Malaria: Difference between revisions
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*Wear long-sleeve shirts and pants
*Wear long-sleeve shirts and pants


==DDX==
==Clinical Features==
*[[Fever]] + exposure to [http://wwwnc.cdc.gov/travel/destinations/list.htm endemic country]
**Cyclic only after chronic infection
* HA, cough, GI
 
==Differential Diagnosis==
{{Template:Fever in Traveler DDX}}
{{Template:Fever in Traveler DDX}}


==Diagnosis==
==Diagnosis==
*High index of suspicion if fever + travel to endemic region
''High index of suspicion if fever + travel to endemic region''
**See CDC list by country: [[http://wwwnc.cdc.gov/travel/destinations/list.htm]]
*Check thick and thin smear initially and if neg, repeat in 12- 24 hrs
*Symptoms
*[[Thrombocytopenia]] and splenomegaly common
**Fever
***Cyclic only after chronic infection
** HA, cough, GI
**thrombocytopenia and splenomegaly common
*check thick and thin smear initially and if neg, repeat in 12- 24 hrs


===Classification===
===Classification===
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*[[Parasitic Diseases]]
*[[Parasitic Diseases]]


==Source==
==References==
*Mirzaian E, Durham MJ, Hess K, et al. Mosquito-borne illnesses in travelers: a review of risk and prevention. Pharmacotherapy. 2010;30(10):1031-1043
*Mirzaian E, Durham MJ, Hess K, et al. Mosquito-borne illnesses in travelers: a review of risk and prevention. Pharmacotherapy. 2010;30(10):1031-1043
<references/>
<references/>
[[Category:ID]]
[[Category:ID]]
[[Category:TropMed]]
[[Category:TropMed]]

Revision as of 02:25, 10 June 2015

Background

  • Caused by parasitic protozoa species of the genus Plasmodium (P ovale, P vivax, P malariae, P knowlesi, and P falciparum) carried by the Anopheles mosquito
    • 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

Traveler Precautions

The CDC recommends travelers to malaria-endemic regions take the following precautions:[1]

  • Chemoprophylaxis
  • Use of insecticide-treated bed nets
  • Use of DEET-containing insect repellents
  • Wear long-sleeve shirts and pants

Clinical Features

Differential Diagnosis

Fever in traveler

Diagnosis

High index of suspicion if fever + travel to endemic region

  • Check thick and thin smear initially and if neg, repeat in 12- 24 hrs
  • Thrombocytopenia and splenomegaly common

Classification

Severe 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[2]

  1. 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)
  2. Hyponatremia in the setting of hypovolemia does not require treatment beyond rehydration
  3. Treat hypoglycemia
  4. Check HIV status (coinfection can lead to worse clinical outcomes)
  5. 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 dosing see the CDC Recommendations or call the Malaria CDC Hotline(855) 856-4713

Uncomplicated Malaria

Severe Malaria

  • Intravenous quinidine plus tetracycline, or doxycycline or clindamycin

Cerebral Malaria

  • Insufficient evidence for or against giving antiepileptics
  • For severe cerebral edema, mannitol and steroids have not show a demonstrable benefit

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)

See Also

References

  • Mirzaian E, Durham MJ, Hess K, et al. Mosquito-borne illnesses in travelers: a review of risk and prevention. Pharmacotherapy. 2010;30(10):1031-1043
  1. ↑ WHO Malaria Policy Advisory Committee and Secretariat. Malaria Policy Advisory Committee to the WHO: conlusionsions and recommendations of September 2013 meeting. Malar J. 2013;12(1):456
  2. ↑ World Health Organization. Guidelines for the treatment of malaria. Second edition. Geneva: World Health Organization; 2009:1-194
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