Clinical manifestations of severe malaria and artemisinin-based combination therapy

In the earlier blog posts, we gave an outline on preventive medications and treatment options for malaria. In this post, I will provide more details on artemisinin-based combination therapies which are recommended for the treatment of uncomplicated malaria caused by P. falciparum.

For recap purposes, P. falciparum malaria parasitic infections are potentially severe and fatal;[1] and rapid diagnosis and appropriate treatment must be administered as soon as possible to improve the prognosis.

Clinical manifestations of severe P. falciparum malaria

The clinical manifestations of severe P. falciparum malaria infections[2] are as follows:

Ps: I have provided translations for people unfamiliar with medical terminologies

  • Cerebral malaria – complications in the brain
  • Severe anemia – severe lack of healthy red blood cells
  • Respiratory distress – difficulty in breathing
  • Renal failure – kidney failure
  • Hypoglycaemia – drastic low blood sugar level
  • Circulatory collapse – shock
  • Coagulation failure – unable / decreased ability to stop bleeding

Artemisinin-based combination therapies

Artemisinin-based combination therapies (ACTs) are the recommended treatment option for uncomplicated/ non-severe form of P. falciparum malaria. ACTs refer to the combination of two malaria drugs with different mechanisms of action[3] which bolsters efficacy and they are thought to have the potential to reduce spreading and resistance development.[4]

Problems facing artemisinin-based combination therapies

  1. P. falciparum malaria resistance has developed in some countries.[5]
  2. Artemisinin-based combination therapies are expensive and inaccessible to needy patients in developing countries.[4]
  3. Artemisinin-based combination therapies are only administered after patients with severe malaria can tolerate oral therapy.[2]

Alternative novel treatment options

How about considering novel malaria treatment alternatives utilising nanotechnology and gene therapy?

Malaria parasites (green) after destroying a red blood cell effectively blocked by nanoparticles (blue). Source:

In the above figure, the blue particles which are extremely small–in nanometers–mimic the red blood cells by tricking malaria parasite particles to bind onto the nanoparticles. This effectively prevents the parasitic malaria from invading and causing death of red blood cells.

And, here I have something for you to ponder on whether we can ethically use gene therapy to treat mosquito-borne diseases such as malaria. Enjoy this highly animated and interesting video below.


[1] JM C, SL H. Malaria. In: Medical Microbiology. 4th Edition. Galveston (TX): University of Texas Medical Branch: Galveston; 1996.

[2] Pasvol G. The treatment of complicated and severe malaria. British Medical Bulletin. 2005;75-76(1):29-47.

[3] Breman JG, Alilio MS, White NJ. Defining and Defeating the Intolerable Burden of Malaria III. Progress and Perspectives. The American Journal of Tropical Medicine and Hygiene. 2007 December 1, 2007;77(6 Suppl).

[4] Mutabingwa TK. Artemisinin-based combination therapies (ACTs): best hope for malaria treatment but inaccessible to the needy! Acta Trop. 2005 Sep;95(3):305-15.

[5] Greenwood B. Treatment of Malaria — A Continuing Challenge. The New England journal of medicine. Massachusetts Medical Society; 2014 Jul 31;371(5):474–5.

[6] Video:


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