We discussed a case of a patient with 3% parasitemia but who had CNS symptoms compatible with cerebral malaria and mild renal failure.
In general, severe malaria is defined as a parasitemia of greater than 5% or disease associated with end-organ dysfuction (see NEJM article and table below)
We also discussed the use of artesunate in the treatment of malaria. This Cochrane review suggests that as compared with IV quinine, artesunate reduced the risk of death (RR 0.62), cleared parasitemia faster, and had a lower risk of hypoglycemia. Consequently, it is likely currently the therapy of choice for severe malaria in non-pregnant adults.
Dosing is 2.4mg/kg given as an IV push at time 0, 12h, 24h and 48h. It is given in combination with a longer acting antimalarial such as doxycycline 100mg PO BID x 7days.
Generally fewer side effects than quinine or quinadine. Side effects include:
- GI symptoms (relatively common)
- Allergy ~1:3000
- Possible neurotoxicity manifesting as oto/vestibular toxicity (rare)
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