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Table 1 Criteria of severe malaria according to the 2014 World Health Organization definition with minor modifications

From: Hypertension is associated with an increased risk for severe imported falciparum malaria: a tertiary care hospital based observational study from Berlin, Germany

Criterion

Specification

Impaired consciousness

Glasgow coma scale (GCS) < 11

Multiple convulsions

> 2 convulsions within 24 h

Respiratory distress or acidotic breathing

Requirement of non-invasive or endotracheal mechanical ventilation or respiratory rate ≥ 40 breaths/min on room air

Circulatory collapse or shock

Systolic blood pressure < 80 mm Hg or ≤ 80 mm Hg despite volume repletion

Acute pulmonary oedema

Confirmed radiologically

Acute respiratory distress syndrome (ARDS)

Lung injury of acute onset, within 1 week of an apparent clinical insult and with progression of respiratory symptoms; bilateral opacities on chest imaging not explained by other lung pathology (e.g. pleural effusion, pneumothorax, or nodules); respiratory failure not explained by heart failure or volume overload; decreased arterial PaO2/FiO2 ratio (≤ 300 mmHg)

Renal impairment

Plasma or serum creatinine > 3 mg/dl (> 265 µmol/l)

Metabolic acidosis

pH < 7.25 or plasma bicarbonate < 15 mmol/l or lactate > 5 mmol/l or ≥ 45 mg/dl

Jaundice

Bilirubin > 50 µmol/l or > 3 mg/dl together with circulatory instability, respiratory distress, impaired consciousness, severe coagulopathy, or acute kidney injury

Malaria-induced anaemia

Haemoglobin level < 70 g/l or haematocrit < 20% not related to other causes than malaria

Abnormal bleeding

Including recurrent or prolonged bleeding from the nose, gums, venepuncture sites, hematemesis or melaena

Macroscopic haemoglobinuria

Macroscopic haemoglobinuria related to malaria

Hypoglycaemia

Blood glucose level < 40 mg/dl (< 2.2 µmol/l)

Hyperparasitaemia

> 5% parasitized erythrocytes