Malaria

Question 1

Pathophysiology

Answer 1

Parasitic infection transmitted by the anopheles mosquito which causes RBC destruction

Question 2

Species of parasite

Answer 2

Plasmodium. Falciparum (severe malaria)
Plasmodium vivax
Plasmodium ovale
Plasmodium Africaans

Question 3

Presentation

Answer 3

Returning traveller 
Sudden onset rigors 
high fever 
Malaise 
Severe headache 
Myalgia 
Nausea and vomiting 
May be jaundiced with hepatomegaly

Question 4

Blood results

Answer 4

Anaemia
Thrombocytopenia
Leukopenia
Abnormal LFTS

Question 5

Complications if untreated

Answer 5

Hypoglycaemia j
Renal failure
Pulmonary oedema
Neurological deterioration

Question 6

Treatment

Answer 6

Pharmological:
- artesunate - IV for severe or complicated
(Follow up blood test due to haemolytic risk with IV)

• quinine 2nd line
• chloroquine - for P.malariae, knowlesi and P. Vivax
• primaquine - p. Ovale and vivax to remove hypnozoites

Question 7

What to do before treatment

Answer 7

Screening for G6PD deficiency as it can cause heamolysis in these pts.

Question 8

Timing of presentation

Answer 8

P. Falciparum - Within 6 months of exposure

P. Ovale/vivax - months to years

Question 9

Complicated malaria

Answer 9

Cerebral malaria - GCS less than 11
Renal impairment 
Acidosis 
Hypoglycaemia 
Respiratory distress 
Severe anaemia 
Shock 
Sepsis - common in pregnant women 
Haemoglobinurea - dark red urine

Question 10

Investigations

Answer 10

Obs
Bloods - FBC, LFTs, U+Es
3 x blood film - thick and thin
Blood culture