Malaria

Question 1

What are the different malaria species?

Answer 1

• Plasmodium falciparum,
• Plasmodium vivax (most common),
• Plasmodium ovale,
• Plasmodium malariae
• Plasmodium knowlesi

Question 2

What are protective factors for malaria?

Answer 2

• Sickle cell anaemia,
• G6PD deficiency
• HLA - B53
• Absence of duffy antigens

Question 3

What are the features of non-falciparum malaria?

Answer 3

• Fever, headache, splenomegaly
• Fever cycles. Every 48 hours for vivax and ovale and every 72 hours for malariae.
• Malariae is associated with nephrotic syndrome.
• Ovale and vivax can lay dormant in hepatocytes to relapse may occur.
• Incubation is 1-4 weeks but can lay dormant for many years

Question 4

What are the signs and symptoms of malaria?

Answer 4

• Fever - Very common feature, think about any recent travel in past 4 years.
• Fatigue,
• Myalgia,
• Headache,
• Nausea,
• Vomiting,
• Pallor due to anaemia,
• Hepatospelnomegaly,
• Jaundice

Question 5

What are the investigations for malaria?

Answer 5

• PCR
• Blood films (thick and thin)
• Antigen testing
• Do other bloods: U&Es, LFTs, glucose, ABG

Question 6

What is the management of non-falciparum malaria?

Answer 6

1. Artemether based therapies or chloroquine if sensitive.
2. All patients with vivax or ovale should be given primaquine following treatment with chloroquine to destroy liver hyponozites and prevent relapse. However must test for G6DP deficiency first as primaquine may cause haemolysis in these individuals.

Question 7

What are features of severe falciparum malaria?

Answer 7

• Schizonts on blood film,
• Parasitaemic > 2%. If > 2% then high risk of developing into severe
• Hypoglycaemia,
• Acidosis,
• Temperature > 39
• Severe anaemia
• Complications

Question 8

What are the complications of severe falciparum malaria?

Answer 8

• Seziures, coma (cerebral malaria)
• Acute renal failure (blackwater fever due to haemolysis),
• Acute respiratory distress syndrome (ARDS),
• Hypoglycaemia
• DIC,
• Multi-organ failure

Question 9

What is the treatment for uncomplicated falciparum malaria?

Answer 9

• Artemether and lumafantrine
• Supportive care

Question 10

What is the treatment for severe malaria?

Answer 10

• IV artesunate
• Supportive management
• If patient is shocked then likely due to secondary bacterial infection so give antibiotics

Question 11

What are the prophylaxis for malaria?

Answer 11

• Mosquito spray,
• Mosquito nets/barriers,
• prophylaxis meds eg, doxycycline or Malarone

Question 12

what are risk factors for severe disease?

Answer 12

• Low host immunity,
• Pregnancy,
• Age under 5 years old,
• Immunocompromise
• Old age

Question 13

What are the differential diagnosis for malaria?

Answer 13

Dengue fever,
Zika virus,
Chikungunya virus
Yellow fever