Malaria physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Malaria is commonly associated with the findings of fever, tachycardia, tachypnea, pallor, and splenomegaly on physical examination. Other pertinent findings include jaundice, petechiae, alar flare, abdominal distention, hepatomegaly, cyanosis and edema.

Physical Examination

Appearance of the Patient

Depending on the stage of the disease the patient may appear ill, nauseated, shivering; or febrile, complaining of headache and sweating. After these periods patients usually feel extremely fatigued and sleepy. In more severe cases of the disease, the patient may appear anemic, with jaundice or even in coma.

Vitals

Temperature

• A fever is often present, according to the patterns described above

Pulse

Rate

• Tachycardia may be present

Blood Pressure

• Hypotension may be present (in severe cases of the disease)

Respiratory Rate

• Tachypnea may be present

Skin

• Cyanosis may be present (in severe cases of the disease, where there may be respiratory distress)
• Jaundice may be present (in severe anemia)
• Pallor may be present
• Petechiae may be present (in severe cases of the disease, when there is thrombocytopenia)

Eyes

• Icteric sclera may be present (in severe anemia with jaundice)
• Conjunctivae may be pale

Nose

• Alar flare (in severe cases of the disease, where there may be respiratory distress)

Throat

• The throat may be erythematous

Lungs

• Pulmonary edema may be present
• Consolidation may be present with reduced breath sounds auscultated
• Intercostal retraction may be present (in severe cases of the disease, where there may be respiratory distress)

Abdomen

• Abdominal distention may be present
• An abdominal mass may be present
• Hepatomegaly may be present
• Splenomegaly may be present

Genitourinary

• Hematuria may be present (in severe hemolysis)

Extremities

• Cyanosis may be present (in severe anemia)
• Edema may be present (in severe disease, where there may be renal failure)

Neurologic

• Coma may be present (in cerebral malaria)
• Mental status may be altered
• Convulsions may be present