Malaria

Clinical features

  • headache

  • lassitude

  • fatigue

  • abdominal discomfort

  • muscle and joint aches

  • high grade fever,

  • chills

  • perspiration

  • anorexia

  • vomiting

  • worsening malaise

Clinical features of severe malaria

  • Impaired consciousness or unrousable coma

  • Prostration (generalized weakness so that the patient is unable to walk or sit up without assistance)

  • Failure to feed/ not tolerating orally

  • Convulsion

  • Deep breathing, respiratory distress (acidotic breathing)

  • Circulatory collapse or shock, systolic blood pressure < 90 mm Hg in adults and < 50 mm Hg in children

  • Clinical jaundice and evidence of other vital organ dysfunction

  • Haemoglobinuria

  • Abnormal spontaneous bleeding

  • Pulmonary oedema (radiological)

Investigations

  • blood film for malaria parasite (BFMP)

  • FBC - ↓ platelet

  • BUSE - ↓ Na, ↓ Calcium, ↓ albumin

  • CRP ↑

  • ↑ bilirubin

  • ↓ glucose

Management

Pharmacological

  • P. Falciparum/P malariae/P. knowlesi - Riamet PO BD for 3 days

  • P ovale/ vivax - Chloroquine PO OD 3/7 + Primaquine PO OD 14/7

Criteria of admission

  • all patient should be admitted

  • severe malaria

  • cannot tolerate orally

  • high parasetaemia (>100,000)

  • G6PD

  • pregnant

  • severe malnutrition

  • children

Follow up after discharge

  • weekly for 1 month

  • monthly for 1 year (P. vivax)

Complications of malaria

  • cerebra malaria

  • anaemia

  • respiratory distress

  • renal failure

  • hypoglycemia

  • circulatory collapse

  • coagulopathy