Malaria

This review addresses recent developments that relate to the pathogenesis of severe malaria and its treatment, and also highlights the increase in the global burden of malaria and provides a summary of clinical trials of malaria vaccines. Malaria, one of the world's most important parasitic infections, is on the increase globally. This has resulted in an increase in the morbidity and mortality from malaria in endemic areas, a resurgence in areas where it was previous eradicated, and an increase in imported malaria in Europe and North America. Mortality from severe malaria continues to be high, even when effective drugs are available, because most deaths occur within hours of admission to hospital. In severe malaria, the presence of acidosis is the most important prognostic factor in children and adults. A number of therapies have resulted in clinical improvements and the correction of acidosis in phase I and II studies, but larger trials are required to examine the effect on mortality. More malaria vaccines are now in phase I or II trials; however, available data do not yet promise an imminent impact on malaria control. Recent developments include a better understanding of the pathogenesis of severe malaria, and have given rise to a number of novel therapeutic strategies that should be examined in larger phase III trials. Similarly, there has been considerable progress in the field of vaccine development.