Severity of Malaria

P. falciparum causes the most severe type of malaria. Consequence of severe malaria include coma & death if untreated (specially children & pregnant women). Splenomegaly (enlarged spleen), severe headache, cerebral ischemia, hepatomegaly (enlarged liver) & hemoglobinuria with renal failure may occur. Renal failure may also cause black water fever, where hemoglobin from lysed RBC leaks into urine. This form cause death within hours or days in more than 20% cases even with intensive care & treatment. P. vivax & P. ovale produces chromic malaria, unlike P. falciparum. In this case the disease relapse months or years after exposure, due to presence of latent parasites in the liver. The largest incubation period reported for a P. vivax infection is 30 years. Malaria is often associated with hypoglycemia which has four causes – (i) High parasitemia (parasite’s inefficient use of glucose); (ii) you don’t as much because of loss of appetite; (iii) depletion of liver glucose & (iv) inhibition of gluconeogenesis.