Key messages

• Falciparum malaria is a common cause of severe illness in patients who have returned from the tropics.

• Thick and thin blood films remain the diagnostic method of choice.

• Severe malaria can occur with low parasite counts.

• Quinine or quinidine are currently the drugs of choice in severe falciparum malaria, except when patients come from very restricted geographical areas of Asia where quinine resistance is a significant problem.

• The most urgent priority is giving adequate antimalarial drugs. Debates about route of administration or exchange transfusion should not be allowed to delay this.

• Renal failure, respiratory problems, and multiple organ failure can occur after all the parasites have been cleared from the blood.

• Pregnant women are at particular risk, particularly of hypoglycemia.

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