Infection with P. falciparum, if not promptly treated, may cause:
- Kidney failure
- Seizures
- Mental confusion
- Coma
- Death.1
Infection with P. falciparum is the most severe form of malaria due to its ability to produce a microvascular disease. The main organs involved include the brain, kidneys, liver, spleen, lung, and gastrointestinal tract, although any organ can be affected. The most important, and potentially life-threatening, complication is cerebral malaria. Cerebral malaria can be fatal. It most commonly occurs in infants, pregnant women, and travelers to high-risk areas. Symptoms of cerebral malaria include:
- High fever
- Severe headache
- Drowsiness
- Delirium and confusion.2
Erythrocytes infected with P. falciparum adhere to the endothelial lining of small blood vessels, causing blockage and a decrease in tissue perfusion, with resulting metabolic acidosis.3
The lysis of erythrocytes and the release of merozoites cause an immune response with the production of cytokines (TNF-α), giving rise to the characteristic fever of malaria.3
The symptom of anemia is caused by the lysis of red blood cells as well as by the suppressive effect that TNF-α has on erythropoiesis.3
Hypoglycemia is often seen in patients with P. falciparum due to the depletion of liver glycogen from decreased intake, glucose consumption by the parasites, and increased levels of TNF-α.3
Renal failure secondary to tubular necrosis can result from increased circulating free hemoglobin (hemoglobinuria), as well as from hypovolemia and microvascular disease.3
The spleen, which is responsible for filtering out the deformed erythrocytes, is enlarged, congested, and at times may rupture.3
Parasitized red blood cells sequestered in the pulmonary vasculature can cause cough, respiratory distress, and pulmonary edema.3
1 Centers for Disease Control and Prevention. Malaria: Topic home [Web site]. Available at: http://www.cdc.gov/Malaria/. Accessed June 6, 2006.
2 Health24. Symptoms of malaria [Web site]. Available at: http://www.health24.com/medical/Condition_centres/777-792-818-1801,29674.asp. Accessed June 15, 2006.
3 Hickman MS. Chapter VI.30: Malaria. Case Based Pediatrics for Medical Students and Residents. May 2003. Available at: http://www.hawaii.edu/medicine/pediatrics/pedtext/s06c30.html. Accessed June 15, 2006.