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Malaria

Dr Kabera Ren Family Physician Kabutare Hospital

Plan
Introduction Risk factors Causes Types Diagnosis Differential diagnosis Treatment Complications

Introduction
Malaria is a mosquito borne disease caused by protozoan parasites of the genus plasmodium. Transmitted by a Female Anopheles mosquito 18th century: from Italian, from mal'aria, contracted form of mala aria 'bad air'. The term originally denoted the unwholesome atmosphere caused by the exhalations of marshes, to which the disease was formerly attributed.

Introduction
Kabutare Hospital: 503 confirmed cases /2013 Mortality 1case(Ped)/2013 Rwanda : 42% (2001),7.6% (2012) mortality all ages 425 = 6% (2011-2012) Worldwide: 300-500 million cases per year and one million deaths 90% in sub-Saharan Africa 75% of those deaths are African children U5 A child dies every 30 seconds from malaria Most malaria deaths occur in rural areas 90% of child deaths occur in the home

Introduction
Some families spend up to 25% of income on malaria treatment Malaria endemic countries can be caught in a cycle of poverty and malaria More people die today from malaria than 40 years ago 8th highest contributor to the global burden of disease and 2nd highest in Africa

Malaria Global burden


Red=Malaria Endemic Regions

Causes
Plasmodium species recognized: Falciparum Malariae Vivax Ovale Knowlesi

Anopheles

Plasmodial life Cycle

Risk factors
Endemic regions Children U5 Elderly HIV Blood transfusions organ transplant

Types of Malaria
Simple Malaria Simple Malaria with minor digestive symptoms Severe Malaria: cerebral form, anemic form Different literature Pulmonary, Renal, Intestinal, other forms

Diagnosis
Simple malaria Definition Uncomplicated malaria is defined as symptomatic malaria without signs of severity or evidence of vital organ dysfunction. Symptoms chills fever sweating Headache myalgia

Diagnosis
Simple malaria with minor digestive symptoms Symptoms Fever Chills Headaches Myalgia Sweating Nausea ,Vomiting or Diarrhea

Diagnosis
Severe malaria Malaria with signs and symptoms of severity Unconsciousness Shock Prostration Dyspnea

Diagnosis
Severe Malaria Cerebral form (WHO) Unconsciousness (Glasgow coma scale <11). Malaria with coma persisting for >30 min after a seizure is considered to be cerebral malaria. Convulsions 2 in 24hrs

Diagnosis
Severe malaria Anemic form (WHO) The signs and symptoms of malaria Anemia Hb<5g

Differential Diagnosis
Flu Meningitis Septicemia Typhus

Diagnosis
Parasitological diagnosis Light microscopy :Giemsa-stained thick and thin blood smears Rapid Diagnostic Tests (RDTs) Others FBC Urea Creatinine, Elecrolytes ALT/AST Plasma glucose Chest x ray LP CSF exam

Treatment
Antimalarial treatment policy National antimalarial treatment policies should aim to offer antimalarials that are highly effective These malaria treatment guidelines recommend that antimalarial treatment policy should be changed at treatment failure rates considerably lower than those recommended previously

Treatment
Four point strategy: Prompt access to treatment, especially for young children Prevention and control in pregnant women Vector control Prediction and containment of epidemics

Treatment
Non-artemisinin based combination therapy sulfadoxinepyrimethamine with chloroquine (SP+CQ) sulfadoxine-pymethamine with amodiaquine (SP+AQ) Artemisinin-based combination therapy (ACTs) artemether-lumefantrine artesunate + amodiaquine artesunate + mefloquine artesunate + sulfadoxinepyrimethamine Cinchona alkaloids Quinine Sulfate Quinidine gluconate

Treatment
Simple malaria Arthemeter and Almefantrine (CO-ARTEM)

Treatment
Simple Malaria with Minor digestive symptoms Artesunate IV: 2.4 mg/kg (time = 0) then at 12 hour, then daily thereafter or Quinine If no more vomiting, change to oral ArtemetherLumefantrine twice a day for three consecutive days

Treatment
Severe Malaria Anemic Form Quinine Transfusion Cerebral Form Quinine Ampicillin IV 50mg/kg QD, Chloramphenicol IV 25mg/kg QD

Treatment
Add treatment of complications Fever, convulsions, hypoglycemia, dyspnea, anemia, vomiting

Complications
Severe anemia Acute renal failure Hypoglycemia Pulmonary edema/ALI/ARDS DIC

References
WHO Malaria Treatment Guidelines Rwanda DHS 2010 Ministry of Health of Rwanda Annual report.2012 Rwanda National Treatment Guidelines. Malaria 2012

Thank you

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