Malaria

Question 1

Malaria lifecycle

Answer 1

Mosquito (Sporozoite) - Liver (merozoite) - RBC (gametocyte)

Question 2

Case fatality rate for different severities of malaria

Answer 2

Severe 10 -40%
Moderately severe 3%
Uncomplicated

Question 3

What caused decrease in malaria in KZN in 2000

Answer 3

Indoor residual spraying (with DDT)

Artemether-Lumefantrine as first line Rx of uncomplicated malaria

Question 4

Non-drug measures for malaria prevention

Answer 4

Indoors
long sleeves
Screens
Repellent
Coils
Treated bed nets
Insecticide spray
Fans
Stagnant water removal

Question 5

ABC of malaria prevention

Answer 5

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

Question 6

Prophylactic regimens in malaria

Answer 6

• 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

Question 7

Malaria Rx in pregnancy

Answer 7

Mefloquine (NOT IN 1st TRIMESTER)

Question 8

Malaria Rx in epilepsy

Answer 8

Atovaquone-proguanil

Question 9

Malaria Rx in someone who is on oral anticoags

Answer 9

No obvious answer. Avoid if possible. Monitor INR carefully.

Question 10

Best malaria drug for long term therapy

Answer 10

Mefloquine

Question 11

Paeds best malaria drug

Answer 11

Mefloquine

Question 12

Malaria management problems in Cape Town

Answer 12

Delay in presentation
Delay in diagnosis
Underassessment of severity
Choice and route of antimalarial

Question 13

Symptoms of uncomplicated malaria

Answer 13

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.

Question 14

Daignosis of malaria

Answer 14

Rapid test

Blood smears

Question 15

Treatment of uncomplicated malaria

Answer 15

Artemisinin-based combination therapy
(Artemether plus Lumefantrine) = Coartem
[take with food or milk] = fat containing

Question 16

Who not to give artemether Lumefantrine?

Answer 16

Allergic

Question 17

When should patient return on Coartem

Answer 17

No response in 3 days
Vomiting
Deterioraion
Return daily if high risk

Question 18

Clinical criteria for severe malaria

Answer 18

Any of the following:

Impaired LOC, Weakness, convulsions, Low BP, Resp distress, Jaundice, Macroscopic haematuria, Bleedign

Question 19

Lab criteria for severe malaria

Answer 19

Severe anaemia (265 urea >10
Hyperlactataemia >4 venous
Hyperparasitaemia >4%
Elevated bilirubin >50

Question 20

Management of severe malaria

Answer 20

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

Question 21

How to treat severe malaria with quinine

Answer 21

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

Question 22

What affect quinine dose

Answer 22

Sepsis decreases Vd
Binds acute phase reactants
Renal elimination

Question 23

Ancillary Rx for malaria

Answer 23

Oxygen
antipyretics
anticonvulsants
consider antibiotics
blood transfusion
mechanical ventilation
haemofiltration / dialysis
? exchange transfusion

Question 24

Problems with quinine

Answer 24

Less effective
Loading dose not given
Infusion rate not controlled
Hypoglycaemia