Abstract
The lack of a gold standard definition for severe malaria has been a longstanding problem for both clinicians and researchers. The definitions currently used comprise a set of clinical and laboratory parameters associated with an increased risk of death combined with the presence of Plasmodium falciparum parasitemia. In young children these criteria are predominantly altered consciousness severe anemia and respiratory distress; a broader range of criteria is applicable to adolescents and adults. While these criteria are sensitive in diagnosing severe malaria they are also present in other serious illnesses. Since asymptomatic parasitemia is common in malaria-endemic areas patients fulfilling current World Health Organization (WHO) criteria for severe malaria often have disease attributable to another cause such as bacterial sepsis with incidental parasitemia thereby limiting the specificity of this definition. For a treating clinician a sensitive but less specific definition of severe malaria is entirely appropriate. However for research purposes a sensitive clinical definition may not necessarily be appropriate and the case definition should depend on the research question. (excerpt)
Highlights
While these criteria are sensitive in diagnosing severe malaria, they are present in other serious illnesses
In a recent randomized controlled trial of quinine versus artesunate for severe malaria [5], the aim was to compare the efficacy of two drugs in real-world resource-poor clinical settings
The primary endpoint, mortality, included all patients enrolled with a bedside clinical diagnosis of severe malaria, who were positive for P. falciparum by a rapid diagnostic test
Summary
The lack of a “gold standard” definition for severe malaria has been a longstanding problem for both clinicians and researchers. The definitions currently used comprise a set of clinical and laboratory parameters associated with an increased risk of death [1,2], combined with the presence of Plasmodium falciparum parasitemia [2,3] In young children, these criteria are predominantly altered consciousness, severe anemia, and respiratory distress [1,3]; a broader range of criteria is applicable to adolescents and adults [2]. The primary endpoint, mortality, included all patients enrolled with a bedside clinical diagnosis of severe malaria, who were positive for P. falciparum by a rapid diagnostic test This sensitive but less specific definition had clinical applicability, but necessitated a large sample size to overcome the loss of power from the. The Perspectives section is for experts to discuss the clinical practice or public health implications of a published article that is freely available online
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