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Table 1 WHO criteria for severe malaria [10, 15, 17]

From: Severe imported malaria in an intensive care unit: a review of 59 cases

Manifestation Definition
Cerebral malaria Impaired consciousness or unrousable coma not attributable to any other cause, with a Glasgow score ≤ 9.
Prostration, i.e. generalized weakness so that the patient is unable to walk, or sit up without assistance
Failure to feed
Multiple convulsions - more than two episodes in 24 h
Haematocrit < 15% or haemoglobin < 5 g/dl in the presence of parasite count > 10 000/μl
Renal failure Urine output < 400 ml/24 hours in adults (< 12 ml/kg/24 hours in children) and a serum creatinine > 265 μmol/l (> 3.0 mg/dl) despite adequate volume repletion
Pulmonary oedema and ARDS The acute lung injury score is calculated on the basis of radiographic densities, severity of hypoxemia, and positive end-expiratory pressure
Hypoglycaemia Whole blood glucose concentration
< 2.2 mmol/l (< 40 mg/dl)
Circulatory collapse Systolic blood pressure < 70 mmHg in patients > 5 years of age (< 50 mmHg in children aged 1-5), with cold clammy skin or a core-skin temperature difference > 10°C
Abnormal bleeding and/or disseminated intravascular coagulation Spontaneous bleeding from gums, nose, gastrointestinal tract, or laboratory evidence of disseminated intravascular coagulation
Repeated generalized seizures ≥2 seizures observed within 24 hours
Acidaemia/acidosis Arterial pH < 7.25 or acidosis (plasma bicarbonate < 15 mmol/l)
Macroscopic haemoglobinuria Haemolysis not secondary to glucose-6-phospha
e dehydrogenase deficiency
Impaired consciousnesss Rousable mental condition
Prostration or weakness Generalized weakness so that the patient is unable to walk
or sit up without assistance
Hyperparasitaemia > 2% parasitized erythrocytes or > 250 000 parasites/μl (in non-immune individuals)
Hyperpyrexia Core body temperature > 40°C
Hyperbilirubinaemia Total bilirubin > 43 μmol/l (> 2.5 mg/dl)