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    Malaria: Pathophysiology, Clinical Manifesta6ons and Treatment

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    Guilherme
    This document discusses malaria, including its global magnitude, pathophysiology, clinical manifestations, diagnosis, and treatment. It provides details on: - 210 million malaria cases and 627,000 deaths globally in 2012, with 91% of deaths in Africa - Pathophysiology involves structural and biochemical changes to red blood cells infected by Plasmodium parasites - Common symptoms include fever, chills, and headaches, while physical findings can include fever, confusion and coma - Diagnosis relies on blood smears, which remain the gold standard, while rapid diagnostic tests provide faster results - Treatment depends on disease severity, with intravenous quinine for severe cases and oral artemether-lumefantrine for

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    Malaria: Pathophysiology, Clinical Manifesta6ons and Treatment

    Uploaded by

    Guilherme
    271 views14 pages
    This document discusses malaria, including its global magnitude, pathophysiology, clinical manifestations, diagnosis, and treatment. It provides details on: - 210 million malaria cases and 627,000 deaths globally in 2012, with 91% of deaths in Africa - Pathophysiology involves structural and biochemical changes to red blood cells infected by Plasmodium parasites - Common symptoms include fever, chills, and headaches, while physical findings can include fever, confusion and coma - Diagnosis relies on blood smears, which remain the gold standard, while rapid diagnostic tests provide faster results - Treatment depends on disease severity, with intravenous quinine for severe cases and oral artemether-lumefantrine for

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    MalariaPathophysiology Barlett

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    This document discusses malaria, including its global magnitude, pathophysiology, clinical manifestations, diagnosis, and treatment. It provides details on: - 210 million malaria cases and 627,000 deaths globally in 2012, with 91% of deaths in Africa - Pathophysiology involves structural and biochemical changes to red blood cells infected by Plasmodium parasites - Common symptoms include fever, chills, and headaches, while physical findings can include fever, confusion and coma - Diagnosis relies on blood smears, which remain the gold standard, while rapid diagnostic tests provide faster results - Treatment depends on disease severity, with intravenous quinine for severe cases and oral artemether-lumefantrine for

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    271 views14 pages

    Malaria: Pathophysiology, Clinical Manifesta6ons and Treatment

    Uploaded by

    Guilherme
    This document discusses malaria, including its global magnitude, pathophysiology, clinical manifestations, diagnosis, and treatment. It provides details on: - 210 million malaria cases and 627,000 deaths globally in 2012, with 91% of deaths in Africa - Pathophysiology involves structural and biochemical changes to red blood cells infected by Plasmodium parasites - Common symptoms include fever, chills, and headaches, while physical findings can include fever, confusion and coma - Diagnosis relies on blood smears, which remain the gold standard, while rapid diagnostic tests provide faster results - Treatment depends on disease severity, with intravenous quinine for severe cases and oral artemether-lumefantrine for

    Copyright:

    © All Rights Reserved
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    Malaria:

     Pathophysiology,  Clinical  
    Manifesta6ons  and  Treatment  
    Malaria:  Magnitude  of  the  Problem    
    •  2012-­‐  210  million  cases  
    •  2012-­‐  627,000  deaths,  91%  in  Africa  
    Pathophysiology  of  Malaria    
    •  Pathophysiology  related  to  structural,  biochemical  and  
    mechanical  modifica6on  of  RBC  when  parasi6zed  by  
    Plasmodia  
    •  Altered  deformability  and  fragility  of  RBC  can  lead  to  
    cytoadherence,  altered  endothelial  ac6va6on  and  
    dysfunc6on,  and  altered  thrombostasis  
    •  Further  complicated  by  parasite  biomass,  and  
    inflammatory  responses  
    Pathology  of  Malaria    
    •  Anemia  with  reac6ve  bone  marrow  
    •  Splenomegaly  due  to  removal  of  aberrant  RBC  
    •  Capillary  obstruc6on  due  to  sequestra6on  of  
    RBC  can  affect  any  organ,  especially  CNS  
    •  Uncontrolled  inflamma6on  with  secondary  
    organ  damage  
    Clinical  Manifesta6ons  of  Malaria    
    •  Symptoms  occur  7-­‐30  days  aSer  infected  
    mosquito  bite  
    •  Symptoms  may  include  fever,  chills,  sweats,  
    headache,  myalgias,  cough,  nausea,  vomi6ng,  
    diarrhea,  back  pain,  dizziness  
    •  Physical  findings  may  include  fever,  tachycardia,  
    tachypnea,  hypotension,  confusion,  focal  
    neurologic  signs  and  coma  
    Laboratory  Manifesta6ons  of  Malaria    
    •  Non-­‐specific  findings  include  anemia,  
    thrombocytopenia,  increased  bilirubin,  renal  
    insufficiency,  and  hypoglycemia  
    •  Diagnos6c  tes6ng  impera6ve  
    Establishing  the  Diagnosis  of  Malaria    
    •  Blood  smears  remain  the  gold  standard;  thick  smears  are  
    more  sensi6ve  because  of  greater  numbers  of  RBC,  and  
    thin  smears  allow  for  species  iden6fica6on  and  
    determina6on  of  parasite  density  
    •  In  suspected  cases  where  pre-­‐test  likelihood  is  low,  blood  
    smears  should  be  repeated  every  12-­‐24  hours  X  3,  and  if  all  
    are  nega6ve,  malaria  diagnosis  is  unlikely  
    •  In  suspected  cases  where  pre-­‐test  probability  is  high,  
    should  ini6ate  empiric  treatment  while  result  is  pending  
    •  Always  depends  on  laboratory  competence  
    Establishing  the  Diagnosis  of  Malaria    
    •  Rapid  diagnos6c  tests  (RDT)  offer  the  advantage  of  15  
    minute  response  6me  
    •  RDT  reliable  for  P.  falciparum,  but  less  certain  for  other  
    species  
    •  PCR  assays  sensi6ve  and  specific,  but  require  
    specialized  lab;  very  useful  for  confirma6on  of  species  
    and  drug  resistance  tes6ng  
    •  Indirect  fluorescent  an6body  test  may  be  useful  for  
    blood  banking  
     
    Rapid  Diagnos6c  Tests  for  Malaria    
     
    Assessing  Malaria  Severity  
    •  Uncomplicated  
    •  Severe-­‐  impaired  consciousness/coma,  severe  
    anemia  (HGB  <  7),  renal  failure,  ARDS,  
    hypotension,  DIC,  spontaneous  bleeding,  
    acidosis,  hemoglobinuria,  jaundice,  repeated  
    seizures,  parasitemia  >  5%  
     Malaria  Treatment  
    •  Uncomplicated-­‐  artemether/lumefantrine  (Coartem);  
    alterna6ves  include  atovaquone/proguanil  (Malarone)  and  
    quinine  sulfate  plus  doxycycline  
    •  Severe-­‐IV  quinine,  or  quinidine  gluconate  (need  careful  
    dosing  and  cardiac  monitoring  if  possible),  or  artenusate;  IV  
    treatment  should  be  followed  by  oral  treatment  
    •  For  P.  vivax  and  P.  ovale  must  extend  treatment  to  
    eliminate  hypozoites  in  liver  with  primaquine  for  14  days  
     Case  History  
    •  A  6  yo  boy  presents  to  clinic  with  a  history  of  
    fever  and  chills  
    •  On  exam  his  temperature  is  39.6,  pulse  140  
    and  RR  40;  he  is  lethargic  and  only  
    intermijently  responds  to  commands  
    •  On  lab  evalua6on  his  HGB=6.5,  platelets  
    50,000  and  bilirubin  5.3  
    Case  History  
    •  In  your  differen6al  diagnosis  you  consider;  
         -­‐  severe  malaria  
         -­‐  bacterial  meningi6s  
         -­‐  Chikungunya  fever  
    Case  History  
    •  Thick  peripheral  blood  smear  is  posi6ve;  thin  
    smear  reveals  morphology  sugges6ve  of  P.  
    falciparum  
    •  You  diagnose  severe  malaria  and  immediately  
    ini6ate  quinine  drip  for  3  days  followed  by  oral  
    artemether/lumefantrine  
    •  He  recovers  well  and  is  discharged  one  week  
    later  to  complete  his  oral  treatment  

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