Clinical falciparum malaria: Its severity, types, splenomegaly, association with malnutrition and criteria for diagnosis

Abstract

A clinical study of 78 consecutive cases - almost all by P. falciparum - was carried out. The population is semi-immune. 1. Most of the patients appeared to have contracted the disease when visiting the rural areas. Relapse malaria appears to be very uncommon. 2. The disease is very common in infants and children. 3. The spleen was palpable in about a third of all the cases, but the number of children who showed a splenomegaly was signifi­cantly greater than in the adults. The possibility that malaria is a cause of sequestration of the spleen is made. 4. A confident diagnosis of acute malaria is seldom made in the absence of positive blood smears. 5. Not uncommonly the main presenting symptoms were those of cough, diarrhoea or severe headache. 6. The main clinical types are described, the most common found being the anaemic type. There was one case which corres­ponded to the psychiatric type. Other types encountered included those of cer­ebral, renal, hepatic, gastrointestinal and algid. 7. Severe malaria may not uncommonly be seen in the malnourished infant or child. 8. A positive blood culture occurred in some of the cases with acute malaria but the importance of this finding was difficult to assess. 9. The criteria for considering a diagnosis of acute malaria in the absence of positive blood smears are made. 10. Often when chloroquine was given to a patient the fever dropped steeply.