

❖ Generalized convulsions > 2 episodes in 24 hours

❖ Difficulty in breathing due to acute pulmonary oedema (with a respiratory rate > 30/min, often with chest indrawing and crepitations on auscultation)

❖ Acute Respiratory Distress Syndrome (ARDS) or deep breathing (acidotic breathing) (rapid, deep, laboured breathing).

❖ Circulatory collapse or shock: Compensated shock is defined as capillary refill ≥ 3 s or temperature gradient on leg (mid to proximal limb), but no hypotension. Decompensated shock is defined as systolic blood pressure < 70 mm Hg in children or < 80 mm Hg in adults, with evidence of impaired perfusion (cool peripheries or prolonged capillary refill) or (algid malaria)

❖ Clinical Jaundice

❖ Severe prostration, i.e. extreme generalized weakness, so patient cannot walk, stand or sit without assistance and in small child failure to feed

❖ Severe vomiting leading to 'non per os'.

❖ Bleeding tendency or abnormal spontaneous bleeding including recurrent or prolonged bleeding from nose, gums or venipuncture sites; Hematemesis or melaena

❖ Severe Anaemia

❖ Oliguria (<400 ml/24 hrs or 0.5 ml/kg/hr over 6 hours)

Laboratory features:

❖ Acidosis: A base deficit of > 8 mEq/L or, if not available, a plasma bicarbonate level of < 15 mmol/L or venous plasma lactate ≥ 5 mmol/L.

❖ Hypoglycaemia: Blood or plasma glucose < 2.2 mmol/L (< 40 mg/dL)

❖ Severe malarial anaemia: Haemoglobin concentration ≤ 5 gm/dl or a haematocrit of ≤ 15% in children < 12 years of age (< 7 gm/dl and < 20%, respectively, in adults) with a parasite count > 10 000/μL

❖ Renal impairment: Plasma or serum creatinine > 265 μmol/L (3 mg/dL) or blood urea > 20 mmol/L

❖ Jaundice: Plasma or serum bilirubin > 50 μmol/L (3 mg/dL) with a parasite count 100 000/ μL,

❖ Pulmonary oedema: Radiologically confirmed or oxygen saturation < 92% on room air

❖ Hyperparasitaemia: P. falciparum parasitaemia > 10% and

❖ Presence of asexual form of P. falciparum in BSE or +ve RDT for P. falciparum