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Sudden onset of High Fever with rigors and sensation of extreme colds followed by feeling of burning, leading to profuse sweating and remission of fever by crisis thereafter. The febrile paroxsyms occur every alternate day. Headache, body ache, nausea etc. may be associated features.

In atypical cases, classical presentation as mentioned above may not manifest. Hence, any fever case until unless proved otherwise, may be considered as malaria in the endemic areas during transmission season.

In most of the cases, the first symptoms are not specific and similar to those of a minor viral illness with malaise, headache, fatigue, abdominal discomfort and muscle aches followed by fever and chills. Repeated infections lead to anaemia, enlargement of spleen, and chronic ill health with bouts of fever. Most patients with uncomplicated acute infection have few abnormal physical findings other mild anaemia and in some cases a palpable spleen. None of the clinical features of malaria is pathognomic.

Severe & Complicated Malaria
The signs & symptoms in children are a history of high fever plus at least one of the following.
  1. Prostration (inability to sit), altered consciousness lethargy or coma,
  2. Breathing difficulties,
  3. Severe anaemia,
  4. Convulsions,
  5. Inability to drink/vomitting.
The same symptoms & signs in children are valid for adults, with addition of dark and/or limited production of urine.
  1. Hypoglycaemia
  2. Shock
  3. Hyperpyrexia (Rectal temperature above 390c)
  4. Dehydration
  5. Acute Renal failure with anuria or oliguria and black water fever.
  6. Hyperkalaemia/Hypo kalaemia
  7. Pulmonaty Oedema
  8. GAstro intestinal complications.
  9. Bleeding (Pulmonary oedema)
  10. Jaundice & lever damage.
  11. Hyperparasitaemia
Differences between presentation of severe malaria in adults and in children.

Signs or Symptoms Adults Children
Anaemia Common Very common
Convulsions Common Very common
Pre treatment hypoglycaemia Less common Common
Metabolic acidosis Less common Common
History of cough Un common Common
Jaundice Very common Common
Renal failure common Less common
Pulmonary Oedema, ARDS Less common Rare
duration of illness Longer (5–7 days) Shorter (1–2 days)
Resolution of coma Longer (2–4 days) Shorter (1–2 days)