Malaria in children

Overview & Definition

Malaria is a mosquito-borne parasitic illness caused by Plasmodium protozoa and transmitted by the bite of an infected female Anopheles mosquito. In children it ranges from a self-limiting febrile illness to a rapidly fatal multisystem disease, and the difference between the two is the single most important judgement a clinician makes. Any febrile child who has been in a malaria-endemic area must be presumed to have malaria until the blood film proves otherwise. [1]

The parasite that dominates severe disease and death is Plasmodium falciparum, which kills through cytoadherence and sequestration of infected red cells in the microvasculature of the brain and other organs. The other species, vivax, ovale, malariae, and the zoonotic knowlesi, cause significant illness but are rarely as lethal, and vivax and ovale carry the added burden of relapse from dormant liver stages called hypnozoites. Recognising the species and the severity drives every treatment decision. [1]

The cardinal principle is speed. Severe falciparum malaria is a medical emergency in which every hour of delay in giving intravenous artesunate measurably increases mortality, so blood films and rapid tests must never postpone the first dose in a sick child. In Australia and New Zealand malaria is almost always imported through travel, which makes a travel history the hinge of the whole encounter. [2]

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1. [1]White NJ Malaria. Lancet, 2014.PMID 23953767
2. [2]Dondorp AM Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet, 2010.PMID 21062666
3. [3]Dondorp A Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet, 2005.PMID 16125588
4. [4]Maitland K Mortality after fluid bolus in African children with severe infection. N Engl J Med, 2011.PMID 21615299
5. [5]Bhatt S The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature, 2015.PMID 26375008
6. [6]Newton CR Pathophysiology of fatal falciparum malaria in African children. Am J Trop Med Hyg, 1998.PMID 9598460
7. [7]Calis JC Severe anemia in Malawian children. Malawi Med J, 2016.PMID 27895843
8. [8]Jaita S Post-Artesunate Delayed Hemolysis: A Review of Current Evidence. Trop Med Infect Dis, 2023.PMID 36668956
9. [9]Syed YY RTS,S/AS01 malaria vaccine (Mosquirix): a profile of its use. Drugs Ther Perspect, 2022.PMID 36093265
10. [10]Guerra Mendoza Y Safety profile of the RTS,S/AS01 malaria vaccine in infants and children: additional data from a phase III randomized controlled trial in sub-Saharan Africa. Hum Vaccin Immunother, 2019.PMID 31012786
11. [11]Barber BE Plasmodium knowlesi malaria in children. Emerg Infect Dis, 2011.PMID 21529389
12. [12]Nayak S Population genomics and transcriptomics of Plasmodium falciparum in Cambodia and Vietnam uncover key components of the artemisinin resistance genetic background. Nat Commun, 2024.PMID 39639029