Management of severe Plasmodium falciparum malaria in adults: A review of national and regional guidelines and their adherence to World Health Organization guidelines

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Abstract

BACKGROUND: Plasmodium falciparum is the most prevalent and pathogenic malaria parasite associated with severe illness and death. In nonendemic countries like the Russian Federation, P. falciparum malaria is a relatively rare but potentially fatal disease found in travelers returning from countries with high malaria burden.

AIMS: This review aimed to analyze the recommendations for managing severe P. falciparum malaria in different World Health Organization (WHO) malaria-endemic regions and considered their adherence to WHO guidelines.

MATERIALS AND METHODS: Countries with the highest number of indigenous P. falciparum malaria cases from four WHO regions were identified, and malaria treatment guidelines were searched using databases.

RESULTS: Intravenous administration of artesunate is the mainstay of treatment for severe P. falciparum malaria. Most guidelines lack a mechanism for referring patients with severe malaria, between different levels of health facilities, and lack specific criteria for intensive care unit admission.

CONCLUSIONS: Mefloquine, artemisinin, combination products containing mefloquine, should be used with caution in cerebral malaria because of neuropsychiatric and cognitive complications. Understanding how guidelines and recommendations for the clinical management of malaria are adopted in different epidemiological settings will help contextualize the value and validity of recommendations for the treatment of severe malaria.

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About the authors

Anatoly K. Tokmalaev

RUDN University

Email: tokmalaev39@mail.ru
ORCID iD: 0000-0001-7046-0799
SPIN-code: 1650-0831

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Vladimir B. Chentsov

Infectious Diseases Clinical Hospital N 2

Email: orit.ikb2@mail.ru
ORCID iD: 0000-0002-6456-3297

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Karl Ch. Emerole

RUDN University

Author for correspondence.
Email: emerole_k@pfur.ru
ORCID iD: 0000-0001-6258-6498
SPIN-code: 7767-7487

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Galina M. Kozhevnikova

RUDN University

Email: kozhevnikova_gm@rudn.university
ORCID iD: 0000-0003-2758-9313
SPIN-code: 2620-5477

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Alla M. Baranova

I.M. Sechenov First Moscow State Medical University

Email: baralla@mail.ru
ORCID iD: 0000-0002-3767-9470
SPIN-code: 5890-3555

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Elena T. Vdovina

Infectious Diseases Clinical Hospital N 2

Email: ikb2@mail.ru
ORCID iD: 0000-0002-4099-0032
Russian Federation, Moscow

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2. Fig. 1. Geographic distribution of Plasmodium falciparum antimalarial resistant to antimalaria drugs. Resistance to the two most widely used drugs, chloroquine and sulfadoxine-pyrimethamine, is represented by blue and yellow circles, respectively. Artemisinin resistance spread to mainland Southeast Asia from Vietnam to Myanmar in 2014, shown black dotted line. Data adapted from World Health Organization.

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3. Fig. 2. Intensive Care Unit protocol for management of Severe Falciparum Malaria at the Moscow State General Hospital for Infectious Diseases N 2. Complied by: [26].

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