Patients with Ebola virus disease (EVD) who develop severe malaria face a high-acuity co-infection requiring a specific, evidence-based treatment approach distinct from uncomplicated malaria management.
Severe malaria in EVD is defined by the presence of one or more critical manifestations: coma (cerebral malaria), metabolic acidosis, severe anaemia, hypoglycaemia, acute renal failure, or acute pulmonary oedema. Each of these features marks a patient at substantially elevated risk and shapes the urgency of the treatment decision.
First-line management for this presentation centres on intravenous artesunate therapy — the complete dosing schedule, weight-based stratification, and transition criteria are specified in the full protocol.
The primary treatment target is malaria testing negative, confirming parasite clearance. The structured protocol specifies when and how to assess this outcome.
Definition of severe malaria – severe malaria usually manifests with one or more of the following: coma (cerebral malaria), metabolic acidosis, severe anaemia, hypoglycaemia, acute renal failure or acute pulmonary oedema.
Adults, including pregnant women: 2.4 mg/kg/dose IV initially, followed by 2.4 mg/kg/dose at 12 hours, 24 hours and 48 hours after the initial dose for a total of four doses over a period of 3 days.
Transition to oral therapy at least 4 hours after the last dose of artesunate.
Infants and children < 20 kg: 3 mg/kg/dose initially, followed by 3 mg/kg/dose at 12 hours, 24 hours and 48 hours after the initial dose for a total of four doses over a period of 3 days.
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