MALARIA Flashcards
Malaria is one of the Commonest Conditions in?
Malaria is endemic in?
Who is at risk of malaria in Ghana?
High risk of having malaria
Malaria is one of the Commonest Conditions in Ghana
–Over 5.0 million confirmed cases 2021
•Economic cost
•Malaria is endemic in Ghana/
entire population is at risk
•High risk-
Children 5yrs,
Pregnant women,
Non-immune,
immunocompromised (HIV, DM etc.),
comorbidities-e.g., SCD
Definition of malaria
Cause of malaria
A disease
caused by a plasmodium parasite, transmitted by the bite of infected mosquitoes.
It follows the introduction of protozoan malaria parasites into the bloodstream by the bite of an infected female Anopheles mosqui
5 plasmodium species cause illness(malaria) in man:
5 plasmodium species cause illness(malaria) in man:
oP. falciparum mono infection 97.4%
oP. malariae mono infection 1.1 %
oP. ovale mono infection 0.8%
oP. vivax
oP. knowlesi has recently been identified in Malaysia but not yet identified in Ghana
Invesigations
Differential Diagnosis
A diagnosis of malaria can be suspected based on the
- patient’s symptoms and the
- physical findings at examination.
However, for a definitive diagnosis to be made laboratory tests
- FBC
- (blood film and/or
- Rapid Diagnostic Test): Rapid Diagnostic Test (RDT) may be used to confirm a diagnosis if microscopy (blood film) is not available.
must demonstrate the malaria parasites or their components since the clinical presentation of the condition can be similar to other common diseases such as
Differentials
- typhoid fever,
- urinary tract infection,
- septicaemia,
- pneumonia and
- meningitis in both adults and children and
- measles,
- otitis media,
- tonsillitis, etc. in children.
Preventions
Exceptions to give artemisinin
Preventions
— Preventive measures in the community mainly target elimination of the insect vector or prevention of mosquito bites
— while additional chemoprophylaxis is required for vulnerable individuals.
The development of resistance of malaria parasites to anti-malarial medications is a matter of major public health concern. This phenomenon is largely the result of ‘over-diagnosis’ and wrong diagnosis of malaria by healthcare practitioners and patients alike, with its attendant over- treatment and sometimes partial or incomplete treatment, leading to over-exposure of the parasites to the anti-malarial drug (drug pressure).
— Additionally, Artemisinin Combination Therapy (ACT), rather than monotherapy with artemisinin derivatives, is currently recommended for the treatment of uncomplicated malaria to prevent the development of drug resistance.
It is therefore necessary to obtain
laboratory confirmation of a diagnosis of malaria before starting treatment.
Exceptions to this principle are
— children under 5 years and
— cases of suspected severe malaria where laboratory confirmation is not immediately possible.
In such circumstances, a complete course of the appropria anti-malarial medication(s) must be given
Uncomplicated Malaria
Symptoms?
Signs?
Symptoms
y Fever
y Chills
y Rigors
y Sweating
y Headache
y Generalized body and joint pain y Nausea and/or vomiting
y Loss of appetite
y Abdominal pain (especially in children) y Irritability and refusal to feed (in infants)
Signs
y Fever
y Mild pallor
y Mild jaundice y Splenomegaly
3 main modes of transmission
3 main modes of transmission
— Mainly bite of infective female anopheles mosquito
— An accidental transmission via blood transfusion or needle stick injury
— Congenital transmission from mother to child during pregnancy or parturition
Malaria Control Interventions in Ghana
Or
Cross cutting interventions
Malaria Control Interventions in Ghana
1. Distribution of long lasting insecticides nets (LLIN)
2. Indoor residual spraying(IRS)
3. Limited lavaesciding
4. Malaria vaccines
5. Intermittent preventative treatment (IPTp)
6. Seasonal malaria chemo prevention (SMC)
7. Case management, diagnosis and treatment
Cross cutting interventions
1. Procurement and supply chain (1-2)
2. Research, surveillance, monitoring and evaluation (3-4)
3. Advocacy, social and behavior communication (5-7)
Classifications of malaria
Uncomplicated malaria
•Severe Malaria
oFever. Positive malaria diagnostic test (RDT or microscopy)
— Severe disease or evidence of vital organ dysfunction (1 or more)
Treatment ( refer to page 483 to 485)
Treatment
Treatment objectives
y To avoid progression to severe malaria
y To limit the duration of the illness
y To minimize the development of drug resistant parasites
Non-pharmacological treatment
y In children, tepid sponging to reduce body temperature
Pharmacological treatment
1st Line Treatment
y Artesunate + Amodiaquine, oral, (See Table 18-5 on page 484, Table 18-6 on page 484, Table 18-7 on page 484 )
Or
Evidence Rating: [A]
y Artemether + Lumefantrine, oral, (See Table 18-8 on page 485) Or
y Dihydroartemisinin + Piperaquine, oral, (See Table 18-9 on page 485)
SEVERE MALARIA
Severe or ‘complicated malaria’ can arise from delay in diagnosis or inappropriate treatment of uncomplicated malaria.
It mostly occurs in
— children under 5 years of age,
— pregnant women and
— non-immune individuals.
The events causing most deaths in severe malaria are related to
— cerebral involvement (cerebral malaria),
— severe anaemia,
— hypoglycaemia,
— severe dehydration,
— renal failure and respiratory acidosis.
Signs and Symptoms Of Severe Malaria ( vital organ dysfunction)
Vital Organ Dysfunction (Signs)
Brain/CNS
— Convulsions,
— unconsciousness,
— confusion,
— restlessness,
— lethargy
Lungs
— Difficulty breathing,
— deep breathing,
— respiratory distress
Heart:
— Shock: low BP, weak rapid pulse, cold extremities
Liver
— Hypoglycemia,
— Jaundice
Kidney
— Decreased urine output (< 0.5ml/kg/h over at least 6 h)
— dark-colored urine
Hematological
— Severe anemia,
— abnormal bleeding
General
— Severe dehydration (sunken eyes etc.),
— high temp/ hypothermia,
— prostration,
— general weakness
Malaria In Pregnancy Complications
Lab Investigations
Pregnant women at increased risk of severe malaria
•Bleeding in pregnancy
•Miscarriage
•Preterm labor
•PPH
•Low birth weight, still birth etc.
•Hypoglycemia, Pulmonary edema*
Lab Investigations
Uncomplicated Malaria is confirmed by either;
•Microscopy (GOLD STANDARD)
•mRDT (Malaria Rapid Diagnostic Test)
