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Table 4 Severe manifestations of P. falciparum malaria in adults (WHO 2000, adapted WHO 2011)[77, 78]

From: Management of imported malaria in Europe

Prognostic

value

Clinical manifestations and laboratory findings

Frequency

(?) no data

Prostration

+++

+

Impaired consciousness (score <11 on the Glasgow Coma Scale)

++

+++

Acute respiratory distress

+

++

Multiple seizures

+

+++

Circulatory collapse (systolic blood pressure <80 mm Hg with features of peripheral circulatory failure)

+

+++

Pulmonary oedema (radiological)

+

++

Abnormal bleeding (clinically defined)

+

+

Jaundice (clinically defined or serum bilirubin >50 mol/L

+++

+

Macroscopic haemoglobinuria

+

+

Severe anaemia (haemoglobin <5 g/dL or haematocrit <15%)

+

+++

Hypoglycaemia (blood glucose concentration <2.2 mmol/L)

++

+++

Acidosis (pH <7.35 or plasma bicarbonate <15 mmol/L)

++

+++

High plasma lactate (>5 mmol/L)

++

++

High parasitemia (especially 2% in non-immune patients and 5% in semi-immune patients)

+

++

Acute renal failure (serum creatinine > 265 μmol/L and 24-hour urine output <400 mL)

+++