Clinical features

• Symptoms include headache, fever with rigors, myalgia, abdominal pain, vomiting and diarrhoea. Signs include splenomegaly, jaundice, tender hepatomegaly and anaemia. Hyponatraemia is common.

• Only a minority of patients with P. falciparumhave paroxysms of fever with 'cold' and 'hot' stages.

If >5% parasitaemia, features include:

• Cerebral malaria, causing coma, delirium, seizures or focal deficits.

• Cough and haemoptysis or acute respiratory distress

• Blackwater fever is associated with massive intravascular haemolysis, jaundice, haemoglobinuria, collapse and renal failure

• Acute renal dysfunction occurs in a third of adult ICU patients

• Acute cardiovascular collapse ('algid malaria') and metabolic acidosis

• Thrombocytopenia, DIC and spontaneous bleeding

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