Severe malaria is invariably caused by Plasmodium falciparum. In India, both adults and children are affectedby severe malaria. However, children are more prone for developing anemia and convulsions as manifestationsof severe malaria, while acute renal failure and jaundice are more common among adults. Pregnant women arevulnerable to hypoglycemia, anemia and pulmonary complications. The case-fatality rate due to severe malariais 10-15% in spite of therapy but it increases in the presence of renal failure or respiratory distress (pulmonaryedema or ARDS). Of late, multi-organ failure and high mortality figures are being reported increasingly fromdifferent parts of India.
Early diagnosis and prompt treatment will reduce the mortality due to malaria. Cerebral malaria should alwaysbe suspected in a patient with altered sensorium in a malaria-endemic area. However, other causes ofunconsciousness such as encephalitis, meningitis or hepatic coma should also be excluded. Parenteral quinineis the mainstay of therapy. A recent multi-centric study has demonstrated the efficacy of intravenous artesunatein reducing the mortality by 30%. The usefulness of adjunct therapy is still controversial.
