2010 54b Malaria Treatment Flashcards
What is the pathogenic pathway of malaria?
- Bite from sporozoite-bearing mosquito
- Development in the liver
- Invasion of erythrocytes
- Consumes Hb & alters cell membrane
- Cytoadherence & rosetting
- Circulation impaired in vital organs
What are the clinical manifestations of severe malaria?
- Prostration
- Impaired consciousness
- Respiratory distress
- Pulmonary oedema
- Multiple convulsions
- Circulatory collapse, shock
- Abnormal bleeding, DIC
- Jaundice
- Haemoglobinuria
What are the lab findings in severe malaria?
- Severe anaemia, Hb < 80
- Thrombocytopenia
- Hypoglycaemia < 2.2
- Acidosis < pH 7.3
- Renal impairment, < 0.4 ml/kg/h urine or Cr > 265
- Raised lactate
- > 2% parasitised RBCs
- Algid malaria: septicaemia
- LP to exclude meningitis
When can a diagnosis of malaria be ruled out?
3 negative malarial smears 12-24 hours apart
What are the fatality rates in P. Falciparum malaria: a) uncomplicated, b) severe, c) severe & pregnant
a) 0.1%
b) 15-20%
c) 50%
What are the principles of treatment for malaria in pregnancy?
- Treat as emergency
- Admit all to hospital
- Severe or complicated to ICU with IV artesunate
- Uncomplicated falciparum: quinine & clindamycin
- Uncomplicated vivax, ovale & malariae: chloroquine
- Antipyretics
What is the dosing of IV artesunate?
2.4mg/kg at 0, 12 & 24 hours then daily
PO stepdown same dose daily, add clindamycin
What is the dose regime for uncomplicated P. Falciparum?
PO quinine 600mg 8-hourly +
PO clindamycin 450mg 8-hourly
For 7 days
What is the dose regime for uncomplicated P. Vivax, Ovale & Malariae?
PO chloroquine 600mg then
300mg 6-8 hours later then
300mg day 2 & 3
What is an alternative to IV artesunate for severe malaria?
IV quinine
20mg/kg loading dose
In 5% dextrose over 4 hours
Then 10mg/kg over 4 hours TDS
Plus clindamycin IV 450mg TDS
When are blood films repeated in malaria?
Every 24 hours
With clinical deterioration
What are the adverse effects of quinine?
Cinchonism:
1. Tinnitus
2. Headache
3. Nausea
4. Diarrhoea
5. Altered auditory acuity
6. Blurred vision
What proportion of women with P. Falciparum develop anaemia?
90%
When does recurrence of malaria most commonly occur?
Days 28-42
How are pregnancy-related complications of malaria managed?
- Profound hypoglycaemia: monitor & treat
- Pulmonary oedema & ARDS: assess JVP or CVP, aim RAP < 10cm H2O
- Anaemia: transfuse packed red cells slowly, with IV furosemide
