Criteria of severity in childhood falciparum malaria

Severe falciparum malaria is responsible for 2 million annual deaths, mostly among children under five years living in sub-Saharian Africa. In France, about 1500 paediatric malaria cases are diagnosed each year, among which 1 % are severe and 1-2 deaths occur. Children are at high risk for severe forms, since malarial immunity is not yet acquired and symptoms are rapidly progressive. The definition of severe malaria relies upon WHO criteria revised in 2000. In children living in endemic areas, the most frequent criteria are impaired consciousness, severe anaemia, respiratory distress or acidosis, multiple convulsions and hypoglycaemia. Some of them have a high prognostic value, e.g., coma, hypoglycaemia or respiratory distress. The pertinence of WHO criteria was not assessed in travelling children, since severe cases are rare. Other severity criteria found in recent surveys from endemic zones, such as thrombocytopenia or, in infants, dehydration or bacteraemia, should also be investigated in childhood imported malaria. However, any fever associated with a convulsion, prostration, or impaired consciousness, in a child returning from the tropics, should be consider severe malaria and indicate an emergency admission to hospital. In France, intravenous quinine is recommended for the treatment of severe forms, without loading dose in children. (C) 2003 Elsevier SAS. All rights reserved.