Complications of malaria

Key specific complications

The greatest danger to the patient's life is infection caused by the pathogen Plasmodium falciparum, as it is precisely this species that can lead to a severe, complicated clinical course. In clinical practice, several critical conditions require immediate intervention:

• Malarial coma (encephalopathy). It develops in the cerebral form of the infection. This severe neurological complication is accompanied by depressed consciousness and requires emergency resuscitation measures.
• Anuria. The complete cessation of urine flow into the bladder, indicating the development of acute renal failure (ARF). This complication dictates the need for peritoneal dialysis to cleanse the blood of toxic metabolic products.
• Blackwater fever. A life-threatening syndrome characterized by massive intravascular destruction of red blood cells (hemolysis). This process is often triggered by the administration of certain chemotherapy drugs. The main management tactic is the immediate withdrawal of the drugs that provoked the hemolysis and a transfusion of donor red blood cell mass to the patient.

Differential diagnosis of malarial coma

When encephalopathy develops and consciousness is depressed in a patient, it is crucial to rapidly establish the exact cause. Malarial coma must be differentiated from other severe pathologies:

1. Comatose states in decompensated diabetes mellitus.
2. Acute hepatic and renal failure.
3. Brain edema and swelling occurring against the background of viral or bacterial meningitis and meningoencephalitis.

Additionally, if the patient is in tropical endemic regions (Africa, India, South America), a severe course of infection with the risk of bleeding and CNS involvement must be distinguished from viral hemorrhagic fevers such as yellow fever or dengue fever.

Principles of treatment for complicated forms

Patients with severe and complicated forms of the disease require mandatory hospitalization in intensive care units (ICUs). Oral administration of medications in such a state is impossible or ineffective, so drugs are administered strictly parenterally.

Specific therapy:

• The drug of choice is often quinine dihydrochloride (Quinine dihydrochloride). It is administered intravenously slowly (in a 5% glucose solution) several times a day. Treatment is continued until the patient emerges from the critical state, after which they are switched to oral medications according to the standard regimen.
• Artemisinin derivatives (administered intramuscularly or intravenously) can serve as an alternative, but their use depends on local regulatory approval in a specific region (for example, they may not be approved in the Russian Federation).

Pathogenetic therapy: Along with parasite elimination, comprehensive management of complications is carried out. The scope of care depends on the severity of the course and includes detoxification, correction of hypoglycemia and metabolic acidosis. Additionally, diuretics, antihistamines, cardiovascular agents, and vitamins are used. In some cases, strictly according to indications, glucocorticosteroids may be prescribed.

Chemotherapy-related complications

In addition to the complications of the disease itself, physicians frequently encounter adverse drug reactions. One of the common phenomena, especially in pediatric practice, is vomiting, which prevents drug absorption and can lead to treatment failure.

There are strict dosing rules in the event of vomiting:

• If vomiting occurs less than 30 minutes after administration, the patient must be given the same (full) dose of the medication again.
• If vomiting occurs after 30–60 minutes, the patient is given half of the initial dose.

If treatment has been initiated but the clinical picture (including severe status) persists alongside parasitemia within the first 3 days, early treatment failure is diagnosed. In this case, if the parasitemia level does not decrease after 48 hours, the drug must be replaced with another one.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• WHO criteria for assessing malaria treatment efficacy
• Regimens of suppressive and radical malaria therapy
• The problem of Plasmodium falciparum resistance to chemotherapy drugs
• Differential diagnosis of malaria with brucellosis and sepsis
• Rapid diagnostic tests (HRP-2 and pLDH)

Other topics in the "Vector-borne infections" section

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