5. Malaria

Question 1

What is malaria and its symptoms

Answer 1

Malaria is a serious tropical disease spread via mosquito bites, which carry the plasmodium. Can be contracted in Africa or Asia

Symptoms:
* Chills
* Headache
* Muscle aches
* Diarrhoea and Vomiting
* Temperature ≥ 38 degrees

Question 2

Groups that should avoid entering malaria ridden zones

Answer 2

Asplenic patients and pregnant women

Question 3

How can mosquito bites be prevented

Answer 3

• Insect repellant DEET 20-50%. Apply DEET after applying sunscreen
• Long sleeve and trousers following dusk
• Mosquito nets

Question 4

Malarial chemoprophylaxis

Answer 4

Drugs that prevent malaria but that are not 100% effective.

• Chloroquine - causes psychiatric reactions. Patients must report new or worsening mental health symptoms
• Chloroquine + Proguanil
• Doxycycline (12+) - 100mg OD 1-2 days before entering endemic area. Continue 4 weeks after leaving
• Malarone
• Mefloquine - causes dizziness and disturbed sence of balance, can cause mental health symptoms. Patients must report new or worsening mental health symptoms.

Question 5

Chloroquine and Mefloquine contraindications

Answer 5

Lower seizure threshold so should be avoided in epilepsy

Question 6

Proguanil contraindications

Answer 6

Should be avoided in patients with renal impairement, if eGFR is <30

Question 7

Chloroquine and Proguanil safety in pregnancy

Answer 7

Both drugs are safe in pregnancy but 5mg of folic acid should be taken alongside proguanil.

Question 8

Patients on warfarin entering into malaria ridden zones

Answer 8

Patients must start their regimen 2-3 weeks before travel as their INR must be stable before they leave.

Their INR must be measured
1. Before their regimen,
2. 7 days after starting their regimen
3. Once their regimen is complete

Question 9

Chemoprophylaxis regimens

Answer 9

Drugs that are taken 1-2 days before travel: Malarone, Doxycicline

Drugs that are taken 1 week before travel: Proguanil, Chloroquine AND Chloroquine & Proguanil

Drugs that are taken 2-3 weeks before travel: Mefloquine

Drugs that are taken 1 week after travel: Malarone

Drugs that are taken 4 weeks after travel: Mefloquine, Doxycycline Proguanil, Chloroquine AND Chloroquine & Proguanil

If there are multiple regimens, choose the high risk regimen

Question 10

Chemoprophylaxis doses

Answer 10

DRUGS THAT ARE ONCE DAILY DOSES:
Malarone, Doxycycline, Proguanil, Chloroquine

DRUGS THAT ARE ONCE WEEKLY DOSES:
Mefloquine

Question 11

Malaria treatment

Answer 11

Patients should be offered standby treatment such as quinine. This is to be used if access to medical care is >24 hours away.

Patients should be offered written instructions if fever is >38 degrees and lasts for over 7 days, urgen medical care should be sought

Question 12

Advice for patients returning

Answer 12

Any illness within 1 year of return, may still be malaria even if recommended precautions were taken. Patient must urgently see the doctor.