Over the past 10 years, there have been several key shifts in
our understanding of what constitutes severe malaria, and
these shifts define the issues in pathogenesis that need to be
explored to develop better treatments for sick children. The
first shift is the increasing recognition that severe malaria is a
disorder that affects several tissues and organs, even when
the most marked manifestations may seem to involve a
single organ such as the brain. In particular, metabolic
acidosis, often profound, has been recognized as a principal