• Pregnant women have an increased susceptibility to malaria infection.
  • Malarial infection of the placenta by sequestration of the infected red blood cells leading to low birth weight and other effects.


FALCIPARUM Malaria fever


  • There are four types of malaria caused by the protozoan parasite
  • This fulminant disease often produces coma, shock, or sudden death.
  • Falciparum malaria in which the brain is affected.
  • Vital organ dysfunction may occur. Parasitemia may be — 3%.
  • Mortality may be high in severe falciparum malaria.


Cerebral malaria


Cerebral malaria
Cerebral malaria


  • It is a serious form of falciparum malaria.
  • There is coma with increased mortality despite treat­ment.
  • Obtundation i.e. altered consciousness, delirium, ab­normal behaviour occur.
  • Onset may be gradual or sudden. There may be convulsions.
  • There is a diffuse symmetric encephalopathy.
  • Focal neurologic signs and signs of meningeal irrita­tion are absent.
  • Corneal reflexes are preserved. Tendon reflexes are variable.
  • Plantar reflexes may be flexor or extensor. Abdominal reflexes are absent.
  • Fundus may show retinal haemorrhages, papil­loedema.
  • There may be residual neurologic deficit, blindness, deafness.


Hypoglycemia in malaria


Hypoglycemia in malaria
Hypoglycemia in malaria


  • Common in children and pregnant women.
  • It is due to failure of hepatic gluconeogenesis. Quinine, used to treat malaria may cause increased pancreatic insulin secretion leading to hypoglycemia.
  • There is sweating, tachycardia.


Lactic acidosis in malaria

  • It may occur in severe malaria. There is lactic acido­sis with ketoacidosis, respiratory distress, circulatory ­failure, with poor prognosis.


Non cardiogenic pulmonary edema

  • May occur in falciparum malaria or vivax malaria. Mortality is 80%.


Renal impairment in malaria


Renal impairment in malaria
Renal impairment in malaria


  • May occur in falciparum malaria in adults.
  • It is due to erythrocyte sequestration, and acute tu­bular necrosis leading to ARF.
  • Treatment is early dialysis.


Hematologic abnormalities in malaria

  • There is anaemia, coagulation abnormalities, throm­bocytopenia with bleeding.
  • There may be disseminated intravascular coagulation (DIe).


Liver dysfunction in malaria Hemolytic jaundice


Liver dysfunction in malaria Hemolytic jaundice
Liver dysfunction in malaria Hemolytic jaundice


  • Hepatic dysfunction
  • Mild or deep jaundice
  • Severe liver dysfunction occurs in falciparum malaria.






  • Associated with low birth weight, increased mortal­ity, congenital malarial infection in children.
  • In the pregnant mother, there is severe anaemia, hypoglycemia, acute pulmonary edema, premature labour.



  • Convulsions, coma, hypoglycemia, severe anaemia is more common in children.



  • Malaria can occur by blood transfusion, needle-prick, as in drug addicts, organ transplantation.






  • Algid malaria may be due to adrenal crisis, absorp­tion of endotoxin from gut or TNF (tumor necrosis factor) from endotoxin-activated macrophages.
  • There is sub-normal temperature, weakness, pros­tration, feeling of cold, vomiting, loose motions, rapid respiration and oliguria.
  • Death may occur but patient is conscious till the end.



  • After several bouts of falciparum malaria, there is occasionally abrupt onset of massive intravascular hemolysis with fever, chills and prostration.
  • It is the result of red blood cell destruction and the release of hemoglobin.
  • Bloody urine (hemoglobinuria) that occurs as a complication of falciparum malaria infection.
  • It occurs most commonly in patients who have been treated with drugs derived from quinine.
  • Hemoglobin escapes in urine turning it black, if the urine is acidic.
  • The illness is marked by high fevers, dark urine, epigastric pain, vomiting, jaundice, and shock
  • This is a serious condition with a bad prognosis.


Patient Care –

  • In such areas, suppressive and prophylactic drugs may be needed to control the disease.
  • Health care providers in endemic areas need to work toward prompt detection and effective treatment of malaria.

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