Malaria Flashcards
Malaria lifecycle
Mosquito (Sporozoite) - Liver (merozoite) - RBC (gametocyte)
Case fatality rate for different severities of malaria
Severe 10 -40%
Moderately severe 3%
Uncomplicated
What caused decrease in malaria in KZN in 2000
Indoor residual spraying (with DDT)
Artemether-Lumefantrine as first line Rx of uncomplicated malaria
Non-drug measures for malaria prevention
Indoors long sleeves Screens Repellent Coils Treated bed nets Insecticide spray Fans Stagnant water removal
ABC of malaria prevention
A: Awareness and assessment of malaria risk
B: Avoidance of mosquito Bites
C: Compliance with Chemoprophylaxis, when indicated
D: Early Detection of malaria
E: Effective treatment
Prophylactic regimens in malaria
• Mefloquine. (Weekly). Start at least one week before entering a malaria area, take weekly while there and for FOUR weeks after leaving the malaria area
• Doxycycline. (Daily). Start one day before entering a malaria area, take daily while there
and for FOUR weeks after leaving the malaria area
• Atovaquone - proguanil (Malanil). (daily). Start one to two days before entering malaria area, take daily while there and for SEVEN days after leaving the area
Malaria Rx in pregnancy
Mefloquine (NOT IN 1st TRIMESTER)
Malaria Rx in epilepsy
Atovaquone-proguanil
Malaria Rx in someone who is on oral anticoags
No obvious answer. Avoid if possible. Monitor INR carefully.
Best malaria drug for long term therapy
Mefloquine
Paeds best malaria drug
Mefloquine
Malaria management problems in Cape Town
Delay in presentation
Delay in diagnosis
Underassessment of severity
Choice and route of antimalarial
Symptoms of uncomplicated malaria
Malaria is suspected clinically primarily on the basis of fever or a history of fever. Other symptoms of uncomplicated malaria include: headache, lassitude, fatigue, abdominal discomfort muscle and joint aches, followed by chills, perspiration, anorexia, vomiting and worsening malaise.
Daignosis of malaria
Rapid test
Blood smears
Treatment of uncomplicated malaria
Artemisinin-based combination therapy
(Artemether plus Lumefantrine) = Coartem
[take with food or milk] = fat containing
Who not to give artemether Lumefantrine?
Allergic
When should patient return on Coartem
No response in 3 days
Vomiting
Deterioraion
Return daily if high risk
Clinical criteria for severe malaria
Any of the following:
Impaired LOC, Weakness, convulsions, Low BP, Resp distress, Jaundice, Macroscopic haematuria, Bleedign
Lab criteria for severe malaria
Severe anaemia (265 urea >10
Hyperlactataemia >4 venous
Hyperparasitaemia >4%
Elevated bilirubin >50
Management of severe malaria
Rapid clinical assessment Check organ function If LOC check and give glucose Urgent IV Artesunate Transfer to highest level of care Watch electrolytes and fluid
How to treat severe malaria with quinine
Load quinine dihydrochloride 20mg/kg IV over 4 hours
Follow with 10mg/kg over 4 hours every 8 hours
Day 3 - quinine sulphate 10mg/kg oral 8 hourly plus:
Doxycycline 3mg/kg daily for 7 days.
NB - monitor glucose and BP
What affect quinine dose
Sepsis decreases Vd
Binds acute phase reactants
Renal elimination
Ancillary Rx for malaria
Oxygen antipyretics anticonvulsants consider antibiotics blood transfusion mechanical ventilation haemofiltration / dialysis ? exchange transfusion
Problems with quinine
Less effective
Loading dose not given
Infusion rate not controlled
Hypoglycaemia
