-Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness. -After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic. -The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds. -The hot stage lasts 2 to 6 hours. Fever is up to 106F with falciparum and up to 104F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium. -The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved. -After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3rd day. -With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern. Ref: 1.

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