Malaria

• Malaria is a notifiable disease.
• What is malaria caused by?

  4 different Plasmodium species can cause malaria in humans (Plasmodium falciparum is the most common)
• Pathophys of malaria

  Feeding mosquito sucks up infected blood → parasites reproduce in mosquito’s gut → thousands of sporozoites (malaria spores) → mosquito then bites someone & sporozoites are injected → travel to liver of newly infected person (can lay dormant = hyponozoites) → sporozoites mature into merozoites → enter blood & infect RBCs → merozoites reproduce in RBCs → RBCs rupture → releases more merozoites into blood → haemolytic anaemia

  Can have swinging fever every 48 hours → due to bursting of RBCs → inflammatory response
• What are the Inx for malaria?


  Obs

  Full Hx & examination

  Bloods (FBC, U&Es, LFTs, CRP, ABG)

  Blood film (gold standard)

  • Microscopy of thick & thin blood films
  • Thick → more sensitive
  • Thin → can determine species
  • Can also see reticulocytosis
• What are the RFs of malaria?


  Travel to endemic area

  Inadequate or absent chemoprophylaxis

  Insecticide-treated bed net not used in endemic area

  Pregnancy

  Immunocompromised

  Extremes of ages
• What are the red flags for malaria?

  Fever + Endemic travel
• What are the signs & symptoms of malaria?


  Non-specific symptoms

  • Fever (up to 41)
  • Fatigue
  • Myalgia (muscle aches & pains)
  • Headache
  • Nausea
  • Vomiting
  • Confusion
  • Pallor
  • Hepatospenomegaly
  • Jaundice
  • Bilirubin released during rupture of RBCs
• What are the possible complications of malaria?

  Cerebral malaria

  Seizures

  Reduced consciousness

  AKI

  Pulmonary oedema

  Disseminated intravascular coagulopathy (DIC)

  Severe haemolytic anaemia

  Multi-organ failure & death
• What is the treatment of malaria?


  Antimalarial medication

  Ring infectious diseases to ask for advice

  
  

  NOTE:

  • Anti-malarial medications are associated with neurological and psychiatric symptoms
  • Artesunate-type drugs are more efficacious and better tolerated in pregnancy than quinines
• What is the prophylaxis for malaria?


  Physical barriers

  Chemical barriers

  Avoidance measures

  Coils/electric vaporisers

  Insecticide spray

  Chemoprophylaxis