The 'non-falciparum' malarias: the roles of epidemiology, parasite biology, clinical syndromes, complications and diagnostic rigour in guiding therapeutic strategies

Abstract

Plasmodium vivax, P. ovale, P. malariae and P. falciparum routinely infect humans. The infections caused by these parasites are loosely referred to as vivax (or benign tertian), ovale, malariae (or quartan) and falciparum (or malignant tertian) malaria, respectively. Recently, P. knowlesi, a parasite of macaque monkeys in South-east Asia, has been identified as the cause of uncomplicated and severe human malaria in Malaysian Borneo. The prescription of appropriate therapies for reliably diagnosed malaria requires a grasp of the epidemiology of the 'non-falciparum' malarias, the biology of the parasites involved, the chemotherapeutic strategies that are available and the problems of emerging drug resistance and changing clinical syndromes. This review is intended to increase clinicians' understanding of how these factors relate to the selection of the antimalarial drugs to be given to a case of 'non-falciparum' malaria, with the aims of improving outcomes and preventing relapses and recrudescences.