Prognosis

There were an estimated 597,000 deaths from malaria globally in 2023. Children ages <5 years were the most vulnerable group. Most deaths occurred in the African region (95%). The majority of deaths were due to Plasmodium falciparum infection.[7]

Approximately 90% of travelers who acquire malaria will not become symptomatic until they return home.[167] Delays in diagnosis and treatment increase malaria-associated morbidity and mortality; malaria can progress from an asymptomatic state to death in as little as 36 to 48 hours.[167] Mortality from treated malaria in nonimmune travelers is predominantly due to P falciparum and ranges from 0.4% to 10.0%.[168] Up to 80% of patients with cerebral malaria will recover with treatment, but mortality is still 15% to 20%.[169][170] Mortality is significantly lower in "visiting friends and relatives" travelers. 

Risk of fatal outcome is highest in older adults, tourists, pregnant women, children (particularly those ages under 5 years), and patients presenting in areas where malaria is not usually seen.[171] Prognostic indicators with the strongest association with death include: renal failure, coma, hypoglycemia, shock, deep breathing, and two or more convulsions.[172]

True relapses of Plasmodium vivax or Plasmodium ovale may occur if no drug active against the hypnozoite stage is given. However, current treatment regimens recommend primaquine (in combination with chloroquine or hydroxychloroquine) in order to eradicate hypnozoite forms and prevent relapse.

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