MALARIA

DR. AHMED ELAMIN AWADELAKARIMMedical Resident

Disease was unknown. Symptoms was written in Chinese medical

literature (Nei Ching)2700 B.C . Hippocrates was the first one to describe

malaria symptoms. Mal-aria = mal air =bad air.

History and events

1880 - Charles Louis Alphose Lavern discovered malarial parasite in wet mount.

1883 - Methylene blue stain 1891 - Polychrome stain 1898 - Roland Ross - Life cycle of parasite. 1948 - Site of Exoerythrocytic development in

Liver by Shortt and Garnham. 1937 - Chloroquine discover in bayyer labs, but

realesd on 1946 .

History and events

Malaria caused by plasmodium parasites:1. P. falciparum.2. P. vivax.3. P. ovale.4. P. malarie.5. P. knowlesi.

Un complicated malaria.symptoms only.

Complicated malariaparasitemia 5-10%.organ dysfunction.

Symptoms

First stages:• Cold – chills.

• Headache.• Nausea .• Vomiting.• Malaise.• Due to rupture of RBCs.• Less than hour.

Second stage:• Fever upto 40 c

• Nausea.• Vomiting.• Headache.• Several hours• Due to invasion of new RBCs

Symptoms

Third stage:• Sweating.

• Nausea.• Vomiting.• Headache.

Symptoms

These symptoms cycling every: 72 hours for malarie.

48 hours for vivax. 48 hours for ovale.

Irregular and tends to be continuous for falciparum.

Symptoms

Oral Parenteral

Generally chloroquine and ACTs

Treatment of un-complicated malaria

Treatment of uncomplicated malaria

Treatment of uncomplicated malaria

Artemether-lumefantrine. Artesunate + Amodiaquin.

Artesunate + Mefloquine.

Artesunate + sulfadoxine–pyrimethamine. (fansidar)

Treatment of uncomplicated malaria

P. vivax and p. ovale

Chloroquine and primequine.

ACTs and primequine.

Treatment of uncomplicated malaria

Malignant malaria

Complicated malariaSevere malaria

Altered mental status with or without convulsions.

Hyperparasitemia. No alternative cause of coma.

Plus

Malaria retinopathy. Blantyre coma scale  ≤ 2. (paedia)

Cerebral malaria

Malaria retinopathies

Severe illness. Recurrent illnesses. Degree of anemia and parasitemia define

needs of BTX.

Exchange transfusion no longer recommended to be used for treatment of severe malaria.

Severe anaemia

Pathology unclear.

Dehydration.

Sequstration of RBCs.

Vasoadherance.

Renal failure

Typhoid fever.

Haemorrhagic fever.

Meningitis.

Pneumonia.

Septicemia.

∆ ∆D D

Good history: recent travel, duration of fever.

physical assessment: ABC, pallor, jaundice, fundscopy

Supportive measures : pulse oximeter, monitoring, O2 antipyretics, antiemetic, rehydration….

L.P should be done for all comatose pts to role out meningitis.

Initial measures

Chinese medicine used for treatment of fever called (qinghaosu).

First line. Rapid in clearing parasitemia than quinine. More tolerable than quinine. No need to adjust the dose in renal and

hepatic failure. Side effects include: n&v, anorexia, dizziness

and delayed onset anemia.

Artemisinins

Extracted from cinchona tree. Induce insulin oversecretion. Hypoglycemia. Should be mixed with dextrose prep. QT prolongation. I.V only infusion and over 4 hours. Can be combined with deoxcycline,

tetracycline or clindamycin.

Quinine and Quinidine

Cinchonismmild tinnitus, impaired hearing, headache,

nausea, disturbed vision, severe vomiting, abd pain, diarrhoea, severe vertigo

25th of April

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