id.malaria.v1

Malaria (uncomplicated + severe)

infectious_diseaseacutesubacuteadultpediatricpregnancyoutpatientacuteinpatienttransition

Start encounter →Print handoutPRODUCTION

Malaria dossier — severe falciparum → IV artesunate (SEAQUAMAT/AQUAMAT); uncomplicated → ACT. Vivax / ovale require radical cure with primaquine 30 mg × 14 d (G6PD-positive) or tafenoquine 300 mg single dose (DETECTIVE). Pregnancy avoids primaquine, tafenoquine, atovaquone-proguanil — use clindamycin + quinine 1st trimester or ACT in 2nd/3rd. Post-artesunate delayed hemolysis 7–28 d — CBC weekly × 4 wks. Open: manifest, problem-package, RxCUI verification, severe-malaria + G6PD calculators absent, tests. Deepened 2026-05-15 (shard-5-obped-id depth-pass-1, solo wave-7): added _briefs/id.malaria.v1.depth.md companion (preserved 2026-04-27 brief) + _research-bundles/id.malaria.v1.md. Added 2 severity triggers: hyperparasitemia_above_5_percent (severe — WHO independent severity criterion), artemisinin_resistance_suspected (severe — emerging East Africa + Greater Mekong; switch ACT partner or to quinine+doxycycline). Bumped last_reconciled to 2026-05-15. Phenotype matrix (species × severity × host × complications × resistance × treatment-status) and Bayesian linkage (microscopy + RDT-HRP2 + pLDH + PCR LRs; HRP2-deletion in East Africa caveat; T_treat / T_test thresholds; cross-dossier routing) documented in the depth brief + research bundle. First-class TS fields remain schema-blocked.

Entry points (4)

symptom
Fever in returned traveler from endemic region (IDSA 2024)
fever_returned_traveler
symptom
Cyclical fever, chills, diaphoresis (IDSA 2024)
cyclical_fever_chills_diaphoresis
symptom
Jaundice, anemia, splenomegaly with fever (IDSA 2024)
jaundice_anemia_splenomegaly
history
Resident of malaria-endemic region with fever (IDSA 2024)
endemic_region_residence

Required inputs (19)

agerequired
demographic • used at CONTEXT
Pediatric severity criteria differ; tafenoquine ≥16 yr (IDSA 2024)
pregnancy_statusrequired
demographic • used at CONTEXT
Drug selection (avoid primaquine, tafenoquine, atovaquone-proguanil) (IDSA 2024)
temperaturerequired
vital • used at CONTEXT
Severity (IDSA 2024)
hrrequired
vital • used at CONTEXT
Tachycardia / shock (IDSA 2024)
sbprequired
vital • used at RED_FLAGS
Shock criterion (IDSA 2024)
spo2required
vital • used at RED_FLAGS
Pulmonary edema severe criterion (IDSA 2024)
gcsrequired
vital • used at RED_FLAGS
Cerebral malaria criterion (IDSA 2024)
thick_thin_smearrequired
lab • used at INITIAL_WORKUP
Species + parasitemia % — gold standard (IDSA 2024)
rdt_hrp2_pldhrequired
lab • used at INITIAL_WORKUP
Rapid diagnosis when smear unavailable (IDSA 2024)
pcr_species
lab • used at BRANCHING_WORKUP
Species confirmation; mixed infection (IDSA 2024)
cbc_with_hgbrequired
lab • used at INITIAL_WORKUP
Anemia + thrombocytopenia common (IDSA 2024)
cmp_glucoserequired
lab • used at INITIAL_WORKUP
Hypoglycemia common; AKI / electrolytes (IDSA 2024)
lftrequired
lab • used at INITIAL_WORKUP
Hepatic involvement, jaundice (IDSA 2024)
lactaterequired
lab • used at RED_FLAGS
Severe criterion (IDSA 2024)
coagsrequired
lab • used at INITIAL_WORKUP
DIC criterion (IDSA 2024)
g6pd
lab • used at BRANCHING_WORKUP
Required before primaquine / tafenoquine (IDSA 2024)
hiv_test
lab • used at INITIAL_WORKUP
Co-infection in endemic regions (IDSA 2024)
travel_or_endemic_residencerequired
history • used at CONTEXT
Risk and species likelihood (IDSA 2024)
chemoprophylaxis_historyrequired
medication • used at CONTEXT
Adherence; resistance pattern (IDSA 2024)

12-phase flow (12)

1FRAME
Confirm malaria via smear / RDT / PCR; identify species + severity (IDSA 2024)
inputs: thick_thin_smear, rdt_hrp2_pldh
advance: Diagnosis + species
2ENTRY
Fever + travel / endemic; cyclical pattern (IDSA 2024)
inputs: age
advance: Engine entered
3CONTEXT
Travel pattern, prophylaxis, pregnancy, immunocompromise (IDSA 2024)
inputs: travel_or_endemic_residence, chemoprophylaxis_history, pregnancy_status
advance: Context complete
4RED_FLAGS
Severe malaria — GCS <11, seizure, acidosis pH <7.25, pulm edema, shock, DIC, hyperparasitemia >5%, hypoglycemia, Hb <7, AKI, jaundice (IDSA 2024)
inputs: gcs, sbp, spo2, lactate
advance: Severity assigned
5INITIAL_WORKUP
Thick + thin smear (parasitemia %), RDT, PCR, CBC, CMP, glucose, LFT, lactate, coags, G6PD, pregnancy test, HIV (IDSA 2024)
inputs: thick_thin_smear, rdt_hrp2_pldh, cbc_with_hgb, cmp_glucose, lft, lactate, coags
actions: panel.cbc, panel.lft, panel.coag, panel.glucose_a1c
advance: Stage-1 returned
6BRANCHING_WORKUP
PCR for species, repeat smear q12h, LP if cerebral, CXR if pulm edema, splenic ultrasound if rupture suspected (IDSA 2024)
inputs: pcr_species, g6pd
actions: fuo
advance: Branch resolved
7DIFFERENTIAL
Falciparum vs vivax / ovale / malariae / knowlesi; rule out typhoid / dengue / lepto / sepsis / hep (IDSA 2024)
advance: Diagnosis confirmed
8RISK_STRATIFICATION
Severe vs uncomplicated; pediatric severity; pregnancy (IDSA 2024)
inputs: gcs, sbp
advance: Tier documented
9TREATMENT
Severe → IV artesunate 2.4 mg/kg 0/12/24 h then daily; transition to oral ACT. Uncomplicated → artemether-lumefantrine OR atovaquone-proguanil OR DHA-piperaquine. Vivax / ovale → chloroquine + primaquine 30 mg × 14 d (G6PD positive) OR tafenoquine. Pregnancy avoids primaquine / tafenoquine / atovaquone-proguanil — use clindamycin + quinine in 1st trimester or ACT in 2nd/3rd. (IDSA 2024)
inputs: lactate, gcs, pregnancy_status
advance: Plan documented
10DISPOSITION
ICU for severe; admit for moderate or pregnant; outpatient if uncomplicated reliable (IDSA 2024)
advance: Disposition documented
11MONITORING
Smear q12h until clearance, glucose q4h, CBC, BMP, lactate, post-artesunate hemolysis CBC weekly × 4 wks (IDSA 2024)
inputs: cbc_with_hgb
advance: Schedule documented
12FOLLOWUP
ID clinic, chemoprophylaxis counselling, relapse counselling vivax/ovale (IDSA 2024)
advance: Follow-up booked