CLINICAL

FEATURES OF
TYPES
OF
MALA
RIA
AND
CAUS
ES
 EARLY SYMPTOMS
The common symptoms include
fever, headache, chills and vomiting
usually reappear after 10-15 days
after a person is affected.
 If not treated promptly with
effective medicines, malaria can
cause severe illness and is often fatal.
 THREE STAGES OF
MALARIA
1. COLD STAGE :
 Lasts for 15 minutes to 1 hr
 Caused due to rupture from host red
cells escape into blood
 The patient feels lassitude, headache,
nausea, intense cold, chills and rigor.
2. HOT STAGE :
 Patient develops a high grade
fever of 39- 41°C and dry burning
skin
Last for several hours and start
invading newer cells
 Headache persists but nausea
diminishes
3. SWEATING STAGE :
Fever comes down with profuse
sweating.
The skin becomes cold and moist.
Patient feels relieved and often
asleep.
This stage lasts for 2-4 hrs.
In P. falciparum, fever more irregular
or even continuous with marked
prostration, headache and nausea.
 ANEMIA
Patient develops normocytic
normochromic anemia which may be
attributed to various factors.
 Parasite induced RBC destruction- Lysis
of RBC due to release of merozoites
 Splenic removal of both infected RBC
and uninfected RBC coated with immune
complexes
Bone marrow suppression leading to
decreased RBC production
 SPLENOMEGALY
After a few weeks of febrile
paroxysms, spleen gets enlarged
and becomes palpable.
Splenomegaly is due to massive
proliferation of macrophages that
engulf parasitized and non
parasitized coated RBCs.
 FALCIPARUM
MALARIA
(MALIGNANT TERTIAN
MALARIA)
Complications:
P. falciparum infection is more acute
and severe in nature with more
complications than benign.
 CEREBRAL MALARIA
 Most serious complication
 Due to plugging of brain capillaries
by sequestered parasitized RBCs
leading to vascular occlusion and
cerebral anoxia.
 Effect brain (appears congested) and
CNS
 Present with hyperpyrexia, paralysis
and can lead to coma
 PERNICIOUS
MALARIA
Life threatening complication in acute
falciparum malaria
 due to heavy parasitization
 Characterized by blackwater fever, algid
malaria and septicaemic malaria
 BLACK WATER

FEVER
characterized by sudden intravascular
hemolysis followed by fever,
hemoglobinuria and dark urine.
 occurs after quinine treatment to
subjects previously infected with P.
falciparum
 Complement mediated massive
destruction of both parasitized and non
parasitized RBCs
 ALGID MALARIA
• cold clammy skin
• Hypotension
• Peripheral circulatory failure
• Profound shock
SEPTICAEMIC
MALARIA
High grade fever with
dissemination of parasite to
various organs leading to
multiorgan failure
PULMONARY EDEMA &
ADULT RESPIRATORY
DISTRESS SYNDROME
 Severe falciparum malaria
may in adults may lead to
noncardiogenic pulmonary
edema, often aggravated by
over hydration.
It does not usually respond to
anti-malarial therapy.
Mortality rate >80%
 HYPOGLYCEMIA
 assosciated with poor prognosis
 particularly problematic in
children and pregnant women and
after quinine
 RENAL FAILURE
due to erythrocyte
sequestration in renal
microvasculature
leading to acute
tubular necrosis.
 Adults > children
 BLEEDING/ DISSEMINATED
INTRAVASCULAR
COAGULATION
Patient presents with significant
bleeding and haemorrhages
from gums, nose and intestines
with or without evidence of
disseminated intravascular
coagulation.
 SEVERE JAUNDICE
o adults > children
o Results from
hemolysis , hepatocyte
injury and cholestatis
 SEVERE
NORMOCHROMIC,
NORMOCYTIC
ANEMIA
Haematocrit < 15%
(or)
Haemoglobin < 5g/dl
with parasitemia level >
105 / μl ( >2%)
 ACIDOSIS
From accumulation
of organic acids like
lactic acid.
 CHROMIC
COMPLICATIONS
1. Tropical splenomegaly syndrome
 alsocalled as hyper- active malarial
splenomegaly occurs in endemic areas
 results from abnormal immunologic response to
repeated malaria infections and characterized by
elevated IgM and massive splenomegaly.
 Patients respond well to anti malarial
chemoprophylaxis.
QUARTAN MALARIAL
NEPHROPATHY
PROMOTES BURKITT’S
LYMPHOMA
 REFEREN
CES:
• Essentials of medical microbiology by
Apurba Sastry
• Manual of practical medicine by R
Alagappan
• Malaria immunology by Karger
publishers
• Internet