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Severe falciparum malaria — DTM&H MCQ

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HardMalariaSevere falciparum malariaDTM&H

A non-immune adult with 11% Plasmodium falciparum parasitaemia, confusion and acute kidney injury improves after 24 hours of intravenous artesunate and can swallow. Which plan completes treatment and addresses a characteristic delayed toxicity?

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Correct answer: D — Complete 3-day oral ACT and monitor haemoglobin for delayed haemolysis

The best answer is “Complete 3-day oral ACT and monitor haemoglobin for delayed haemolysis”. WHO requires at least 24 hours of parenteral artesunate for severe malaria, followed by a complete three-day artemisinin-based combination once oral therapy is tolerated. High-parasitaemia non-immune patients are at particular risk of delayed post-artesunate haemolysis. Artemisinin monotherapy, premature cessation and routine exchange transfusion are not recommended substitutes.

Reference: WHO guidelines for malaria, 13 August 2025: https://iris.who.int/bitstream/handle/10665/382254/B09514-eng.pdf; WHO information note: delayed haemolytic anaemia after artesunate: https://www.afro.who.int/publications/information-note-delayed-haemolytic-anaemia-following-treatment-artesunate