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Malaria: Department of Internal Medicine, School of Medicine
Malaria: Department of Internal Medicine, School of Medicine
Malaria: Department of Internal Medicine, School of Medicine
27-Jun-21
Definition
• Malaria is a protozoan disease transmitted to man by the bite of the female
anopheles mosquitoes. (Anopheles arabiensis)
• Five species of the genus Plasmodium cause nearly all malarial infections in humans.
• On average,
• Endemicity of malaria is based on splenic rates (proportion of palpable spleen in children between 2 & 9 years):
• Hypo endemic - < 10%
Unstable
• Meso-endemic - 10-50% transmission
• Hyper-endemic - 51-75%
Stable
• Holo-endemic - > 75%
transmission
Life cycle and pathogenesis
• Hypnozoites
• Ring forms and gametocytes
can be found on peripherally.
Clinical features
• Incubation period:
• 10-14 days in P. vivax, P. ovale, & P. falciparum, and
• 18 days to 6 weeks in P. malariae.
• Classical regular paroxysms of high grade fever, chills and rigors occurring every
• 2 days (Tertian) in P. vivax and P. ovale,
• 3rd day (Quartan) in P. malariae,
• Irregularly in P. falciparum
Uncomplicated vs Complicated
• Uncomplicated malaria: - fever, malaise, and mild anemia, a palpable spleen and
liver and mild jaundice.
• Young Children
• Pregnant women
Clinical Criteria for Complicated malaria
1. Cerebral Malaria
• Failure to localize or respond appropriately to noxious stimuli;
• Results from: -
• Failure of hepatic gluconeogenesis
• Increase in the consumption of glucose by both host and the malaria parasites.
• Quinine
3. Acidosis
• Arterial pH of <7.25 or plasma bicarbonate level of <15 mmol/L; venous lactate level of >5
mmol/L.
• Results from:
• Anaerobic glycolysis in host tissues where sequestered parasites interfere with microcirculatory flow
• Hypovolemia
• This complication may develop even after several days of antimalarial therapy.
• Results from:
• Erythrocyte sequestration and agglutination interfering with renal microcirculatory flow and
metabolism (acute tubular necrosis).
• In survivors, urine flow resumes in a median of 4 days, and serum creatinine levels return
to normal in a mean of 17 days.
6. Anemia
• Severe normochromic, normocytic anemia with hematocrit of <15%, Hgb <5g/dl.
• Acute anemia – in non-immune individuals and areas with unstable transmission.
• Results from:
• Hemolysis of parasitized red cells
• Increased splenic sequestration and clearance of erythrocytes with diminished
deformability
• Cytokine suppression of hematopoiesis
• Shortened erythrocyte survival
• Repeated infections and
• Ineffective treatments
7. Liver dysfunction
• Serum bilirubin level of >3 mg/dL if combined with other evidence of vital-organ
dysfunction.
• Severe jaundice
• Is associated with P. falciparum infections;
• Is more common among adults than among children.
3. Burkitt's Lymphoma
• Lives in malaria-endemic areas or has a history of travel within the last 30 days to malaria-
endemic areas.
• Coagulation profile
• Serum Na
Species Diagnosis
P. falciparum P. vivax P. ovale P. malariae
Number of parasites
multiple Usually one Usually one Usually one
per RBC
Schuffner's
Band forms,
Other Banana-shaped granules,
Schuffner's granules gametocytes fill
characteristics gametocytes gametocytes fill
cytoplasm
cytoplasm
P. Falciparum & P. Malariae
P. Vivax & P. Ovale
Treatment
• Classified as Uncomplicated Vs. Complicated/Severe malaria
• Further classified into –
• First line
• Second line &
• Supportive Treatments.
• Objective is to:
- Cure
- Reduce transmission of infection.
- Prevent the emergence & spread of resistance.
Treatment of Uncomplicated Malaria
➢First line Drugs – P. Falciparum or Mixed Infection
• Artemisinin-based Combination Therapy (ACTs),
• A medical emergency !!
• Medications
• IV or IM Artesunate preferred - 2.4 mg/kg on admission, at 12h and 24h, then daily x 5-7 days
▪ 2 Components
2. Chemoprophylaxis
1. Vector Control
• Environmental management
• Larviciding
• Proper clothing
2. Chemoprophylaxis
• For all visitors to and residents of the tropics who have not lived
there since infancy, including children of all ages