Malaria Flashcards
List criteria for defining a) uncomplicated malaria
Fever
Chills
Sweats
Headaches
Nausea and vomiting
Body aches
General malaise
Elevated temperatures
Perspiration
Weakness
Enlarged spleen
Mild jaundice
Enlargement of the liver
Increased respiratory rate
Severe malaria
Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
Severe anemia due to hemolysis (destruction of the red blood cells)
Hemoglobinuria (hemoglobin in the urine) due to hemolysis
Acute respiratory distress syndrome (ARDS), an inflammatory reaction in the lungs that inhibits oxygen exchange, which may occur even after the parasite counts have decreased in response to treatment
Abnormalities in blood coagulation
Low blood pressure caused by cardiovascular collapse
Acute kidney injury
Hyperparasitemia, where more than 5% of the red blood cells are infected by malaria parasites
Metabolic acidosis (excessive acidity in the blood and tissue fluids), often in association with hypoglycemia
Hypoglycemia (low blood glucose). Hypoglycemia may also occur in pregnant women with uncomplicated malaria, or after treatment with quinine.
Danger signs in malaria patient
Danger signs include neurological change, abnormal breathing pattern, persistent vomiting and diarrhea, jaundice, bleeding, dark urine, delayed capillary refill, intense pallor, hyperpyrexia, hyperparasitemia and schizontemia.
Advantages of IV (IM) artesunate vs. quinine
Advantages of IV (IM) artesunate vs. quinine
- Reduction in mortality
- More rapid parasite clearance
- Simple to administer
- Simple dose regimen
- Better safety profile
- No dose adjustments required in renal and hepatic impairment
High risk malaria patients
pregnant and postpartum women
infants and young children
elderly persons (older than 65 years)
splenectomised persons
immune compromised persons (including HIV-infected)
Artemether-lumefantrine benefit in treating uncomplicated malaria
Rapid clinical and parasitological response,
improved cure rates,
decreased malaria transmission and
have the potential to delay antimalarial drug resistance.
Artemether-lumefantrine has the advantages of a short treatment course (six doses over three days)
and good tolerability
Disadvntages of Artemether-lumefantrine
only indicated for the treatment of uncomplicated malaria as there is no evidence of its efficacy in more severe disease
Benefits of treatment of uncomplicated malaria with oral quinine plus either doxycycline or clindamycin
When artemether-lumefantrine is not available
or
is contraindicated (e.g. a history of allergy to artemisinins or lumefantrine
or
becuase In infants weighing less than five kilograms, the preferred treatment is quinine artemetherlumefantrine use in this weight band is off-labe
Disadvantages of quinine use
should ideally be used as directly observed treatment of inpatients, due to the poor tolerability and thus poor adherence with this seven-day regimen.
Shortened courses of quinine (three days) cannot be recommended for treatment, given their poor efficacy
Risks of quinine use
A syndrome known as cinchonism (mild hearing impairment (notably high tone deafness), tinnitus, headache, nausea and slight visual disturbances) occur in up to 70 percent of patients with therapeutic quinine concentrations
Hypoglycaemia is the most frequent serious adverse reaction and it is particularly common in young children, pregnant women and elderly patients
Quinine toxicity presents with central nervous system (CNS) disturbances (primarily visual and auditory) and cardiovascular abnormalities
Cardiotoxicity is particularly related to rapid infusion of quinine
Hypersensitivity reactions
How should the treatment course be completed in patients with severe malaria once they can tolerate oral treatment?
Complete treatment with a full course of artemether-lumefantrine
Describe in detail the safe and effective dosing IV quinine in severe malaria
Loading dose of 20mg/kg of quinine dihydrochloride salt by SLOW intravenous infusion over 4 hours
Ø
Followed by 10mg/kg by SLOW intravenous infusion over 4 hours, and given every 8 hours
treatment duration of 7 days
Should dosing of IV artesunate be adjusted in patients with renal failure and if so, how?
None needed
Should dosing of IV quinine be adjusted in patients with renal failure and if so, how?
a 2/3 reduction in the usual intravenous dose of quinine is recommended (600 mg per 24 h instead of 600 mg per 8 h
What monitoring would you recommend for a patient being administered IV quinine?
Frequent monitoring of blood glucose concentrations
Cardiac monitoring
