Malaria history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]


The hallmark symptom of malaria is fever, which commonly occurs in paroxysms, separated by fever-free time intervals. The classical but rarely observed malaria attack lasts 6-10 hours, and it consists of a cold stage, hot stage, and sweating stage. Other common symptoms of malaria include chills, headache, nausea, vomiting, weakness, night sweats, flu-like symptoms, and myalgia. In the presence of a paroxysmal fever, travel history to a country where malaria is endemic is an important alert for the diagnosis.[1] Most importantly, malaria symptoms must be distinguished as to whether they reflect an uncomplicated or a severe course of infection. While uncomplicated infection is a benign process, severe malaria causes organ damage and is considered a medical emergency.


In the presence of a paroxysmal fever, travel history to a country where malaria is endemic is an important alert for the diagnosis.[1] Following the infective bite by the Anopheles mosquito, a period of time ranging from 7 to 30 days goes by before the first symptoms appear.

Fever in malaria is classically described as occurring in paroxysms of a few hours. These may be described as:

  • Cold stage: where the patient experiences rigors and chills
  • Hot stage: characterized by fever, headaches, and children may experience seizures
  • Sweating stage: characterized by sweats, return to normal temperature with a feeling of fatigue

The time-interval between fever paroxysms changes according to the type of plasmodium causing the disease:

  • "Tertian" fever: paroxysms occur every second day, caused by "tertian" parasites:
  • "Quartan" fever: paroxysms occur every third day, caused by the "quartan" parasite:


Common Symptoms

Less Common Symptoms

Distinguishing Uncomplicated vs. Severe Symptoms

Malaria may either present as an uncomplicated infection or as a severe infection. While the former follows a benign course, the latter is characterized by target organ damage. More importantly, recognition of the severity of malarial symptoms is important because severity directly alters the management plan and the treatment options for patients with malaria.

The following table compares symptoms of uncomplicated malaria and severe malaria.

Comparison of Malaria Infections According to Severity [2]
Severity Clinical Significance

Attack lasts 6-10 hours consisting of 3 stages

  • Cold stage: Shivering
  • Hot stage: Fever, vomiting, and seizure
  • Sweating stage: Sweating and fatigue

Non-specific symptoms

  • Chills
  • Sweating
  • Headache
  • Nausea and vomiting
  • Body aches
  • General malaise

Physical findings

  • Fever
  • Tachypnea
  • Perspiration
  • Weakness
  • Hepatosplenomegaly
  • Jaundice

Malaria complicated by organ damage. It is considered a medical emergency that requires prompt hospitalization.

  • Cerebral malaria: Altered mental status, seizures, coma, neurologic deficit
  • Hemolytic anemia: Hemoglobinuria, jaundice, splenomegaly
  • Coagulopathy
  • Acute respiratory distress syndrome (ARDS): Dyspnea, cough, hypoxia
  • Cardiovascular collapse
  • Acute kidney injury
  • Metabolic acidosis
  • Hypoglycemia


  1. 1.0 1.1 Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  2. ("Malaria". Center for Disease Control and Prevention. Center for Disease Control and Prevention (CDC). Nov. Feb 8 2010. Retrieved Jul 24 2014. Check date values in: |accessdate=, |date= (help))

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