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Harrison's Principles of Internal Medicine, 17e
| Part Seven: Infectious Diseases > Section 18: Protozoal Infections > |
Clinical Features
Sections: Severe Falciparum
Malaria, Cerebral Malaria, Hypoglycemia, Acidosis, Noncardiogenic
Pulmonary Edema, Renal Impairment, Hematologic
Abnormalities, Liver Dysfunction, Other Complications, Malaria in Pregnancy, Malaria in Children, Transfusion
Malaria.
Topics Discussed: acidosis; anemias; hypoglycemia; jaundice; kidney failure; malaria; malaria, cerebral; malaria, falciparum; respiratory distress syndrome, acute.
Excerpt:
"Malaria is a very common cause of fever in
tropical countries. The first symptoms of malaria are nonspecific;
the lack of a sense of well-being, headache, fatigue, abdominal discomfort,
and muscle aches followed by fever are all similar to the symptoms
of a minor viral illness. In some instances, a prominence of headache,
chest pain, abdominal pain, arthralgia, myalgia, or diarrhea may
suggest another diagnosis. Although headache may be severe in malaria, there
is no neck stiffness or photophobia resembling that in meningitis.
While myalgia may be prominent, it is not usually as severe as in
dengue fever, and the muscles are not tender as in leptospirosis
or typhus. Nausea, vomiting, and orthostatic hypotension are common.
The classic malarial paroxysms, in which fever spikes, chills, and
rigors occur at regular intervals, are relatively unusual and suggest
infection with P. vivax or P. ovale. The fever is irregular at
first (that of falciparum malaria may never become regular); the
temperature of nonimmune individuals and children often rises above
40°C in conjunction with tachycardia
and sometimes delirium. Although childhood febrile convulsions may
occur with any of the malarias, generalized seizures are..."
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