Malaria

Question 1

What causes non-falciparum malaria?

Answer 1

P. vivax (commonest)

P. ovale

P. malariae

P. knowlesi

Question 2

What are the features of P.vivax and ovale?

Answer 2

Cyclical fever every 48 hours –> have a hypnozoite stage (dormant liver stage) :. may relapse following treatment

Question 3

What are the features of malariae?

Answer 3

Cyclical fever every 72 hours + associated nephrotic syndrome

Question 4

What is the treatment of non-falciparum?

Answer 4

ACT or chloroquine

ACT - should be avoided in pregnant women

Patients with ovale or vivax = primaquine for 14 days following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse

Malaria = chloroquine

Question 5

What is the problem with primaquine?

Answer 5

Haemolysis in G6PD deficiency

Question 6

When do you treat non-falciparum as falciparum?

Answer 6

• Mixed infection with falciparum
• Cannot exclude falciparum
• Severe/complicated non-falciparum
• Resistance to chloroquine eg. Indonesia

Question 7

What are the general features of non-falciparum?

Answer 7

Fever, headache, splenomegaly

Question 8

What are features of falciparum malaria?

Answer 8

• commonest and most severe type of malaria
• Shizonts on a blood film
• Parasitaemia
• Patient not ambulant
• Complications: hypoglycaemia, acidosis, temp > 39, severe anaemia, cerebral: seizures, coma, impaired concsiousness
• Acute renal failure: blackwater fever, secondary to intrvascular heamolysis, mechanism unknown, ARDS, shock, DIC

Question 9

What is the treatment for falciparum?

Answer 9

1st: ACT

4 tablets at 0, 4, 8, 24, 36, 48 and 60 hours

2nd: Quinine plus doxycylcine
3rd: Malarone

Severe:

1st: Artesunate IV at 0, 12, 24 hrs for 5 days

If parasite count > 10% exchange treatment transfusion should be considered