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To the Editor: In their review of the treatment of malaria in the United States, Dr Griffith and colleagues¹ provided a concise summary for clinicians who infrequently encounter malaria. While the information is important, they propose that the second question to be asked when managing malaria is "What is the parasite density?" Although there is an association between the peripheral parasite count and patient outcome, it is a relatively weak one. Other clinical and laboratory variables have stronger prognostic value, particularly acidosis and pulmonary and renal disease.² In an international trial, almost 70% of 1050 severe malaria patients had a peripheral parasite count of less than 5%, and the mortality in this population was 18%.³ Emphasis on a "low" parasite count, rather than disease manifestations, may offer the clinician false reassurance or lead to an underestimation of the contribution of the malaria infection to a patient's symptoms.

The central pathophysiological . . . [Full Text of this Article]

Josh P. Hanson, FRACP
joshua.hanson@fmc.sa.gov.au
Flinders Medical Centre
Adelaide, Australia

Arjen M. Dondorp, MD, PhD; Nick P. J. Day, MD, PhD
Faculty of Tropical Medicine
Mahidol University
Bangkok, Thailand

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