Treatment of falciparum malaria

By Sanjay Gowda

1. TREATMENT OF FALCIPARUM MALARIA SANJAY GOWDA 1

2. CONTENTS INTRODUCTION CLINICAL FEATURES INVESTIGATIONS TREATMENT OF UNCOMPLICATED F.MALARIA TREATMENT OF COMPLICATED F.MALARIA REFERENCE 2

3. INTRODUCTION Malaria in man is caused by four distinct species of malaria parasite.They are: P.vivax , P.falciparum , P.malariae and P.ovale . In India about 50 percent of infections reported are due to P.falciparum and 4-8 percent are due to mixed infections and the rest due to P.vivax . The malarial parasite undergoes 2 cycles of development- -the human cycle(asexual cycle) -the mosquito cycle(sexual cycle) occurs in infected female Anopheline mosquito. 3

4. CLINICAL FEATURES OF F.MALARIA Fever- In F.malaria the primary fever in first few days is usually irregular and then the classical 48 hr periodicity becomes established. The typical attack consists of 3 distinct stages i.e., a) Cold stage : The onset is with lassitude,headache,nausea and chills and rigors.Temperature rises rapidly to 39-41* c.This stage lasts for ¼-1 hr. b) Hot stage : The patient feels burning hot and casts off his clothes. The skin is hot and dry to touch.This stage lasts for 2-6 hrs. 4

5. CONTINUED…, c) Sweating stage: Fever comes down with profuse sweating. The temperature drops rapidly to normal and skin is cool and moist. > In persons with poor immunity the paroxysms are associated marked prostration and there is tendency to develop features of complicated malaria. 5

6. FEATURES OF COMPLICATED F.MALARIA Impaired consciousness/coma Repeated generalized convulsions Renal failure Jaundice Severe anaemia Pulmonary oedema Hypoglycaemia and metabolic acidosis DIC Haemoglobinuria,shock and death 6

7. INVESTIGATIONS Microscopy: two types of blood films are prepared on a single glass slide.They are: a) Thin film: For species identification b) Thick film: For detection and quantification of parasite. Serological test: The malarial fluorescent antibody test. Useful in epidemiological studies. Rapid diagnostic test: Based on detection of circulating parasite antigens with a simple dipstick format. 7

8. TREATMENT OF UNCOMPLICATED F.MALARIA In other states (other than North-Eastern states): 1) Artemisinin based combination therapy (ACT-SP)* Artesunate 4mg/kg b.w daily for 3 days, plus Sulfadoxine (25 mg/kg b.w )- Pyrimethamine (1.25 mg/kg b.w ) on the first day. * ACT is not given in 1 st trimester of pregnancy. 2) Primaquine : 0.75 mg/kg b.w on day 2. 8

9. DOSAGE CHART WITH ACT-SP 9

10. In North-Eastern states (NE states): 1) ACT-AL co-formulated tablet of Artemether (20mg)- - Lumefantrine (120mg) (Not recommended during 1 st trimester of pregnancy and children- - less than 5kg). 2) Primaquine * : 0.75 mg/kg b.w on day 2. 10

11. DOSAGE CHART WITH ACT-AL 11

12. TREATMENT IN PREGNANCY 1 st trimester: Quinine salt 10mg/kg 3 times daily for 7 days. 2 nd and 3 rd trimester: Area- specific ACT as per dosage schedule given above i.e., ACT-AL in NE states and ACT-SP in other states. 12

13. TREATMENT OF MIXED INFECTIONS (P.VIVAX + P.FALCIPARUM) CASES In North Eastern states : Age specific ACT-AL for 3 days+Primaquine - -0.25 mg/kg b.w daily for 14 days. In other states: ACT-SP 3 days + Primaquine 0.25 mg/ k.g b.w daily for 14 days. 13

14. DOSAGE CHART FOR MIXED INFECTIONS 14

15. TREATMENT OF COMPLICATED F.MALARIA Severe malaria is an emergency and treatment is given as per severity and associated complications which can be best decide by treating physicians. Before admitting or referring patients, the attending doctor or health worker should do RDT and take blood smear ,give a parenteral dose of artemisinin derivative or quinine in suspected cerebral malaria cases and send details of treatment history and blood slide with the patient. 15

16. CHEMOPROPHYLAXIS FOR COMPLICATED MALARIA 16

17. REFERENCE K.Park , Park textbook of Preventive and Social Medicine, 23 rd e.d ., Jabalpur, M/s Banarsidas Bhanot,p.g . no 255-267. 17

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