Initial World Health Organization criteria from 1990 [11] | |
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Manifestation | Features |
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 | Â |
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) |