CASE PRESENTATION OF MALARIA

Case presentation of malaria includes patient demographics, chief complaints, past medical and medication history, personal history, physical examination, laboratory investigations, treatment, Adverse drug reactions, disease information includes definition, causative organism and their classification, clinical presentation, pathophysiology, diagnostic tests, anti malarial drugs patient counseling, lifestyle modifications.

1. CASE PRESENTATON ON MALARIA presented by M.DURGA ROHITHA Pharm-d VI year 174T1T0005

2. PATIENT DEMOGRAPHICS Patient Name : Venkatasai Age : 22yrs Gender : Male DOA : 19/7/22 Dept : MMW CHIEF COMPLAINTS ; Headache and nausea feeling - since 3 days. Chills with intermittent fever – since 3 days. Weakness/tiredness – since 3 days. PAST MEDICAL HISTORY ; NILL

3. Personal history : Diet – veg Sleep – sleeplessness Allergies – no Appetite – normal Physical examination: Vitals Day1 Day2 Day3 Day4 Bp (mmHg) 110/70 110/70 110/70 110/70 Spo2(%) 98 98 98 98 Temp(0f) 101 100 99.8 98.6 PR(bpm) 80 83 83 76

4. Laboratory investigation : Parameter Observed values Normal values RBC count 3.1mil/ cumm 3.8-5.8mill/ cumm Esinophils 10% 1-6% Direct serum bilirubin 0.3mg/dl 0-0.25mg/dl Indirect serum bilirubin 0.9mg/dl 0-0.75mg/dl Total bilirubin 1.2mg/dl 0.1-1.0mg/dl PLT count (1-400000 cells/cum) Day1 day2 Day3 day4 33000 8.Am-35000 7.30pm-40000 45000 55000 65000 Other investigations : RDT + ve

5. DIAGNOSIS : MALARIA

6. SOAP NOTES : Subjective Headache and nausea feeling - since 3 days. Chills with intermittent fever – since 3 days. Weakness/tiredness – since 3 days . Objective temp-1010f. platelet count-33000cells/cum. eosinophils-10%. Assessment based on patient chief complaints and laboratory abnormalities and RDT test the patient was diagnosed as ALGID malaria.

7. P-PLANNING DAYS OF TREATMENT Brand name Genric name ROA Dose Frequency 1 2 3 4 I.Oframax Ceftriaxone IV 1gm BD - - - I.Oframax forty Ceftriaxone + sulbactum IV 1.5gm BD - I.Larinate Artisunate IV 120mg BD I.Pacimol Paracetomol IV 100ml OD - - - T.Dolo Paracetomol ORAL 650mg TID - IVF ringers solution & normal saline - IV - OD - - - IVF-NS - IV - OD - - T.Pantop Pantaprazole Oral 40mg OD

8. ceftriaxone * 3 rd generation antibiotic from cephalosporins family. * selectively and irreversibly inhibits bacterial cellwall synthesis by binding to transcmdiasis which are penicillin binding protin . * PBP is repair mechanism that normaly helps to maintain bacterial cellwall integrity. * Uses UTI ,infection of ears , lungs , sorethroat . ceftriaxone + sulbactum - * cettriaxone works by interfering and certain process,that helps the bacterial to grow and increses in number. * sulbactum inhibits some chemicals produce by the bacteria and makes the bacteria more sensitive to the ceftriaxone activity. pantoprazole- PPI(proton pump inhibitor) * PPI irreversibly binds to the H+/K+ ATPase pump. then prevent the movement of hydrogen ions from parietal cells into stomach it results no. * HCL production it means neutralizes the excess acid. * Uses prevent ulcers,GERD . A rtisunate – antimalarial drug It is a prodrug,rapidly converted into DHA then inhibition of DNA replication and transcription . Pantaprazole - Inhibits prostaglandin synthesis.

9. DISEASE INFORMATION DEFINATION: Malaria is a mosquito-borne infectious disease that affects humans and other animals . Mainly it is caused by plasmodium species. Causative organisms: P . Vivax , p . Falciparum , p . ovalae , p. malarial, p. knowlesi Cla ssification: Algid malaria - p. falciparum - cause hemodynamic disorders. Bilious malaria - p.falciparum - affects liver. Cerebral malaria - p.falciparum - affects cerebrum. Congenital malaria - p.falciparum / p.vivax - mother via fetal circulation. Transfussion malaria - various plasmodium species - introduced by blood transfusion, needles sharing. Qustidian malaria - p.falciparum and p.vivax - recurrent fever every 36 to 48hrs. Tertian malaria - p.falciparum and p.vivax and p.ovalae - paroxysms occurring every 2 days .

10. Signs and symptoms

11. Pathophysiology

12. Diagnostic tests: L ight microscopy-species identification. serology tests-for antibody against malarial parasite. RDT- detects specific antigen produced by malarial parasite in blood of infected individual. some RDT can detect only one species ( p.falciparum ) while others detect multiple species. PCR – amplification of malaria DNA. I mmunofluorescence

13. Anti malarial drugs Cinchona alkaloids – quinine, quinidine Quinoline methanol – mefloquine 4-aminoquinoline – choloroquine , piperaquine Biguanides - chloroquanides 8-aminoquinolines – primaquins.tafenoquine Sulfonamides and sulfons – sulfadoxine,sulfamethopyrazine Naphihyndine – pyronaridines Ivophthoquinom – atovaquaone Sesquiturine analogues – arthemether , artesunate Newly antimalarial – arthemisinon , fosmidomycin Pregnant women - quinine 600mg- TID + clindamycin- 300mg TID

14. PATIENT COUNSELLING Malaria can often be avoided using abcd approach to prevention. A : awareness of risk; find out whether your at risk of getting malaria. B : bite prevention; avoid mosquito bites by using insect repellants covering your arms and legs and using a mosquito nets. C : check whether you need to take malaria prevention tablets; if you do make sure you take the night antimalarial tablets at right dose and finish the coarse. D : diagnosis; seek immediately medical advice if you have malaria symptoms.

15. Life style changes: Avoid junk oil ad spicy foods Go for long sleeves Use insect repellent Take vit C and A rich foods such as popaya , beetroot, other citrous foods T vit B complex Take orange juicies -may helps in boostimg immunity ,also helpful to reduce fever.