- In severe malaria, the lungs are most commonly involved, resulting in acute respiratory distress syndrome (ARDS).
- This occurs due to increased pulmonary vascular permeability and sequestration of parasitized red cells in the pulmonary microvasculature, leading to pulmonary edema and hypoxia.
- Lung involvement significantly contributes to mortality in severe malaria, making respiratory complications a critical focus in management.
- Although multiple organs can be affected, the development of respiratory failure is a hallmark of severe disease.

Reference: Davidson’s Principles and Practice of Medicine, 23rd Edition, Chapter: Malaria, Page 593.