MALARIA - SUMMARY UPDATE 2022 by mhafzam.pptx

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1. SUMMARY MALARIA DEFINITION An acute febrile illness caused by Plasmodium parasites Transmitted by bites of infected female anopheles mosquito Plasmodium Species Falciparum Knowlesi Vivax Ovale Malariae CURRENT MALARIA STATUS IN MALAYSIA Pre – elimination phase via control strategies using Usage of mosquito nets Increase spraying Increase use of ACT PATHOPHYSIOLOGY Pattern of Fever DIAGNOSIS OF MALARIA BFMP Thin and thick slide Result should available in < 2hours FBC Normal TW, occasional lymphopenia Neutrophenia : severe or 2ry infection Thrombocytopenia : 90% immunocomp Anemia Busec / Alb Low in Sodium / Calcium / Albumin LFT Raised bilirubin, if LFT normal = hemolysis phase Glucose Hypoglycaemia = severe malaria or due to quinidine treatment Severe Malaria GCS <11 in adult Prostration Seizures >2 / 24h Acidosis ( Base <-8, HOC3<15, Lac > 5 ) Hypoglycaemia <2.2 Significant bleeding Severe anemia + parasites >10000 + Adult:HB <7(HCT <20%) Child :HB<5,HCT<15% AKI:Urea >20, Creat >265 APO @ Jaundice Shock SUPPORTIVE MX OF MALARIA FLUID Judicious fluid mx : iatrogenic overload Bolus fluid : Contraindicated Early HD if AKI / severe met acidosis Blood Tx If severe anemia as stated above Antibiotic Low threshold, if indicated – braod sprectrum abx Anti - seizures IV route prefer, if not rectal Prophylaxis not recommended Choice : BZD / paraldehyde Choices of Antimalaria Severe Malaria ? If Yes : IV Artesunate 2.4mg/kg BW If not severe and but has vomiting : IV Artesunate If not severe and no vomiting, look for species PK/PF : T Riamet , if >35kg, 4 tablets Vivax : T Chloroquine + T Primaquine If in pregnancy IV artesunate in all trimester, if no IM artemeter , if no IV quinine