MALARIA - Disease Management

Malaria is an acute and chronic protozoan infection transmitted by Anopheles mosquitoes to humans. Four parasitic protozoa of the genus Plasmodium (Plasmodium ovale, Plasmodium vivax, Plasmodium malaria, Plasmodium falciparum) cause malaria. Of the 4 species, P falciparum causes the most severe morbidity and mortality. Malaria can also be transmitted via a blood transfusion or congenitally between mother and fetus, although these forms of infection are rare. According to the World Health Organization estimate, there are around 300-500 million cases of malaria and more than one million people die due to malaria.

Causes

• Bites from infected Anopheles mosquitoes
• Transfusion of infected blood

Risk Factors

• Traveling and/or living in endemic area

Signs and Symptoms

• Fever
• Flu-like illness
• Chills
• Headache
• Muscle ache
• Tiredness
• Nausea
• Hemolysis
• Diarrhea
• Anemia

DIAGNOSIS

Dirferential dlagnosis

• Babesiosis
• Q Fever
• Viral Hemorhagic Fevers
• Dengue Fever
• Encephalitis
• Endocarditis
• Gastroenteritis
• Giardiasis
• Hepatitis
• Hypothemia
• Leishmaniasis
• Meningitis
• Mononucleosiss
• Pneumonia
• Tropical splenomegaly
• Blood dyscrasias

Investigations

• Malarial smear
• Indirect fluorescent antibody (IFA)
• ELISA
• DNA probe
• Renal function tests
• Urine and blood cultures
• .Chest X-ray
• CT scan of the head
• Microhematocrit centrifugation
• Giemsa-stained thick and thin peripheral blood smears
• Polymerase chain reaction
• parasite F (dipstick test)

TREATMENT

Goal

• identity the type of parasite and treat accordingly

Pharmacological treatment
Classes of drugs used are:

• Antipyretics
• Antiprotozoal
• Antimalarials

PATIENT EDUCATION

• Take prophylactic drugs at proper intervals if traveling to endemic regions... Use topical insect repellent (30-35% diethyltoluamide [DEET]),especially from dusk to dawn.
• Wear long-sleeved permethrin-coated clothing if not allergic to permethrin; spray under beds,chairs, tables, and along walls.
• Sleep under fine-nylon netting impregnated with permethrin.
• Seek medical attention immediately upon contracting any tropical fever or flu-like illness.

Complications

• Coma (cerebral malaria)
• Seizures
• Renal failure
• Hemoglobinuria (blackwater fever)
• Noncardiogenic pulmonary edema
• .Profound hypoglycemia
• Lactic acidosis
• Hemolysis resulting in severe anemia and
• jaundice
• Bleeding (coagulopathy).

Prognosis

• Most patients with uncomplicated malaria exhibit marked improvement within 48 hours after the initiation of treatment and are fever-free after 96 hours.
• Only P falciparum infection carries a poor prognosis with a high mortality rate if untreated. However, if diagnosed early and treated appropriately, the prognosis Is excellent.