EVD with Severe Malaria: Coma, Metabolic Acidosis, and Severe Anaemia
When Ebola virus disease occurs alongside severe malaria, management must address the critical complications of malaria — including coma, metabolic derangement, and severe haematological compromise — while the patient remains within an EVD context.
Clinical scenario
Severe malaria in EVD is defined by the presence of one or more of the following: coma (cerebral malaria), metabolic acidosis, severe anaemia, hypoglycaemia, acute renal failure, or acute pulmonary oedema.
Treatment approach
The approach centres on an intravenous antimalarial agent administered as an initial course, with a planned transition to oral therapy once the patient has stabilised. Dosing is adjusted by patient weight. The complete sequence, weight-based regimen, and step-down criteria are set out in the full protocol.
Treatment goal
The primary clinical target is confirmed negative malaria testing.
References
- 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.
- 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.
- Transition to oral therapy at least 4 hours after the last dose of artesunate.
- Stop treatment once malaria testing is negative or the treatment course is finished.
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