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Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 78

Changing pattern of severe malaria

1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
2 Department of Nursing, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria

Date of Web Publication23-Mar-2015

Correspondence Address:
Aliyu Ibrahim
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2315-7992.153822

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How to cite this article:
Ibrahim A, Ibrahim ZF. Changing pattern of severe malaria. Ann Bioanthropol 2014;2:78

How to cite this URL:
Ibrahim A, Ibrahim ZF. Changing pattern of severe malaria. Ann Bioanthropol [serial online] 2014 [cited 2018 Sep 6];2:78. Available from: http://www.bioanthrojournal.org/text.asp?2014/2/2/78/153822


About 3.4 billion people are at risk of malaria globally, and of these, 1.2 billion are at high risk. In 2012 there were 207 million cases of malaria reported globally, with an estimated 627,000 deaths, about 90% of which occurred in sub-Saharan Africa. [1] However, in most African countries with an endemic transmission pattern, including Nigeria, cases of severe forms of malaria are rare in the adult population. This is due to protective immunity acquired at a younger age. A few cases of severe malaria have indeed been documented in the adult population, [2],[3] which were mostly cerebral malaria in the southern part of this country. [4] Severe malarial anemia is mostly seen in younger children, [5] therefore, its occurrence in an adolescent is worth reporting.

A 12-year-old girl presented with fever associated with headache and body pains for 5 days. She had no complaints of vomiting, diarrhea, or blood loss from any site; she had not attained menarche and had no family history of bleeding diathesis. The girl did not have sickle-cell anemia (genotype AA) and had not traveled out of the country. Additionally, she was not on any routine malaria chemoprophylaxis and did not use insecticide-treated mosquito nets. Further evaluation showed that she was pale, tachypneic, tachycardic, and had heart failure caused by anemia. The blood culture, urinalysis, and urine culture were not remarkable, but she tested positive for malarial parasites, with thin film showing Plasmodium falciparum. The full blood count (packed cell volume 13%) revealed a normocytic, normochromic anemia. She was also HIV-negative, and stool microscopy was unremarkable. For treatment she received blood transfusion and parenteral antimalarial therapy. She improved and was subsequently discharged.

Severe malarial anemia is commoner in children, especially in those aged less than 3 years; it is characterized by the extensive hemolysis of parasitized and unparasitized young and old red blood cells, which results in anemia. However, its occurrence in older children is a rarity in a malaria-endemic area. The predominant manifestations of severe malaria in adults in an unstable malaria transmission area are cerebral malaria, convulsion, hypoglycemia, and hypotension. However, Abdallah et al. in Sudan [6] reported about 36.2% of adults with severe malarial anemia; similarly, Akhwale et al. [7] in Kenya reported severe malarial anemia in 20% of women of childbearing age. Though nutritional anemia and parasitic infestation, such as hookworm, may be contributory, the indexed case had normocytic, normochromic anemia. Thus, malarial anemia may not be a rarity after all.

  References Top

World Health Organization. Fact-Sheet on the World Malaria Report 2013. Available from: http://www.who.int/malaria/media/world_malaria_report_2013/en/. [Last accessed on 2014 Jul 12].  Back to cited text no. 1
Makani J, Matuja W, Liyombo E, Snow RW, Marsh K, Warrell DA. Admission diagnosis of cerebral malaria in adults in an endemic area of Tanzania: Implications and clinical description. QJM 2003;96:355-62.  Back to cited text no. 2
Sowunmi A, Walker O, Salako LA. Cerebral malaria in non-paediatrics subjects resident in southwestern Nigeria. Afr J Med Med Sci 1993;22:49-53.   Back to cited text no. 3
Okubadejo NU, Danesi MA. Diagnostic issues in cerebral malaria: A study of 112 adolescents and adults in Lagos, Nigeria. Niger Postgrad Med J 2004;11:10-4.  Back to cited text no. 4
Ogoina D, Obiako RO. Clinical presentation and outcome of severe malaria in adults in Zaria, Northern Nigeria. Ann Afr Med 2012;11:245-6.   Back to cited text no. 5
[PUBMED]  Medknow Journal  
Abdallah TM, Abdeen MT, Ahmed IS, Hamdan HZ, Magzoub M, Adam I. Severe Plasmodium falciparum and Plasmodium vivax malaria among adults at Kassala Hospital, eastern Sudan. Malar J 2013;12:148.  Back to cited text no. 6
Akhwale WS, Lum JK, Kaneko A, Eto H, Obonyo C, Björkman A, et al. Anemia and malaria at different altitudes in the western highlands of Kenya. Acta Trop 2004;91:167-75.  Back to cited text no. 7


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