A 28-year-old woman from Assam presents with fever for 5 days, altered sensorium, and jaundice. Her rapid diagnostic test (RDT) is positive for P. falciparum. Peripheral smear shows >5% parasitised RBCs. Which criterion ALONE qualifies this as severe malaria?
- A Parasitaemia >5% of RBCs (hyperparasitaemia) ✓
- B Fever duration of 5 days
- C Positive RDT for P. falciparum
- D Female sex aged 15–45 years
Correct answer: A. Parasitaemia >5% of RBCs (hyperparasitaemia)
Explanation
WHO criteria for severe P. falciparum malaria include hyperparasitaemia defined as parasitised RBC count >5% on a standard blood smear (or >500,000 parasites/µL). This alone classifies the case as severe malaria requiring parenteral artesunate. Altered sensorium (cerebral malaria) and jaundice are additional severity criteria, but hyperparasitaemia independently qualifies as severe disease. Fever duration and sex are not severity criteria.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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