First symptoms in adults:

• Feel weak, lethargic, uncomfortable, dizzy
• Chills, sweats, fever
• Muscular / abdominal pain
• Vomiting, watery diarrhoea

First symptoms in children:

• Cough
• Rapid shallow breathing
• Feverish convulsions

Uncomplicated P. falciparum malaria:

• Fever, vomiting, diarrhoea, anaemia
• In non-immune people this rapidly becomes severe, life-threatening malaria if it remains untreated.

Severe malaria (always P. falciparum)
In children:

• Cerebral: unrousable coma, convulsions, muscle spasm causing backward arching of body.
• Respiratory distress: deep breathing, flaring nostrils.
• Low blood glucose: restless/aggressive, coma, drowsy, convulsions, sweating.

In adults:

• Cerebral: unrousable coma, convulsions, muscle spasm causing backward arching of body, facial grimace.
• Kidney failure: low urine output (less than 400ml per day)
• Fluid on the lungs: laboured or rapid, shallow breathing, frothy sputum, lack of oxygen in tissues.

Other complications:

• Anaemia,
• low blood sugar,
• failure of circulation (shock),
• repeated general convulsions,
• spontaneous bleeding,
• red urine,
• jaundice
• fever with temperature over 40 degrees C.

Vivax, ovale & malariae malaria

• Similar to uncomplicated falciparum.
• Vivax: can have long latent periods and relapse after treatment.
• Ovale: more gradual onset than vivax, can relapse, but less common. Death rare.
• Malariae: more gradual onset, less severe symptoms, can recur after many years. Death rare.
• Malaria can be confused with flu, blood poisoning, typhoid, dengue, viral haemorrhagic fevers, meningitis.

Pregnancy: (See Malaria in Pregnancy Brochure )

Maternal issues:

• increased risk of severe malaria,
• increased risk of death (especially in first pregnancy) sepsis or bleeding after delivery.
• More common and more often fatal than in non-pregnant women.

Foetal complications:

• abortion,
• still birth,
• foetal anaemia,
• low birth weight,
• retarded growth of the foetus,
• premature delivery,
• baby born with malaria.