Malaria

Background

• Caused by parasitic protozoa species of the genus Plasmodium (P ovale, P vivax, P malariae, P knowlesi, and P falciparum)
  • 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

DDX

• Fever
• Travel Medicine

Diagnosis

• High index of suspicion if fever + travel to endemic region
  • See list by country: [[1]]
• Symptoms
  • Fever
    • Cyclic only after chronic infection
  • HA, cough, GI
  • thrombocytopenia and splenomegaly common
• check thick and thin smear initially and if neg, repeat in 12- 24 hrs

Classification

1. Severe
   1. Any one of the following:
      1. AMS/coma
      2. Severe normocytic anemia [hemoglobin < 7]
      3. Renal failure
      4. ARDS
      5. Hypotension
      6. DIC
      7. Spontaneous bleeding
      8. Acidosis
      9. Hemoglobinuria
      10. Jaundice
      11. Repeated generalized seizures
      12. Parasitemia >5%
2. Uncomplicated
   1. None of the above

Treatment

1. 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)

• ]]Hyponatermia]] in the setting of hypovolemia does not require treatment beyond rehydration

1. Treat hypoglycemia
2. Check HIV status (coinfection can lead to worse clinical outcomes)
3. Exchange transfusion for patients with:
   1. P falciparum malaria with a parasitemia greater than 10%
   2. Life-threatening complications (ie, coma, respiratory failure, coagulopathy, fulminant kidney failure)

For specific medications see: [[2]]

Disposition

1. Admission for:
   1. Patients with suspected or confirmed P falciparum or P knowlesi infection
   2. Children
   3. Pregnant women
   4. Immunodeficient individuals
2. ICU for:
   1. Severe complications (e.g.coagulopathy or end-organ failure)
   2. Cerebral malaria (e.g. AMS, repeated seizures, coma)
   3. Parasitemia
      1. >2% in pts non-immune (i.e. travelers)
      2. >5% in pts semi-immune (i.e. locals)

See Also

Travel Medicine

Source

Medscape