Severe Malaria Criteria (WHO, 2015):
- General Danger Signs:
- Prostration (inability to sit, stand, or walk unassisted)
- Generalized weakness
- Altered consciousness
- Difficulty breathing
- Inability to feed (in children)
- Convulsions (in children)
- Specific Severe Manifestations:
- Cerebral malaria: Unarousable coma (Glasgow Coma Scale <9)
- Severe anemia: Hemoglobin <7 g/dL or hematocrit <20%
- Respiratory distress: Acidotic breathing, chest indrawing, nasal flaring
- Hypoglycemia: Blood glucose <40 mg/dL
- Acute kidney injury: Serum creatinine >2.5 mg/dL or oliguria (<400 mL/day in adults)
- Acute hemolytic anemia: Hemoglobin <7 g/dL with parasitemia
- Shock: Systolic blood pressure <80 mmHg (adults) or lower in children
- Acute respiratory distress syndrome (ARDS): PaO2/FiO2 <300 mmHg
- Disseminated intravascular coagulation (DIC): Platelets <50,000/μL + elevated fibrin degradation products
- Acute liver failure: Jaundice + serum bilirubin >3 mg/dL
- Hyperparasitemia: Parasitemia >5% (or >10% in non-immune individuals)
- Rationale:
- The WHO criteria define severe malaria based on clinical and laboratory markers associated with high mortality risk. Hyperparasitemia (>5%) is a key indicator, as it correlates with organ dysfunction and poor outcomes. Cerebral malaria and severe anemia are particularly critical in children, while ARDS and DIC are more common in adults.