What are the possible complications of malaria caused by Plasmodium falciparum (P falciparum)?

Updated: Jun 03, 2020
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Most complications are caused by P falciparum. One of them is cerebral malaria, defined as coma, altered mental status, or multiple seizures with P falciparum in the blood. Cerebral malaria is the most common cause of death in patients with malaria. If untreated, this complication is lethal. Even with treatment, 15% of children and 20% of adults who develop cerebral malaria die. The symptoms of cerebral malaria are similar to those of toxic encephalopathy. Other complications of P falciparum infection include the following:

  • Seizures - Secondary to either hypoglycemia or cerebral malaria

  • Renal failure - As many as 30% of nonimmune adults infected with P falciparum suffer acute renal failure

  • Hypoglycemia

  • Hemoglobinuria (blackwater fever) - Blackwater fever is the passage of dark urine, described as Madeira wine colored; hemolysis, hemoglobinemia, and the subsequent hemoglobinuria and hemozoinuria cause this condition

  • Noncardiogenic pulmonary edema - This affliction is most common in pregnant women and results in death in 80% of patients

  • Profound hypoglycemia - Hypoglycemia often occurs in young children and pregnant women; it often is difficult to diagnose because adrenergic signs are not always present and because stupor already may have occurred in the patient

  • Lactic acidosis - This occurs when the microvasculature becomes clogged with P falciparum; if the venous lactate level reaches 45 mg/dL, a poor prognosis is very likely

  • Hemolysis resulting in severe anemia and jaundice

  • Bleeding (coagulopathy)

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