malaria

Question 1

what are the symptoms of malaria

Answer 1

• A high temperature of ≥38C
• Feeling hot and shivery
• Headaches
• Vomiting
• Muscle pain
• Diarrhoea

Question 2

how long does it take for symptoms of malaria to appear

Answer 2

depends on the person. can be between 7 to 18 days after an infected mosquito bite or 1 year+ after infected bite

Question 3

what should happen if a person falls ill within 3 months to 1 year of returning from a malarial region

Answer 3

urgent doctors appointment to exclude malaria

Question 4

what can patients do protect themselves from mosquito bites

Answer 4

• Apply DEET insect repellent 20-50% to the skin, with a higher concentration providing longer protection
• Mosquito nets impregnated with permethrin to provide
  barrier protection
• Wear long sleeve tops and trousers after dusk
• Avoid still water - where mosquitoes lay eggs

Question 5

which patients can use DEET insect repellent

Answer 5

adults and children over 2 months of age

Question 6

if a patient wants to wear sunscreen + DEET insect repellent, how should this be applied to the skin

Answer 6

sunscreen applied first, then DEET insect repellent applied afterwards.

• This is because DEET reduces the SPF of sunscreen, so a sunscreen of SPF 30–50 should be applied

Question 7

which 2 antimalarials should be started one week before travel

Answer 7

chloroquine and proguanil

Question 8

name the only antimalarial that needs to be started 2-3 weeks before travel

Answer 8

mefloquine

Question 9

name the antimalarials that can be started 1-2 days before travel

Answer 9

• atovaquone with proguanil
  or
• doxycycline

Question 10

how long should antimalarials be continued for after leaving the area

Answer 10

Prophylaxis should be continued for 4 weeks after leaving the area (except for atovaquone with proguanil hydrochloride prophylaxis which should be stopped 1 week after leaving

Question 11

which antimalarials can be used if a patient has a history of epilepsy

Answer 11

• Atovaquone with proguanil
  or
• doxycycline (may interact with antiepileptics so dose may need to be adjusted)

note chloroquine and mefloquine are unsuitable in epilepsy

Question 12

When should travellers taking warfarin begin chemoprophylaxis (antimalarial treatment)

Answer 12

2–3 weeks before departure and the INR should be stable before departure.

Question 13

how does renal impairment affect chemoprophylaxis (antimalarial treatment)

Answer 13

Dose reductions and cautions advised with all antimalarials and atovaquone with
proguanil should be avoided if eGFR <30

Question 14

which antimalarial is associated with potentially serious neuropsychiatric reactions

Answer 14

Mefloquine. Adverse reactions may occur and persist up to several months after discontinuation because mefloquine has a long half-life

• note: neuropsychiatric reactions can be- abnormal dreams, insomnia, anxiety, and depression occur commonly. Psychosis, suicidal ideation, and suicide have also been reported*