Pathophysiology

The clinical presentation of malaria can be quite variable. Normally, the appearance of a prodrome with headache, abdominal pain, fatigue, fever, and chills, which coincides with the erythrocytic phase of malaria occurs frequently between 10 and 21 days after being exposed. 8,51 This phase causes extensive hemolysis, which results in anemia and splenomegaly. The most serious complications are caused by P. falciparum infections. Infants and children under the age of 5 years and nonimmune pregnant women are at high risk for severe complications with falciparum infections.5 -5 The complications associated with falciparum malaria are related to two unique features of P. falciparum : (a) its ability to produce high parasitism (up to 80%) of red cells of all ages; and (b) the propensity to be sequestered in po5tcapillary venules of critical organs such as brain, liver, heart, lungs, and kidneys. 3,54 It has been postulated that tissue hypoxia from anemia, together with P. falciparum-parasitized red blood cell adherence to endothelial cells in capillaries, contribute to severe ischemia and metabolic derangements. P. malariae is implicated in immune-mediated glomerulonephritis and nephrotic syndrome.

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