| ID | 190 |
|---|---|
| Name | MALARIA |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: Blood for malarial parasite (M.P)- well stained thick and thin blood films seen under microscope- repeat if mecessary. |
| Management | Management of malaria: A. Uncomplicated malaria: Day Drug Weight in Kg - - 30-39 40-49 >50 1st Chloroquine tablet (150mgbase*) 2nd “ 2 3 4 “ 2 3 3 3rd “ 2 3 3 4th Primaquine 15mg tab. l½ 2 3 * The initial dose for children is 5-15mg/kg. B. Treatment failure or when there is no response with chloroquine: Day Drug Weight in Kg - - 30-39 40-49 >50 1st Quinine (300mg tab.) l½ 2 2 TDS 2nd “ “ “ “ 3rd Quinine (300mg tab.) TDS + + + + Fansider 2 1½ 3 4th Primaquine single dose 1½ 2 3 C. In severe malaria: 1. A loading dose of Quinine dihydrochloride 20mg/kg body wt, by i.v infusion in 5% dextrose saline (5-10ml/kg) for 4 hours (never by bolus 1.v infusion). Or, the same dose may be given by i.m injection in 2 divided doses into 2 sites i.e in each anterior thigh at a concentration of 60mg/ml. 2. Maintenance dose- should be started 12 hours after loading dose-Quinine dihydrochloride 10mg/kg body wt. by very slow i.v infusion as before in DA (dextrose in aqua). When patient is able to take orally, treatment should be given orally with Quinine 2 tablet 3 times daily upto 3-7 days + single dose of Fansider (3 tablet) on 3rd day + Primaquine 112 tablet on 4th day of oral therapy. General management: 1. Bed rest. 2. Paracetamol 500mg t.d.s after meal. 3. Ice bag and cold sponging. 4. Adequate diet and fluid should be given. |
| Introduction | Malaria is caused by a protozoa of the genus plasmodium, transmitted to man almost always by the infected female anopheles mosquito. Malaria may also be transmitted by blood transfusion or inoculation. There are four species of malarial parasites e.g P. falciparum producing malignant tertain malaria, P. vivax producing benign tertian malaria, P. ovale producing ovale tertian malaria and P. malarie producing quartan malaria. The incubation period is 10-15 days |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Clinical manifestations vary according to different species of plasmodium. Some features are common. These are fever, chill and rigor, headache, muscle pain, anemia, herpes labialis, enlargement of spleen & liver and mild jaundice. Paroxysmal attacks are characteristic of malaria except in plasmodium falciparum infection. A typical paroxysm may be divided into - 1. Cold stage- lasting for 20 minutes to 1 hour, followed by- 2. Hot stage- lasting for 1-4 hour, followed by- 3. Sweating stage- which lasts for 2-3 hours. |
| Preventions | |
| Treatment | |
| Complications | Comlications: Comlications of malaria due to P. falciparum:1'2 1. Cerebral malaria with oedema 2. Hyperpyrexia 3. Severe anemia (hemolytic) 4. Organ damage due to anoxia- Brain: confusion, coma Kidneys: oliguria, uremia (acute tubular necrosis) Lungs: cough, pulmonary oedema Heart: cardiac dysrhythmias Intestine: diarrhoea, congestion, possibly leaky to bacteria Liver: acute hepatopathy, Jaundice, encephalopathy (rare) Adrenal: adrenal insufficiency- like syndrome 5. Intravascular hemolysis- Black water fever 6. Hypoglycemia, specially with quinine treatment 7. Septicemia secondary to shock 8. Hypotensive shock 9. Metabolic acidosis 10. Splenic rupture 11. In pregnancy-Maternal death, abortion, stillbirth, low birth weight. Comlications of malaria due to P. malarie:13 1. Glomerulonephritis & 2. Nephrotic syndrome in children. |
| Prognosis | |
| Types | Types of fever in malaria: 1. Tertian fever (P. vivax or P. ovale)- paroxysm occurs on alternate days. Spleen becomes palpable. 2. Quartan fever (P. malarie)- paroxysm occur at interval of 2 days. Scanty urine, albuminuria and hematuria may occur. Falciparum fever (P. falciparum)- the onset may be insidious and the fever continuous, remittent or irregular. Typical paroxysms are unusual. Splenomegaly and serious complications may develop. Quotidian fever- fever recuring at intervals of 24 hours. Such type of fever has been observed in mixed infections with P. vivax & P. malarie due to maturation of 2 generation of tertian parasites and 3 generation of quartan parasites. |
| Classification | |
| Observation | |
| Pathology |
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