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id.malaria.v1PRODUCTION
id.malaria.v1

Malaria (uncomplicated + severe)

infectious_diseaseacutesubacuteadultpediatricpregnancy
Hard-required inputs
0 / 16
Care setting:

Encounter flow

12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Confirm malaria via smear / RDT / PCR; identify species + severity (IDSA 2024)

Inputs
2
Actions
0
Advance rule
Set
Advance when

Diagnosis + species

Patient inputs (19)

Pediatric severity criteria differ; tafenoquine ≥16 yr (IDSA 2024)

Drug selection (avoid primaquine, tafenoquine, atovaquone-proguanil) (IDSA 2024)

Severity (IDSA 2024)

Tachycardia / shock (IDSA 2024)

Risk and species likelihood (IDSA 2024)

Adherence; resistance pattern (IDSA 2024)

Species + parasitemia % — gold standard (IDSA 2024)

Rapid diagnosis when smear unavailable (IDSA 2024)

Anemia + thrombocytopenia common (IDSA 2024)

Hypoglycemia common; AKI / electrolytes (IDSA 2024)

Hepatic involvement, jaundice (IDSA 2024)

DIC criterion (IDSA 2024)

Shock criterion (IDSA 2024)

Pulmonary edema severe criterion (IDSA 2024)

Cerebral malaria criterion (IDSA 2024)

Severe criterion (IDSA 2024)

Species confirmation; mixed infection (IDSA 2024)

Required before primaquine / tafenoquine (IDSA 2024)

Co-infection in endemic regions (IDSA 2024)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (9)

9 need judgement
  • informationallife_threateningsevere_falciparum_criteria
    WHO severe malaria criteria — GCS <11, seizure, lactate >5, parasitemia >5%, hypoglycemia, Hb <7, AKI, jaundice, shock, DIC, pulm edema
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningcerebral_malaria
    Coma / GCS <11 with falciparum (IDSA 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverepregnancy_with_malaria
    Malaria in pregnancy (IDSA 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverepost_artesunate_delayed_hemolysis
    Hgb drop ≥10% with rising LDH 7–28 d after artesunate (IDSA 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveremixed_or_relapse_falciparum_with_resistance
    Treatment failure or recurrence (IDSA 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverehyperparasitemia_above_5_percent
    Parasitemia ≥ 5% in non-immune patient OR ≥ 10% in semi-immune endemic patient — independent prognostic for severe malaria (WHO 2023; SEAQUAMAT)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereartemisinin_resistance_suspected
    Persistent parasitemia day 3 OR fever clearance > 72 h on artemisinin OR kelch13 mutation detected — emerging in East Africa (Uganda, Rwanda, Eritrea) + Greater Mekong (WHO 2023; Balikagala NEJM 2021; Conrad 2023)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderateg6pd_deficiency_radical_cure
    Vivax / ovale with G6PD deficiency (IDSA 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmilduncomplicated_falciparum_outpatient_eligible
    Tolerating PO, no severe criteria, reliable follow-up (IDSA 2024)
    Trigger could not be auto-evaluated — needs clinician judgement.

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RED_FLAGSoptionalDrives severity classification
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Recommended regimen

Severe malaria — IV artesunate then ACT (IDSA 2024)
axis: malaria_severe_artesunate
Selected axis "Severe malaria — IV artesunate then ACT (IDSA 2024)" by default fallback (first axis)
  • artesunate_iv
    first line
    artemisinin
    2.4 mg/kg IV at 0, 12, 24 h then daily • IV • 0/12/24 h then daily until tolerating PO
    triggers: severe_falciparum, hyperparasitemia_gt_5
    SEAQUAMAT / AQUAMAT — superior to quinine (IDSA 2024)
    rxcui 18346
  • artemether_lumefantrine
    first line
    ACT
    4 tablets BID × 3 d (≥35 kg) • PO • BID × 3 d
    triggers: transition_from_artesunate_or_uncomplicated_falciparum
    Most widely used ACT (IDSA 2024)
    rxcui 282448
  • quinine
    second line
    cinchona_alkaloid
    20 mg/kg IV load + 10 mg/kg q8h • IV • load + q8h
    triggers: artesunate_unavailable
    Backup; cinchonism, hypoglycemia (IDSA 2024)
    rxcui 9071
  • clindamycin
    add on
    lincosamide
    20 mg/kg/d divided • IV/PO • TID
    triggers: pregnancy_first_trimester_with_quinine
    Pregnancy 1st trimester regimen with quinine (IDSA 2024)
    rxcui 2582

outpatient playbook — drug actions (3)

  1. 1. artemether-lumefantrine
    4 tabs BID × 3 d • PO with fat • BID × 3 d
    trigger: Uncomplicated falciparum (IDSA 2024)
    WHO first-line
  2. 2. chloroquine + primaquine
    CQ 600 then 300 at 6/24/48 h + primaquine 30 mg × 14 d • PO • per regimen
    trigger: Vivax / ovale, G6PD normal (IDSA 2024)
    Radical cure (IDSA 2024)
  3. 3. tafenoquine 300 mg
    300 mg single dose • PO • single
    trigger: Vivax / ovale ≥16 yr, G6PD ≥70% (IDSA 2024)
    DETECTIVE single dose (IDSA 2024)

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Fever in returned traveler from endemic region (IDSA 2024); Cyclical fever, chills, diaphoresis (IDSA 2024); Jaundice, anemia, splenomegaly with fever (IDSA 2024).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Malaria (uncomplicated + severe)** (id.malaria.v1).
Phenotype framing: Falciparum vs vivax / ovale / malariae / knowlesi; rule out typhoid / dengue / lepto / sepsis / hep (IDSA 2024)
Scope: Confirm malaria via smear / RDT / PCR; identify species + severity (IDSA 2024)

No severity triggers fired against current inputs.

Plan

Regimen axis: **Severe malaria — IV artesunate then ACT (IDSA 2024)**.
1. artesunate_iv 2.4 mg/kg IV at 0, 12, 24 h then daily IV 0/12/24 h then daily until tolerating PO (artemisinin, first line) — SEAQUAMAT / AQUAMAT — superior to quinine (IDSA 2024)
2. artemether_lumefantrine 4 tablets BID × 3 d (≥35 kg) PO BID × 3 d (ACT, first line) — Most widely used ACT (IDSA 2024)
3. quinine 20 mg/kg IV load + 10 mg/kg q8h IV load + q8h (cinchona_alkaloid, second line) — Backup; cinchonism, hypoglycemia (IDSA 2024)
4. clindamycin 20 mg/kg/d divided IV/PO TID (lincosamide, add on) — Pregnancy 1st trimester regimen with quinine (IDSA 2024)

Setting playbook (outpatient) — Treat uncomplicated, ensure radical cure for vivax/ovale, education (IDSA 2024)
5. artemether-lumefantrine 4 tabs BID × 3 d PO with fat BID × 3 d — Uncomplicated falciparum (IDSA 2024) (WHO first-line)
6. chloroquine + primaquine CQ 600 then 300 at 6/24/48 h + primaquine 30 mg × 14 d PO per regimen — Vivax / ovale, G6PD normal (IDSA 2024) (Radical cure (IDSA 2024))
7. tafenoquine 300 mg 300 mg single dose PO single — Vivax / ovale ≥16 yr, G6PD ≥70% (IDSA 2024) (DETECTIVE single dose (IDSA 2024))

Non-pharmacologic actions:
- Repeat smear at d3, d7, d28 (IDSA 2024)
- Report case to public health (IDSA 2024)
- Travel + chemoprophylaxis education (IDSA 2024)

AVOID / contraindication checks:
- Artesunate post artesunate hemolysis monitor CBC weekly x4 (IDSA 2024)
- Quinine hypoglycemia monitor glucose (IDSA 2024)
- Artemisinin pregnancy 1st trimester data evolving (IDSA 2024)

Monitoring

Regimen monitoring:
- smear q12h until clearance (IDSA 2024)
- glucose q4h (IDSA 2024)
- CBC q24h then weekly x4 post artesunate (IDSA 2024)
- BMP lactate q12h until resolved (IDSA 2024)

Setting (outpatient) monitoring:
- Follow-up smears (IDSA 2024)

Follow-up plan: ID clinic, chemoprophylaxis counselling, relapse counselling vivax/ovale (IDSA 2024)
- Close-out criterion: Follow-up booked

Monitoring phase: Smear q12h until clearance, glucose q4h, CBC, BMP, lactate, post-artesunate hemolysis CBC weekly × 4 wks (IDSA 2024)

Disposition

Current setting: outpatient — Treat uncomplicated, ensure radical cure for vivax/ovale, education (IDSA 2024)

Disposition criteria:
- Discharge with follow-up (IDSA 2024)

Escalation triggers (move to higher acuity):
- Severity criteria → ED (IDSA 2024)
- Pregnancy → admit (IDSA 2024)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] WHO severe malaria criteria — GCS <11, seizure, lactate >5, parasitemia >5%, hypoglycemia, Hb <7, AKI, jaundice, shock, DIC, pulm edema
- [LIFE_THREATENING] Coma / GCS <11 with falciparum (IDSA 2024)
- [SEVERE] Malaria in pregnancy (IDSA 2024)

Citations

- WHO 2023 Guidelines for the Treatment of Malaria; CDC Yellow Book 2024 [PMID:16125588](https://pubmed.ncbi.nlm.nih.gov/16125588/)
- Cited evidence (PMID 21062666) [PMID:21062666](https://pubmed.ncbi.nlm.nih.gov/21062666/)
- Cited evidence (PMID 30650322) [PMID:30650322](https://pubmed.ncbi.nlm.nih.gov/30650322/)

Last reconciled with current guidelines: 2026-05-22.
References