Malaria Flashcards
Malaria risk assessment
Travel destination
Altitude of destination
Time of travel
Type of accommodation
Length of stay
Atovaquone/Proguanil
Chemoprophylaxis for all malaria endemic regions
Begin 1-2 days before departure and continue 7 days after leaving endemic area
Atovaquone/Proguanil reasons to avoid use
Contraindicated in CrCl < 30 mL/min
Pregnant women or breastfeeding infants < 5 kg
Children < 5 kg
Chloroquine
Chemoprophylaxis for regions with chloroquine-sensitive malaria
Begin 1-2 weeks before departure and continue for 4 weeks after leaving
Taken once weekly
Chloroquine side effects
Blurred vision
Dizziness
GI disturbance
HA
Insomnia
Pruritis
Chloroquine reasons to avoid
Leaving in < 1 week
Hydroxychloroquine
Alternative to chloroquine
Doxycycline
Chemoprophylaxis for all malaria endemic regions
Begin 1-2 days before departure and continue for 4 weeks after leaving
Can prevent rickettsiae and leptospirosis
Doxycycline reasons to avoid
Pregnant women
Children < 8 years of age
Women prone to getting yeast infections
Mefloquine
Chemoprophylaxis in regions with mefloquine-sensitive malaria
Begin > or equal to 2 weeks before departure and continue for 4 weeks after leaving
Mefloquine reasons to avoid
Active/recent depression
Recent history of psychiatric disorders or seizures
Cardiac conduction abnormalities
Primaquine
Chemoprophylaxis in regions with P. vivax
Begin 1-2 days before departure and continue 7 days after leaving
Primaquine reasons to avoid
G6PD deficiency
Have not been tested for G6PD deficiency
Pregnant women or breastfeeding unless infant test for G6PD deficiency
Tafenoquine
Chemoprophylaxis in all malaria endemic regions
Begin 3 days before departure and continue for 1 week after leaving
Tafenoquine reasons to avoid
G6PD deficiency
Have not been tested for G6PD deficiency
Pregnant women or breastfeeding unless infant test for G6PD deficiency
Psychotic disorders
Children
When to consider malaria?
Fever AND has traveled to a malaria endemic region before fever onset
Symptoms onset
Typically, 2-4 weeks after mosquito bite
Can occur up to 3 years after exposure to P. vivax or P. ovale
Malaria diagnosis
Giemsa-stained blood smear
Thick smear: RBCs are lysed so visualize parasite outside of cells–>estimate parasite density
Thin smear: used to determine species
Check blood smear q12-24 hrs x 3 to rule out malaria
Severe malaria
Patients have severe malaria if they have AT LEAST 1 of the following:
- Impaired consciousness/coma
- Hgb < 7 g/dL
- AKI
- ARDS
- Circulatory collapse/shock
- Acidosis
- Disseminated intravascular coagulation
- Parasite density of > or equal to 5%
Treatment of uncomplicated malaria–>presence of chloroquine resistance or unknown resistance
Artemether-lumefantrine: preferred if available
- take with food or milk
Atovaquone-proguanil
- take with food or milk
- cause elevated LFTs
Quinine sulfate + doxycycline/tetracycline/clindamycin–>use of doxycycline or tetracycline is preferred in adults
- Quinine can cause QTc prolongation
Mefloquine–>usually last line
- can cause psychosis, seizures
Treatment of uncomplicated malaria–>chloroquine sensitive
Chloroquine is preferred if no resistance
Hydroxychloroquine
Anti-relapse treatment–>P. vivax and P. ovale
Primaquine phosphate
- need G6PD testing before treatment
Tafenoquine
- need G6PD testing before treatment
- long t1/2= 17 days
- avoid if hx of psychotic disorders
Treatment of uncomplicated malaria–>P. Falciparum or unknown in an area with chloroquine resistance
Preferred:
- Artemether-lumefantrine
Alternatives:
- Atovaquone-proguanil
- Quinine + doxycycline/tetracycline/clindamycin
- Mefloquine IF NO OTHER OPTIONS
Treatment of uncomplicated malaria–>P. Falciparum or unknown in an area with no chloroquine resistance
Preferred:
- Chloroquine
- Hydroxychloroquine
Alternatives:
- any options used for chloroquine resistance infections
