Rationale:

• Physical exam findings of malaria may include an axillary temperature 37.5°C (99.5°F), splenomegaly, or pallor; and coma, seizures, jaundice, and respiratory distress are signs of severe P. falciparum malaria.
• Rash and lymphadenopathy are uncommon in malaria.

Evidence:

• The World Health Organization has established guidelines for the diagnosis of severe P. falciparum malaria that is life-threatening and requires immediate treatment (55).

Comments:

• Although physical exam signs of pulmonary consolidation are uncommon in malaria, the clinical features of pneumonia (i.e., cough, dyspnea, and tachypnea) may overlap with those of malaria. During a period of high malaria transmission in The Gambia, 38% of young children (n=666) with clinically suspected pneumonia had P. falciparum parasitemia, no radiologic evidence of pneumonia, and no other cause of fever (56). In Uganda, 30% of young children (n=3671) had symptoms of both malaria and pneumonia, necessitating treatment with both antimalarials and antibiotics (57).
• Pernicious complications of “benign” tertian malaria caused by P. vivax occur rarely and may include clinically significant hemolysis, splenic rupture, and acute respiratory distress syndrome (58; 59; 60).