Malaria: Difference between revisions

Revision as of 00:07, 10 June 2012

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

Diagnosis

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

Classification

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%
Uncomplicated
1. None of the above

Treatment

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

Treat hypoglycemia
Check HIV status (coinfection can lead to worse clinical outcomes)
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

Admission for:
1. Patients with suspected or confirmed P falciparum or P knowlesi infection
2. Children
3. Pregnant women
4. Immunodeficient individuals
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)

Source

Medscape

Authors:

@@ Line 1: / Line 1: @@
-# most imp cause of fvr
+==Background==
-# plasmodium falciparum can be rapidly fatal and needs to be ruled out soon
+*Caused by parasitic protozoa species of the genus Plasmodium (P ovale, P vivax, P malariae, P knowlesi, and P falciparum)
-# p falciparum from sub Saharan Africa, 90% of pt have sx within 1 mo of return
+**P falciparum most severe
-# p vivax- Asia and Latin, 50% pt have sx within 1 mo- 2% up to 1 yr out
+*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
+*Chemoprophylaxsis does not guarantee protection
-# usually have fvr, but 10- 40% may not
+*CDC Malaria Hotline: 770-488-7788
-# fvr q 48- 72 hr pathognomic of vivax, ovale, malariae infc
+*Malaria is a US nationally notifiable disease and all cases should be reported
-# can also have ha, cough, gi sx
-# check thick smear initially and if neg, repeat in 12- 24 hrs
+==DDX==
-# thrombocytopenia and splenomegaly common
+*[[Fever]]
-# p falciparum unpredictable- admit and monitor for hypoglycemia
+*[[Travel Medicine]]
-# iv meds if renal, resp failure, ams, sx, shock, anemia, p falcip rbc load >4% in nonimmune pt
+==Diagnosis==
+*High index of suspicion if fever + travel to endemic region
+**See list by country: [[http://wwwnc.cdc.gov/travel/destinations/list.htm]]
+*Symptoms
+** HA, cough, GI
+**thrombocytopenia and splenomegaly common
+*check thick and thin smear initially and if neg, repeat in 12- 24 hrs
+===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==
+#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
+#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 medications see: [[http://www.cdc.gov/malaria/resources/pdf/treatmenttable.pdf]]
+==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==
 [[Travel Medicine]]
+==Source==
+Medscape
 [[Category:ID]]
 [[Category:TropMed]]