Clinical presentations of acute malaria and its major complication

1. MD.Kiyumars Karimi
MALARIA CLINICAL FEATURES

2. CLINICAL FEATURES
 First symptoms are non specific:
 Headache
 Fatigue
 Myalgia and Arthralgia
 Incubation period:
 Depends on species
 8 to 25 days
 Affected by partial immunity
 Signs:
 Non specific
 Anemia
 Hepatolienal syndrome

3. Clinical
Syndromes
Acute disease
Complicated Uncomplicated
Chronic
disease
Asymptomatic

4. Acute Malaria Disease
 Malarial paroxysm stages:
1. Cold stage
2. Hot stage
3. Diaphoresis stage
o Cold stage:
 Feeling of intense cold
 Vigorous shivering
 Lasts 15-30 minute
 Accompanied by headache, nausea & myalgia

5. Paroxysm stages
o Hot stage:
 Intense Heat
 Dry burning skin
 Hypotension
 Lasts 15 minute to several hours
o Sweating stage:
 Profuse sweating
 Declining temperature
 Exhaustion
 Lasts 2-4 hours

6. Complicated Malaria
 Cerebral Malaria
 Hypoglycemia
 Non Cardiogenic Pulmonary Edema
 Metabolic Acidosis
 Renal Impairment
 Hematological Disorders
 Liver Dysfunctions
 Hyperpyrexia
 Hyperparasitemia
 Hemoglobinuria

7. Cerebral Malaria
 Ominous feature of P.falciparum
 Sudden or gradual onset
 Diffuse symmetric encephalopathy
 Focal neurological deficit is uncommon
 Divergent eye and pout reflex is common
 Muscle dystonia
 Preserved corneal reflex except indeep coma
 Retinal hemorrhage in 15 % of patients
 Residual neurological defecit

8. Hypoglycemia
 Important and common complication
 Associated with poor prognosis
 Problematic in children and pregnant women
 Clinical diagnosis maybe difficult
 Causes:
 Hepatic gluconeogenesis failure
 Increase glucose consumption by host and lesser
by parasite
 drug induced hypoglycemia

9. Acidosis
 Important cause of death
 Results from organic acid accumulation
 Hyperlactatemia coexist with hypoglycemia
 Acidotic breathing is a sign of poor prognosis
 Bicarbonate or lactate are best biochemical
prognosticators
 Causes:
 Anaerobic glycolysis
 Hypovolemia
 Lactate production by the parasites
 Failure of hepatic and renal lactate clearance

10. Noncardiogenic Pulmonary Edema
 May develops even after antimalarial therapy.
 More common in adults.
 Mortality rate is >80%
 Predisposing factors:
 Renal failure
 Pregnancy
 Hyper parasitemia
 Pathogenesis:
 Exact pathogenesis is unclear.
 Pulmonary microvascular obstruction and increased
TNF α.
 Aggravated by vigorous administration of IV Fluid.

11. Renal impairment
 More common among adults.
 High mortality (upto 45%)
 May occur with other vital-organ
dysfunction.
 Manifest as Acute tubular necrosis.
 Renal cortical necrosis never develops
 Pathogenesis:
 Exact pathogenesis is unclear.
 May related to microcirculatory obstruction.

12. Other Complications
 Anemia results from:
 Accelerated RBC removing by spleen
 RBC destruction by schizont
 Ineffective erythropoiesis
Liver Dysfunction
• Hemolytic jaundice is common.
• sever with P.falciparum infection.
• Pathogenesis:
∙ Hemolysis
∙ Hepatocyte injury
∙ Cholestasis

13. Malaria in Pregnancy
 Pregnant women prone to sever infection.
 Common adverse effect on foetal:
 Stillbirths
 Fetal distress
 LBW
 IUGR
 Prematurity
 Maternal effect:
 Maternal anemia
 Higher mortality from cerebral malaria
 Premature labor

14. Malaria in Children
 Mortality is more in children.
 May present with labored deep breathing
 Long term neurocognitive & developmental deficit
 Conditions rare in child:
 Deep jaundice
 Acute renal failure
 Acute pulmonary edema