The clinical features and laboratory findings in acute Plasmodium falciparum malaria in Harare, Zimbabwe

The immune status of patients in Harare modifies their response to acute P.falciparum infection. Malnourished children were the group at greatest risk and fits were a feature of malaria in this age group. Fever and headache were the commonest symptoms overall, but 12,5% of patients were never pyrexial. Splenomegaly was common in young children but uncommon in adults. A leukocytosis, thrombocytopenia and normochromic normocytic anemia were common features of acute P. falciparum malaria as were hyponatremia and hypokalemia. The leukocytosis and hypokalemia are not well documented features of acute malaria and genetic differences may account for varying responses. The diagnosis was proven in only 26% of cases thought clinically to have malaria. In several cases malaria was not considered in the differential diagnosis. More than 1/2 the patients with positive blood slides received antibiotics as well as chloroquine. Bacteria were isolated from blood cultures in 8 patients. Septicemia may be an uncommonly recognized complication of acute P. falciparum malaria.