Malaria

Question 1

Define

Answer 1

Transmitted by the Anopheles mosquito

Infection from FIVE strains of plasmodium: P. falciparum, vivax, ovale, malariae, knowlesi
* Falciparum is the most fatal

Question 2

Symptoms

Answer 2

1. Fever (not cyclical, its persistent with spikes)
2. Diarrhoea and vomiting
3. Rigours
4. Flu-like symptoms (shaking, chills, night sweats, headache, myalgia)
5. Jaundice
6. Anaemia

Onset usually 7-10 days after inoculation but infections can present months later

Children are susceptible to cerebral malaria and severe anaemia

Question 3

Investigations

Answer 3

3 thick and thin blood films (thick = parasite; thin = species, parasitaemia)

Malaria rapid antigen detection tests (plasmodial HRP-II, parasite LDH)

Thrombocytopenia is commonly seen in malaria

Question 4

Management

Answer 4

Prevention:
* Anti-malarial prophylaxis with quinine
* Bite prevention – repellent and nets

Arrange immediate admission -> Medical emergency; notify PHE (can have a RAPID deterioration)

Treatment (very variable, dependant on strain, severity, tolerability, resistance):

Non-falciparum:
· 1st line = Chloroquinine

Mild falciparum (Mild = if not vomiting, parasitaemia <2% and ambulant):
· 1st line = ACT (Artemisinin Combination Therapy)

· 2nd line = Atovaquone-proguanil (cannot give doxycycline to age <12yo)

Severe/complicated falciparum:
· 1st line = IV Artesunate N.B. anti-malarial drugs may precipitate G6PDD
· 2nd line = IV Quinine

Primaquine (not G6PDD) for eradication of hypnozoites (dormant parasites in liver in vivax and ovale)

Question 5

Management

Answer 5

Prevention:
* Anti-malarial prophylaxis with quinine
* Bite prevention – repellent and nets

Arrange immediate admission -> Medical emergency; notify PHE (can have a RAPID deterioration)

Treatment (very variable, dependant on strain, severity, tolerability, resistance):

Non-falciparum:
· 1st line = Chloroquinine

Mild falciparum (Mild = if not vomiting, parasitaemia <2% and ambulant):
· 1st line = ACT (Artemisinin Combination Therapy)

· 2nd line = Atovaquone-proguanil (cannot give doxycycline to age <12yo)

Severe/complicated falciparum:
· 1st line = IV Artesunate N.B. anti-malarial drugs may precipitate G6PDD
· 2nd line = IV Quinine

Primaquine (not G6PDD) for eradication of hypnozoites (dormant parasites in liver in vivax and ovale)