Malaria

Question 1

75% of cases are caused by which type?

Answer 1

Plasmodium falciparum

Question 2

Pathophysiology of malaria

Answer 2

Parasitic invasion of the erythrocyte consumes Hb and alters the red cell membrane. This allows P.falciparum infected erythrocytes to stick inside the small blood vessels of brain, kidneys and other affected organs.

In pregnancy parasites are sequestered in the placenta and evade host defence mechanisms: splenic processing and filtration.

Question 3

What are the adverse affects of malaria in pregnancy?

Answer 3

Due to systemic infection:

• maternal and fetal mortality
• Miscarriage
• Stillbirth
• Premature Birth

Due to the parasitisation itself:

• fetal growth restriction
• maternal and fetal anaemia
• interaction with HIV
• susceptibility of the infant to malaria

Question 4

Clincial and laboratory findings of severe or complicated malaria in adults

Answer 4

Question 5

How do you diagnose malaria in pregnancy?

Answer 5

Microscopic examination of thick and thin blood films for parasites

OR rapid diagnostic tests which detect specific parasite antigen or enzyme (less sensitive)

In a febrile patient, three negative malaria smears 12-24h apart rules out the diagnosis of malaria

Question 6

How to treat malaria infection in pregnancy

Answer 6

Treat as an emergency

Admit to hospital/ICU

IV artesunate for severe falciparum malaria

Use quinine and clindamycin to treat uncomplicated P.falciparum

Use chloroquine to treat P.vivax, P.ovale or P.malariae

Primaquine should not be used in pregnancy

Seek advice from ID

Treat fever

Do not persist with oral therapy if vomiting

Treat anaemia