Malaria

Chloroquine phosphate

is effective against P vivax, P ovale, P malariae, and drug-sensitive P falciparum. It can be used for prophylaxis or treatment. This is the prophylactic drug of choice for sensitive malaria.

Quinidine Gluconate

is indicated for severe or complicated malaria and is used in conjunction with doxycycline, tetracycline, or clindamycin. Quinidine gluconate can be administered IV and is the only parenterally available quinine derivative in the United States.

Clindamycin

is part of combination therapy for drug-resistant malaria (eg, typically with quinine or quinidine). It is a good second agent in pregnant patients.

Mefloquine

is structurally similar to quinine. It is used for the prophylaxis or treatment of drug-resistant malaria.

DX: Alternatives to blood smear

(used if blood smear expertise is insufficient): Include rapid diagnostic tests, polymerase chain reaction assay, nucleic acid sequence-based amplification, and quantitative buffy coat

Signs/SX: More common

HA (noted in virtually all patients with malaria) Paroxysm of fever, shaking chills, and sweats (every 48 or 72 hours, depending on species. Cough Fatigue Malaise Arthralgia Myalgia

Transmission: congenital

infected mothers transmit parasites to their child during pregnancy before or during delivery. Therefore, though congenital transmission is rare, health-care providers should be alert to the diagnosis of malaria in ill neonates and young infants, particularly those with fever.

Incubation Period: P falciparum infection

infection typically develops within one month of exposure, thereby establishing the basis for continuing antimalarial prophylaxis for 4 weeks upon return from an endemic area.

Coartem

is a combination drug that is indicated for the treatment of acute, uncomplicated P falciparum malaria

What is Malaria

is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito vector.

Malarone

is approved in the United States for the prophylaxis and treatment of mild chloroquine-resistant malaria. It may be a good prophylactic option for patients who are visiting

Quinine

is used for malaria treatment only; it has no role in prophylaxis. It is used with a second agent in drug-resistant P falciparum. For drug-resistant parasites, the second agent is doxycycline, tetracycline, pyrimethamine sulfadoxine, or clindamycin.

P knowlesi

knowlesi-naturally infects macaques in Southeast Asia, also infects humans, causing malaria that is transmitted from animal to human ("zoonotic" malaria). monkeys

Doxycycline

light sensitivity is used for malaria prophylaxis or treatment. When it is administered for treatment of P falciparum malaria, this drug must be used as part of combination therapy (eg, typically with quinine or quinidine).

Where Malaria is found depends mainly on....

mainly on climatic factors such as temperature, humidity, and rainfall. Malaria is transmitted in tropical and subtropical areas.

Pathophysiology: vector

the Anopheles species mosquito, transmits plasmodia, which are contained in its saliva, into its host while obtaining a blood meal.

Malaria Worldwide

3.2 billion ppl live in areas at risk of malaria transmission in 106 countries and territories. The World Health Organization estimates that in 2015 malaria caused 214 million clinical episodes, and 438,000 deaths. Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfall. Malaria is transmitted in tropical and subtropical areas. The highest transmission is found in Africa South of the Sahara and in parts of Oceania such as Papua New Guinea

signs/sx: less common

Anorexia and lethargy Nausea and vomiting Diarrhea Jaundice

ABCD for malaria

Awareness: recognizing malaria Bite prevention: controlling mosquitoes chemo-prophylaxis: use preventive medication diagnosis: early recognition

Malaria in the US

Between 1957 and 2015, in the US, 63 outbreaks of locally transmitted mosquito-borne malaria have occurred; in such outbreaks, local mosquitoes become infected by biting persons carrying malaria parasites (acquired in endemic areas) and then transmit malaria to local residents Anopheles mosquitoes capable of transmitting malaria ("vectors") exist in the United States. Always risk of resurgence in the US.

LABS: DX

Blood cultures, CBC, iron panel, CMP, liver & renal function tests, electrolytes, LDH,

Malaria in the US: 1st and 2nd generation immigrants

First- and second-generation immigrants from malaria-endemic countries returning to their "home" countries to visit friends and relatives tend not to use appropriate malaria prevention measures and thus are more likely to become infected with malaria.

CXR

If resp sx present

P vivax

If this kind of infection goes untreated, it usually lasts for 2-3 months with diminishing frequency and intensity of paroxysms. Of patients infected with P vivax, 50% experience a relapse within a few weeks to 5 years after the initial illness. Splenic rupture may be associated

DX

In depth history including recent or remote travel to an endemic area. Order labs: Blood cultures, CBC, iron panel, CMP, liver & renal function tests, electrolytes, LDH, CXR if respiratory symptoms present. CT of head if CNS symptoms present

Pathophysiology: parasite growth

In humans the parasites grow and multiply first in the liver cells and then in the red cells of the blood. In the blood, successive broods of parasites grow inside the red cells and destroy them, releasing daughter parasites ("merozoites") that continue the cycle by invading other red cells

Physical findings: respiratory abnl

Include metabolic acidosis, associated respiratory distress, and pulmonary edema; signs of malarial hyperpneic syndrome include alar flaring, chest retraction, use of accessory muscles for respiration, and abnormally deep breathing.

CDC: Malaria

Malaria tx is not always straightforward and may be complex. Contacting the CDC for the latest treatment guidelines and drug regimens is advised. CDC Malaria Hotline at (770) 488-7788 (M-F, 8 am-4:30 pm, eastern time). For emergency consultation after hours, call (770) 488-7100 and request to speak with a CDC Malaria Branch clinician.

drug that can eradicate all forms of parasite's life cycle

No single drug can eradicate all forms of the parasite's life cycle has been discovered or manufactured yet. Therefore, 1 or more classes of drugs often are given at the same time to combat malarial infection synergistically. Treatment regimens are depende

Protozoa Species

P falciparum P vivax P ovale P malariae P knowlesi

P ovale

P ovale infection often resolves without treatment

P malariae

Persons infected with this species of Plasmodium remain asymptomatic for a much longer period of time than do those infected with P vivax or P ovale. Often associated with nephrotic syndrome

Pathophysiology: parasite differentiation

Some parasites differentiate into gametocytes that are ingested by an Anopheles mosquito during blood meal. The parasites multiply grow into sporozoites that may their way to the uninfected mosquito's salivary glands and transmitted to another human host perpetuating the malaria cycle.

Physical findings

Splenic or liver enlargement Fever Mild jaundice Cerebral malaria (sometimes with coma) Severe anemia Respiratory abnormalities Renal failure (typically reversible)

P falciparum

The most malignant form of malaria is caused by this species. Can be fatal and is often resistant to standard chloroquine treatment.

see these alot with malaria under microscope

gametocytes

Incubation period: The shorter periods are observed most frequently with ______

The shorter periods are observed most frequently with P. falciparum and the longer ones with P. malariae.

Prevention

The use of long clothing to reduce exposed skin during biting periods (dusk through to dawn. The use of topical repellents :DEET, picaridin ), PMD,MGK-326, MGK-264, IR3535 and oil of citronella. Other repellents: mats, lotions, vaporizers. It must be remembered that no chemoprophylaxis regime provides 100% protection. Primary prophylaxis: Use of antimalarial drugs at recommended dosage, started 2-20 days before departure and continued for the duration of stay and for 1-4 weeks after return.

Primary prophylaxis

Use of antimalarial drugs at recommended dosage, started 2-20 days before departure and continued for the duration of stay and for 1-4 weeks after return.

DDX

Viral illness Bacteremia Food borne illness Seizure disorder (with CNS symptoms) Relapsing fever

DX: peripheral blood smear

gold standard is the standard. Multiple smears. The microscopic tests involve staining and direct visualization of the parasite under the microscope.

CT

if CNS sx present

The 4 major drug classes for tx of Malaria

classes currently used to treat malaria include quinoline-related compounds, antifolates, artemisinin derivatives, and antimicrobials.

Individuals w/ malaria typically acquired the infection in an...

endemic area following a mosquito bite.

Worldwide Malaria: highest transmission

found in Africa South of the Sahara and in parts of Oceania such as Papua New Guinea

Incubation period: P vivax and P ovale

may emerge weeks to months after the initial infection. In addition, P vivax and P ovale have a hypnozoite form, during which the parasite can linger in the liver for months before emerging and inducing recurrence after the initial infection. In addition to treating the organism in infected blood, treating the hypnozoite form with a second agent (primaquine) is critical to prevent relapse from this latent liver stage.

Approximately 1,500 cases of malaria are reported each year in the United States, almost all are

recent travelers

Transmission: "airport"

refers to malaria caused by infected mosquitoes that are transported rapidly by aircraft from a malaria-endemic country to a non-endemic country. If the local conditions allow their survival, they can bite local residents who can thus acquire malaria without having traveled abroad.

Pathophysiology: protozoan broad

replicates inside the cell and induces RBC cytolysis, causing the release of toxic metabolic byproducts into the bloodstream that the host experiences as flulike symptoms.

TX: Failure to consider malaria in the differential diagnosis of a febrile illness in a patient who has traveled to an area where malaria is endemic can result in??

significant morbidity or mortality, especially in children and in pregnant or immunocompromised patients.

Tx regimens are dependent on

the geographic location of infection, the likely Plasmodium species, and the severity of disease presentation.

Transmission: Transfusion

transmitted malaria is rare in the United States, but it is a potential severe complication in blood recipients. On average, only one case of transfusion-transmitted malaria occurs in the United States every 2 years. no approved tests are available in the United States to screen donated blood for malaria

Pathophysiology: parasite life cycle involves how many hosts

two