What happens during a typical malaria attack?

A typical malaria attack lasts between 4 and 10 hours and is characterized by a cycle of three distinct stages. These periodic episodes coincide with the synchronized rupture of red blood cells by new generations of [merozoites], which release toxins into the bloodstream.12

The stages of an attack are:
* Chills: The onset begins with a phase of shaking and chills.1
* Fever: This is followed by a stage of high fever and severe [headache].1
* Sweating: The final stage involves profuse sweating, during which the body temperature drops back to normal.1

While these cycles typically recur every 48 hours (tertian malaria) or 72 hours (quartan malaria), the pattern can become irregular if a patient is infected with multiple parasite species or if different generations of the same species are released out of synchrony. In the case of P. knowlesi, which has a 24-hour life cycle, fever spikes may occur daily. Between these attacks, a patient's temperature may be normal or even subnormal.12