Manifestation of severe falciparum malaria
A CRASH CHaT
A
Acidosis
pH < 7.25, HCO₃ < 15 mmol/L, lactate > 5 mmol/L → respiratory distress
C
Coma (Cerebral malaria)
Unarousable > 30 min after seizure
R
Renal failure
Creatinine > 265 µmol/L (> 3 mg/dL) or urine < 400 mL/day
A
Anemia (Severe normocytic)
Hb < 5 g/dL or Hct < 15% with parasitemia > 10,000/µL
S
Shock (Hypotension)
SBP < 80 mmHg (adults) or < 50 mmHg (children); cap refill > 2 s
H
Hypoglycemia
Glucose < 2.2 mmol/L (< 40 mg/dL)
C
Coagulopathy (DIC/Bleeding)
Bleeding gums, GI bleed, DIC evidence
H
Hypoxia (Pulmonary edema/ARDS)
Non-cardiogenic pulmonary edema
a
(and)
—
T
Twitching (Convulsions)
≥ 2 seizures in 24 h; tonic-clonic eye movements
are the best biochemical prognosticators in severe malaria
Plasma concentrations of bicarbonate or lactate
Poor prognosis in severe malaria
BAD CLASH + LAB CHAMP = Poor Prognosis in Severe Malaria
should be avoided as follow-on treatment for severe malaria because of the increased risk of post-malaria neurologic syndrome
Mefloquine
is the only drug advised for pregnant women traveling to areas with drug-resistant malaria
Mefloquine
Provides radical cure in malaria*Radical cure; eradicates hepatic forms of P. vivax and P. ovale; kills P. falciparum gametocytes development; kills developing liver stages of all species
Primaquine
Do not give in pregnant, give chloroquine instead
Anti malarial prohylaxis should be started
2 days to 2 weeks before travel and 4 weeks after leaving except if with if atovaquone-proguanil or primaquine, may stop after 1 week
