Malaria: review of features pertinent to the emergency physician

Malaria is a health problem of growing concern to the emergency physician. Plasmodium vivax, P ovale, and P malaria infections are relatively benign and can be treated in an outpatient setting with oral chloroquine or amodiaquine. In contrast, P falciparum can present fulminantly, often resulting in death with multiple organ system failure. Although quinine historically has been the mainstay of therapy for severe falciparum malaria in the United States, and still is outside the U.S., quinidine gluconate as a continuous infusion is currently recommended as the agent of choice for severe P falciparum infection. In addition to the rapid administration of appropriate chemotherapeutic agents and the institution of aggressive supportive care, exchange transfusion may be utilized as a means of rapidly reducing the parasitemia and consequently, the mortality.