A poor prognosis for severe malaria in children can often be indicated by clinical and laboratory findings.
Differences between children and adults with severe malaria:
(1) Common causes of death in adults are acute renal failure and acute pulmonary edema, but these are rare in children.
(2) Common causes of death in children are severe anemia and lactic acidosis.
Indicator
Findings indicating a poor prognosis
neurological status
combination of cerebral malaria with coma and extensor posturing
hypoglycemia
blood glucose < 2.2 mmol/L
heart rate (tachycardia)
> 150 beats/minute
respiratory rate (tachypnea)
> 50 breaths per minute
hyperlactatemia
plasma lactate > 5 mmol/L
malarial parasites in peripheral blood
parasite count > 500,000 per µL
malarial parasites in peripheral blood
> 40% trophozoites (pigment evident in asexual stage)
where:
• Coma is indicated by a Blantyre coma score of 0, 1 or 2.
Additional Laboratory Indicators
Findings indicating poor prognosis
serum urea nitrogen
> 6.4 mmol/L
"corrected" serum calcium
> 2.2 mmol/L
serum potassium
> 5 mmol/L
serum albumin
normal
liver function tests
elevations of total bilirubin, GGT, AST
where:
• Serum albumin in survivors is usually mildly decreased.
• How the serum calcium is "corrected" is not stated, but is assumed to be for low serum albumin [approximate total serum calcium in mg/dL with normal albumin = (current total serum calcium in mg/dL) + (0.8 * (4 - (albumin in g/dL)); approximate total serum calcium in mmol/L with normal albumin = (current total serum calcium in mmol/L) + (0.8 * (1 - ((albumin in g/L) /40))].
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