Diagnosis of malaria

Question 1

Clinical features of malaria

Answer 1

• Prostration
• Impaired consciousness
• Respiratory distress (acidotic breathing, acute respiratory distress syndrome)*
• Pulmonary oedema (including radiological)*
• Multiple convulsions
• Circulatory collapse, shock (blood pressure

Question 2

Lab values in malaria

Answer 2

• Severe anaemia (Haemoglobin 265 μmol/l)
• Hyperlactataemia (correlates with mortality)
• Hyperparasitaemia (> 2% parasitised red blood cells)
• ‘Algid malaria’ - Gram-negative septicaemia*
• Lumbar puncture to exclude meningitis

Question 3

Symptoms of malaria

Answer 3

• Fever/chills/sweats
• Headache
• Muscle pain
• Nausea
• Vomiting
• Diarrhea
• Cough
• General malaise

Question 4

Signs of malaria

Answer 4

• Jaundice
• Elevated temperature
• Perspiration
• Pallor
• Splenomegaly
• Respiratory distress

Question 5

Main red flag for thinking of malaria

Answer 5

• Travel in endemic areas

- For non falciparum malaria, travel could be > 1 year before symptoms present

Question 6

Blood film for malaria

Answer 6

• Essential for diagnosis
• Cannot be substituted by rapid test, although rapid test can help with diagnosis
• Three negative malaria smears 12–24 hours apart rules out the diagnosis of malaria
• It can be neg if women are taking prophylaxis or have some immunity

Question 7

Prognostic factors for malaria

Answer 7

• The presence and count of mature trophozoites and schizonts of P. falciparum
• Finding malaria pigment in more than 5% of the polymorphonuclear leucocytes in the peripheral blood
  film

Question 8

Fatality rate in malaria

Answer 8

• Uncomplicated malaria, fatality rates are low: approximately 0.1% for P. falciparum
• In severe malaria, particularly in pregnancy, fatality rates are high (15–20%) in nonpregnant women compared with 50% in pregnancy