Malaria Flashcards
Define malaria
Malaria is a protozoa infection of the genius PLASMODIUM.
There are five many species of Plasmodium namely:
- Plasmodium falciparum
- Plasmodium Vivax
- Plasmodium Malariae
- Plasmodium Ovale
- Plasmodium Knowlesi
Malaria transmitted through the bite of an infected female mosquito belonging to the
genus ____________.
Anopheles
Symptoms of uncomplicated malaria are ?
• Symptoms of malaria are generally non-specific
• Fever/sweats/chills
• Malaise
• Weakness
• Gastrointestinal complaints (nausea, vomiting, diarrhea) • Headache
• Back pain
• Myalgia
• Cough
Major features of severe or complicated falciparum malaria in adults:
Cerebral malaria (coma not attributed to any identifiable cause in a patient with P. falciparum malaria)
• Impaired consciousness or seizures ( > 2 episodes/24 h)
• Drowsiness/lethargy
• Pulmonary oedema or acute respiratory distress syndrome (ARDS)
Shock (algid malaria: BP < 90/60 mmHg) Persistent/excessive vomiting Spontaneous bleeding/disseminated intravascular coagulation Anaemia (haemoglobin ≤ 8 g/dL)
Acute kidney injury (oliguria: urine output < 400ml/24 h in adults) Jaundice
Severe or complicated malaria in children:
Impaired consciousness or seizures Respiratory distress or acidosis (pH < 7.3) Hypoglycaemia (2.2 mmol/l) Severeanaemia(<8g/dL)
Prostration (inability to sit or stand without support) Parasitaemia > 2% red blood cells parasitized
Laboratory indicators of severe malaria
• Hyperparasitaemia ( proportion of parasitized red blood cells > 5% in the non-immune and 10% in semi-immune population)
• Metabolic acidosis (pH < 7.3, serum bicarbonate < 15mmol/L)
• Severe normocytic anaemia (Hb < 5g/dL or PCV < 15%)
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• Hyperlactataemia (serum lactate > 5 mmol/L)
• Renal impairment (serum creatinine > 265μmol/L)
• Haemoglobinuria (without G6PD deficiency)
• Hypoglycaemia (blood glucose < 2.2mmol/L)
Diagnosis of malaria
• Most important test is examination of thick and thin blood slides by microscopy (highly sensitive and specific in expert hands)
• Gold standard for laboratory confirmation of malaria
• Rapid diagnostic tests (RDTs) based upon detection of parasite antigens ( HRP ǀ or ǀǀ ) or enzymes (lactate dehydrogenase)
• Slightly less sensitive than good quality blood films
• Commonly used in addition to blood slides
• Easier for the non expert to use to detect falciparum infections
• Not as specific and sensitive for the detection of non falciparum infections
• If falciparum malaria is diagnosed, the percentage of red blood cells that are parasitized should be estimated.
Monitoring of malaria
• Assessment of the patient should include careful clinical evaluation and review of investigations for the features of severe malaria
Investigations (should be done routinely)
• Full blood count (FBC)
• Blood glucose level
• Liver function tests (LFTs)
• Urea and electrolytes (U/Es)
• In ill patients, arterial blood gases, blood culture, lactate and clotting studies (prothrombin time) should also be performed.
• Urine dipstick and culture, stool culture and chest X-ray may be appropriate.
• Lumbar puncture to exclude meningitis should be considered in febrile patients with impaired consciousness or repeated seizures.
Malaria treatment can be classified into three (3) namely:
- Uncomplicated Malaria.
- Severe Malaria
- Malaria in Pregnancy
First Line Treatment of uncomplicated malaria :
• Artemether – Lumefantrine (AL), an Artemisinin Based Combination Therapy (ACT) children below 5kg of weight should be treated under medical supervision.
• Sulphadoxine – Pyrimethamine (SP) for children below 5kg of weight.
Severe Malaria first line treatment:
a. Injectable Artesunate is the drug of choice in adults and children with severe malaria.
b. If injectable (IV) artesunate is unavailable, artemether (intramuscular (IM) ) or quinine (IV/IM) are suggested alternatives.
C. following initial parenteral treatment for a minimum of 24 hours, once the patient can tolerate oral therapy, it is essential to continue and complete treatment with an effective oral antimalarial using a full course of an effective ACT.
Intermittent Preventive Treatment during pregnancy (IPTp).
Sulphadoxine – Pyrimethamine should be usedfor for IPTp during the second and third trimesters of pregnancy on a monthly basis at all scheduled antenatal care visits.
ARTESUNATE
This is the medicine of choice for the treatment of severe malaria in all categories of patients.
Artesunate is dispensed as a powder of Artesunic acid. This must be dissolved in sodium
Bicarbonate (5%) of 5% Dextrose and given by IV injection or IM injection to the arterior thigh.
•The solution should be freshly prepared prior to administration and should never be stored.
DOSE
2.4mg/kg body weight IV or IM given on admission (time=0) then at 12 Hours and 24 Hours, then
once a day.
ADVERSE EFFECTS
Anorexia
Dizziness
Mild blood abnormalities
QUININE
•Altenative treatment of severe and complicated Malaria in all population group.
•First-line treatment for uncomplicated malaria during first trimester of pregnancy.
•Second line treatment in case of treatment failure with the first-line treatment.
DOSE
•By IV injection : loading dose of 20mg/kg body weight (Max. 1200mg) diluted in 10ml/kg of 5% or 10% Dextrose ( or isotonic fluid if hypoglycaemia is excluded) per kg body weight by infusion over 4 hours.
•Then give a maintenance dose of 10mg/kg over 4 hours.
ADVERSE EFFECTS
• Tinnitus
• Headache
•Hot and flushed skin
•Abdominal pain
•Visual disturbances, confusion, hypoglycaemia and cardiovascular effects.
Quinine is an alkaloid extract from the bark of the _________ tree.
CINCHONA
Malaise
Malaise is described as any of the following:
a feeling of overall weakness
a feeling of discomfort
a feeling like you have an illness
simply not feeling well
It often occurs with fatigue and an inability to restore a feeling of health through proper rest.
Myalgia
Myalgia describes muscle aches and pain, which can involve ligaments, tendons and fascia, the soft tissues that connect muscles, bones and organs. Injuries, trauma, overuse, tension, certain drugs and illnesses can all bring about myalgia.
Oliguria
Oliguria is the medical term for low urine output. In several malaria urine output < 400ml/ 24h
Fansidar
sulfadoxine and pyrimethamine
Co-trimoxazole (septrin)
sulfamethoxazole and trimethoprim
Malaria in pregnancy treatment
Uncomplicated malaria
1st line - quinine 1st trimester
Artemether-Lumefatrine 2nd & 3rd trimester
SEVERE
Quinine 1st trimester
Injectable artesunate in 2nd & 3rd trimester
Intermittent preventive treatment during pregnancy (IPTp)
Sulphadoxine – Pyrimethamine should be usedfor for IPTp during the second and third trimesters of pregnancy on a monthly basis at all scheduled antenatal care visits
