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Malaria is a topic covered in the 5-Minute Emergency Consult.

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  • Protozoan infection transmitted through the Anopheles mosquito
  • Incubation period 8–16 days
  • Periodicity of the disease is due to the life cycle of the protozoan:
    • Exoerythrocytic phase: Immature sporozoites migrate to liver, where they rapidly multiply into mature parasites (merozoites).
    • Erythrocytic phase: Mature parasites are released into circulation and invade RBCs.
    • Replication within RBCs followed 48–72 hr later by RBC lysis and release of merozoites into circulation, repeating cycle
    • Fever corresponds to RBC lysis.
  • Plasmodium falciparum:
    • Cause of most cases and almost all deaths
    • Usually presents as an acute, overwhelming infection
    • Able to infect red cells of all ages:
      • Results in greater degree of hemolysis and anemia
    • Causes widespread capillary obstruction:
      • Results in end-organ hypoxia and dysfunction
    • More moderate infection in people who are on or who have recently stopped prophylaxis with an agent to which the P. falciparum is resistant
    • Post-traumatic immunosuppression may cause relapse of malaria in patients who have lived in endemic areas.
  • Plasmodium vivax and Plasmodium ovale:
    • May present with an acute febrile illness
    • Dormant liver stages (hypnozoites) that may cause relapse 6–11 mo after initial infection
  • Plasmodium malariae:
    • May persist in the bloodstream at low levels up to 30 yr


  • Transmission usually occurs from the bite of infected female Anopheles mosquito.
  • North American transmission possible:
    • Anopheles mosquitoes on east and west coasts of US.
    • Transmission may also occur through infected blood products and shared needles.

Pediatric Considerations
  • Sickle cell trait protective
  • Cerebral malaria more common in children
  • In highly endemic areas with minimal lab capability, all children presenting with febrile illness may be treated.

Pregnancy Considerations
Pregnant patients, especially primigravida, at higher risk

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Rosen, Peter, et al., editors. "Malaria." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307115/all/Malaria.
Malaria. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307115/all/Malaria. Accessed April 25, 2019.
Malaria. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307115/all/Malaria
Malaria [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307115/all/Malaria.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Malaria ID - 307115 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307115/all/Malaria PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -