Malaria: Difference between revisions
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'''Severe''' | '''Severe''' | ||
Any one of the following: | Any one of the following: | ||
*AMS/coma | |||
*Severe normocytic anemia [hemoglobin < 7] | |||
*Renal failure | |||
*ARDS | |||
*Hypotension | |||
*DIC | |||
*Spontaneous bleeding | |||
*Acidosis | |||
*Hemoglobinuria | |||
*Jaundice | |||
*Repeated generalized seizures | |||
*Parasitemia >5% | |||
'''Uncomplicated''' | '''Uncomplicated''' | ||
*None of the above | |||
==Treatment<ref>World Health Organization. Guidelines for the treatment of malaria. Second edition. Geneva: World Health Organization; 2009:1-194</ref>== | ==Treatment<ref>World Health Organization. Guidelines for the treatment of malaria. Second edition. Geneva: World Health Organization; 2009:1-194</ref>== | ||
*Mixed infections involving more than one species of Plasmodium may occur in areas of high endemicity (have a low threshold for including treatment for P falciparum) | |||
*[[Hyponatremia]] in the setting of hypovolemia does not require treatment beyond rehydration | |||
*Treat [[hypoglycemia]] | |||
*Check HIV status (coinfection can lead to worse clinical outcomes) | |||
*Exchange transfusion for patients with: | |||
**P falciparum malaria with a parasitemia greater than 10% | |||
**Life-threatening complications (ie, coma, respiratory failure, coagulopathy, fulminant kidney failure) | |||
| Line 71: | Line 71: | ||
==Disposition== | ==Disposition== | ||
;Admission for: | ;Admission for: | ||
*Patients with suspected or confirmed P falciparum or P knowlesi infection | |||
*Children | |||
*Pregnant women | |||
*Immunodeficient individuals | |||
;ICU for: | ;ICU for: | ||
*Severe complications (e.g.coagulopathy or end-organ failure) | |||
*Cerebral malaria (e.g. [[AMS]], repeated [[seizures]], coma) | |||
*Parasitemia | |||
**>2% in pts non-immune (i.e. travelers) | |||
**>5% in pts semi-immune (i.e. locals) | |||
==See Also== | ==See Also== | ||
Revision as of 02:26, 10 June 2015
Background
- Caused by parasitic protozoa species of the genus Plasmodium (P ovale, P vivax, P malariae, P knowlesi, and P falciparum) carried by the Anopheles mosquito
- P falciparum most severe
- Failure to consider for febrile illness following travel, even if seemingly temporally remote, can result in significant morbidity or mortality, especially in children and pregnant or immunocompromised patients
- Chemoprophylaxsis does not guarantee protection
- CDC Malaria Hotline: 770-488-7788
- Malaria is a US nationally notifiable disease and all cases should be reported
Traveler Precautions
The CDC recommends travelers to malaria-endemic regions take the following precautions:[1]
- Chemoprophylaxis
- Use of insecticide-treated bed nets
- Use of DEET-containing insect repellents
- Wear long-sleeve shirts and pants
Clinical Features
- Fever + exposure to endemic country
- Cyclic only after chronic infection
- HA, cough, GI
Differential Diagnosis
Fever in traveler
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid fever
- Typhus
- Viral hemorrhagic fevers
- Chikungunya
- Yellow fever
- Rift valley fever
- Q fever
- Amebiasis
- Zika virus
Diagnosis
High index of suspicion if fever + travel to endemic region
- Check thick and thin smear initially and if neg, repeat in 12- 24 hrs
- Thrombocytopenia and splenomegaly common
Classification
Severe Any one of the following:
- AMS/coma
- Severe normocytic anemia [hemoglobin < 7]
- Renal failure
- ARDS
- Hypotension
- DIC
- Spontaneous bleeding
- Acidosis
- Hemoglobinuria
- Jaundice
- Repeated generalized seizures
- Parasitemia >5%
Uncomplicated
- None of the above
Treatment[2]
- Mixed infections involving more than one species of Plasmodium may occur in areas of high endemicity (have a low threshold for including treatment for P falciparum)
- Hyponatremia in the setting of hypovolemia does not require treatment beyond rehydration
- Treat hypoglycemia
- Check HIV status (coinfection can lead to worse clinical outcomes)
- Exchange transfusion for patients with:
- P falciparum malaria with a parasitemia greater than 10%
- Life-threatening complications (ie, coma, respiratory failure, coagulopathy, fulminant kidney failure)
- For specific dosing see the CDC Recommendations or call the Malaria CDC Hotline(855) 856-4713
Uncomplicated Malaria
- Atovaquone-proguanil or
- Arthemeter-lumefantrine or
- Quinine plus Tetracycline, doxycycline, or clindamycin
Severe Malaria
- Intravenous quinidine plus tetracycline, or doxycycline or clindamycin
Cerebral Malaria
- Insufficient evidence for or against giving antiepileptics
- For severe cerebral edema, mannitol and steroids have not show a demonstrable benefit
Disposition
- Admission for
- Patients with suspected or confirmed P falciparum or P knowlesi infection
- Children
- Pregnant women
- Immunodeficient individuals
- ICU for
- Severe complications (e.g.coagulopathy or end-organ failure)
- Cerebral malaria (e.g. AMS, repeated seizures, coma)
- Parasitemia
- >2% in pts non-immune (i.e. travelers)
- >5% in pts semi-immune (i.e. locals)
See Also
References
- ↑ WHO Malaria Policy Advisory Committee and Secretariat. Malaria Policy Advisory Committee to the WHO: conlusionsions and recommendations of September 2013 meeting. Malar J. 2013;12(1):456
- ↑ World Health Organization. Guidelines for the treatment of malaria. Second edition. Geneva: World Health Organization; 2009:1-194