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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



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


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


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


> 2% parasitized erythrocytes or > 250 000 parasites/μl (in non-immune individuals)


Core body temperature > 40°C


Total bilirubin > 43 μmol/l (> 2.5 mg/dl)