Malaria

• Malaria is an infectious disease caused by members of the Plasmodium family of protozoan parasites - most common type associated with UK cases is Plasmodium falciparum
• Malaria is spread through bites from the female Anopheles mosquitoes that carry the disease
• Risk factors:

  • Travel to sub-Saharan Africa, southeast Asia and part of south America
  • Pregnant people, young children and older people
  • Immunocompromised people
  • Inadequate use of chemoprophylaxis
• Symptoms:

  • Fever with sweats and rigors
  • Fatigue
  • Myalgia (muscle aches and pain)
  • Headache
  • Nausea
  • Vomiting
• Signs on exam:

  • Pallor due to anaemia
  • Hepatosplenomegaly
  • Jaundice - rupture of red blood cells
• The most characteristic symptom of malaria is a fever which spikes very high every 48 hours - cyclic fever
• Diagnosis:

  • Malaria blood film
  • Will show the parasites (concentration and type)
  • Three negative samples over three days are required to exclude malaria due to the parasites being released from red blood cells every 48-72 hours
• Management:

  • Notifiable disease in UK
  • Inform infectious diseases team
  • Uncomplicated - Artemether with lumefantrine (Riamet)
  • Severe - IV Artesunate - Quinine if Artesunate is not immediately available
• Complications:

  • Cerebral malaria
  • Seizures
  • Reduced consciousness
  • AKI
  • Pulmonary oedema
  • DIC
  • Severe haemolytic anaemia
  • Multi-organ failure and death
• Prophylaxis:

  • Proguanil with atovaquone (Malarone)
  • Doxycycline