In North America, imported malaria is the principal cause of febrile illness and life threatening infection in travelers and immigrants arriving from endemic areas. Severe malaria due to Plasmodium vivax is an emerging infectious disease that requires prompt identification and appropriate management. Malaria symptoms may present in a gradual or fulminant fashion. With treatment, severe malaria has a case fatality of 10 to 20%; if left untreated or with a significant treatment delay, severe malaria is usually fatal with death due to multiorgan dysfunction including adult respiratory distress syndrome. Consultation with an infectious diseases or tropical medicine specialist is strongly recommended in the management of malaria, as timely diagnosis and treatment are essential. Parenteral artesunate or quinine is recommended for treatment of severe malaria. Speciation of plasmodium is required, as P. vivax and P. ovale require additional treatment to eliminate dormant parasites (radical cure).