When should I consider referring a patient with severe malaria to a specialist unit?

Refer a patient with severe malaria to a specialist unit immediately for admission and specialist assessment and treatment. Severe or complicated malaria is a medical emergency requiring urgent specialist care, often in a high dependency or intensive care unit setting to allow for parenteral therapy and close clinical monitoring.

All people with suspected falciparum malaria, which can rapidly deteriorate, should be admitted for at least 24 hours to ensure treatment tolerance and effective parasitaemia reduction, with rapid transfer to specialist care if condition worsens.

Pregnant women, children, and people over 65 years with suspected malaria should also be admitted and referred due to higher risk of complications and mortality.

Patients with mixed infections including P. falciparum or unidentified Plasmodium species should be managed as falciparum malaria and referred accordingly.

Outpatient management is only considered in uncomplicated cases with facilities for daily clinical and parasitological monitoring and experienced clinicians; otherwise, referral is indicated.

All cases of malaria must be notified to Public Health England as part of routine surveillance.

Urgent discussion with an infectious disease specialist is recommended for all suspected malaria cases outside the above groups.

Referral to specialist units is critical to manage the risk of rapid deterioration and to provide appropriate antimalarial treatment such as intravenous artesunate or quinine.