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Since December 2008 Sabah Department of Health has recommended intravenous artesunate and referral to a general hospital for all severe malaria cases of any species. This paper reviews all malaria deaths in Sabah subsequent to the introduction of these measures. Reporting of malaria deaths in Malaysia is mandatory.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Details of reported malaria deaths during 2010-2011 were reviewed to determine the proportion of each <jats:italic>Plasmodium<\/jats:italic> species. Demographics, clinical presentations and management of severe malaria caused by each species were compared.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Fourteen malaria deaths were reported, comprising seven <jats:italic>Plasmodium falciparum<\/jats:italic>, six <jats:italic>P. knowlesi<\/jats:italic> and one <jats:italic>Plasmodium vivax<\/jats:italic> (all PCR-confirmed). Of the six <jats:italic>P. knowlesi<\/jats:italic> deaths, five were attributable to knowlesi malaria and one was attributable to <jats:italic>P. knowlesi<\/jats:italic>-associated enterobacter sepsis. Patients with directly attributable <jats:italic>P. knowlesi<\/jats:italic> deaths (N\u2009=\u20095) were older than those with <jats:italic>P. falciparum<\/jats:italic> (median age 51 [IQR 50-65] <jats:italic>vs<\/jats:italic> 22 [IQR 9-55] years, p\u2009=\u20090.06). Complications in fatal <jats:italic>P. knowlesi<\/jats:italic> included respiratory distress (N\u2009=\u20095, 100%), hypotension (N\u2009=\u20094, 80%), and renal failure (N\u2009=\u20094, 80%). All patients with <jats:italic>P. knowlesi<\/jats:italic> were reported as <jats:italic>P. malariae<\/jats:italic> by microscopy<jats:italic>.<\/jats:italic> Only two of five patients with severe knowlesi malaria on presentation received immediate parenteral anti-malarial treatment. The patient with <jats:italic>P. vivax<\/jats:italic>-associated severe illness did not receive parenteral treatment. In contrast six of seven patients with severe falciparum malaria received immediate parenteral treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>\n              <jats:italic>Plasmodium knowlesi<\/jats:italic> was responsible, either directly or through gram-negative bacteraemia, for almost half of malaria deaths in Sabah. Patients with severe non-falciparum malaria were less likely to receive immediate parenteral therapy. This highlights the need in Sabah for microscopically diagnosed <jats:italic>P. malariae<\/jats:italic> to be reported as <jats:italic>P. knowlesi<\/jats:italic> to improve recognition and management of this potentially fatal species. Clinicians need to be better informed of the potential for severe and fatal malaria from non-falciparum species, and the need to treat all severe malaria with immediate intravenous artesunate.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1475-2875-11-284","type":"journal-article","created":{"date-parts":[[2012,8,20]],"date-time":"2012-08-20T10:16:12Z","timestamp":1345457772000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":82,"title":["Deaths due to Plasmodium knowlesi malaria in Sabah, Malaysia: association with reporting as Plasmodium malariae and delayed parenteral artesunate"],"prefix":"10.1186","volume":"11","author":[{"given":"Giri S","family":"Rajahram","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget E","family":"Barber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"William","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayaram","family":"Menon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas M","family":"Anstey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsin W","family":"Yeo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2012,8,20]]},"reference":[{"key":"2225_CR1","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1086\/524888","volume":"46","author":"J Cox-Singh","year":"2008","unstructured":"Cox-Singh J, Davis TM, Lee KS, Shamsul SS, Matusop A, Ratnam S, Rahman HA, Conway DJ, Singh B: Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening. 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