Malaria
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Transcript of Malaria
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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