At a glance
- Diagnosing malaria within a few hours of a patient presenting at a healthcare facility can prevent cases from progressing to be life-threatening.
- Parasitemia should be estimated as soon as possible in positive cases.
- Higher levels of parasitemia (≥ 5%) require treatment with IV artesunate.
Malaria: an urgent health issue
Malaria is a mosquito-borne disease that can cause severe complications and death if left untreated. In the absence of prompt diagnosis and appropriate treatment, uncomplicated malaria can rapidly progress to severe life-threatening disease. On average, there are about seven malaria-related deaths per year in the United States.
Malaria burden in the U.S.
malaria cases per year across all 50 states (typically acquired during travel to malaria-endemic areas)
Malaria in healthcare settings
Travelers returning from areas with malaria transmission can present with symptoms to any hospital across the country. All U.S. hospitals should be able to perform urgent malaria diagnostic testing.
Diagnostic testing
Diagnostic testing for malaria should be done urgently and without delay using point-of-care or laboratory-based testing with turnaround times of a few hours. Results are necessary to initiate treatment and guide clinical management. Clinicians should be informed of the turnaround time and urgency for obtaining results when a malaria test is ordered.
Microscopic evaluation of blood specimens must be performed from all individuals with suspected malaria to confirm Plasmodium species infection, determine species, calculate parasitemia, and monitor response to treatment. Treatment can be initiated if preliminary review of a blood smear indicates intracellular parasites. In addition, a malaria antigen rapid detection test (RDT) or a nucleic acid amplification test (NAAT) should be performed concurrently if they can provide results more quickly to support prompt treatment.
Smears should be prepared immediately after specimen collection. Blood that is held too long before smear preparation results in poor morphological features that complicate Plasmodium species identification. Both thick and thin smears should be prepared.
If positive, parasitemia should be estimated as soon as possible to inform treatment decisions. Patients with a parasitemia of ≥ 5%, regardless of clinical symptoms, require treatment with IV artesunate and possibly a higher level of care.
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