Patient selection: malaria suspected based on history of exposure together with signs and symptoms of malaria
Parameters:
(1) Does the patient appear toxic?
(2) Is Plasmodium falciparum the dominant species in the exposure area?
(3) Is the patient likely to be partially immune to falciparum malaria?
Criteria for partial immunity to falciparum malaria - all of the following:
(1) > 6 years of age
(2) history of malaria infection
(3) resided in an area where malaria is highly endemic within past 2 years
If toxic:
(1) admit to hospital ICU
(2) perform multiple thick and thin smears
(3) consider PCR if available
(4) start parenteral therapy
If non-falciparum species suspected:
(1) perform thick and thin smears
(2) if initial smears are negative repeat as outpatient every 8-12 hours for minimum of 3 sets
If Plasmodium falciparum suspected and the patient likely has partial immunity:
(1) perform thick and thin smears
(2) if initial smears are negative repeat as outpatient every 8-12 hours for minimum of 3 sets
If Plasmodium falciparum suspected and the patient is likely nonimmune:
(1) admit to the hospital
(1) perform thick and thin smears
(2) if initial smears are negative repeat every 8-12 hours and with fevers
