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Pathology
Disease found predominantly in tropical / subtropical areas. Protozoan infection transmitted by the bite of female Anopheles mosquito.
All 6 species give rise to similar symptoms, but Plasmodium falciparum is responsible for most deaths and complications.
P ovale and P vivax have dormant liver stages called hypnozoite, which can give rise to recurrent attacks over several months for up to 5 years.
Aetiology
Protozoan parasites. P. falciparum, P. vivax, P. ovale, P. malariae, P. knowlesi, P. ovale wallikeri.
Signs
No specific physical findings.
Symptoms
Uncomplicated: Chills, rigors, fever, intense headache and myalgia, headache
and exhaustion persist till next paroxysm.
Complicated falciparum malaria: Hypoglycaemia, diarrhoea, pulmonary
oedema, bleeding, severe anaemia, renal failure haemoglobinuria, cerebral malaria.
Cerebral malaria (WHO definition = GCS < 11)
o Confusion, aggression
o Focal neurological signs, seizures
o Retinal haemorrhage
Investigations
Bloods: FBC, Thick and Thin blood films for malarial parasites, U&E, LFTs..
Treatment
Uncomplicated malaria: (vivax, ovale and malariae): chloroquine, primaquine.
Falciparum malaria: Chloroquine resistance is almost universal for falciparum
malaria. Oral quinine 5-7 followed with 1 week of
doxycycline or atovaquone with proguanil (Malarone)
Prophylaxis: Should be taken before the start and end of the trip.
Prognosis
Uncomplicated malaria will usually recover with no sequelae if treated.
High mortality from untreated falciparum malaria.
Acute: Hypoglycaemia, pulmonary oedema, AKI, acidosis, sepsis, cerebral
malaria, GI involvement, splenic rupture.
Chronic: Quartan malarial nephropathy, hyper-reactive splenomegaly.
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