PRESENTATION
By DR. Ramesh
Bhargava

Mr. R aged 17 yrs, Male admitted to my HOSPITAL ON 3/08/2008 with H/O
High Grade Fever, Vomiting, Loose Motions & Breathlessness for Last 8 days
O/E S/E
P.120 per min A/S- ABD SOFT
BP 100/70
R-34/M LIVER - JP
T-102 F SPLEEN – JP
JVPNR NO-F.F.
ICTERUS +
CYANOSIS ABSENT
CLUBBING ABSENT R/S B/L CLEAR
NOACC
OEDEMA ABSENT CVS. FAINT SYSTOLIC MUMER
TONGUE - DRY CNS – CLINICALLY NAD
MILD DEHYDRATION +

ON INVESTIGATION
1.CBP- Hb 6 gm %
 TWBC- 11,200
 P- 64%
 L- 30%
 M- 3%
 E- 3%
2. Urine Routine & Microscopic test - NAD
3. PS FOR MP- NEGATIVE
4. X- Ray Chest – NAD
5. Blood Widal -VE
6.Blood Glucose R-98 mg %
7. S. Bilirubin 6.00 mg %
 SGOT -70
 SGPT -60
 Hbs Ag- NEGATIVE
8. Blood Urea 30 mg %
 S. Creatinine 1.4 mg %
9. Widal – ve
10. Ultra Sonography shows Hepatosplenomegaly
11.Echo- NAD

X- RAY [ NAD ]

 TREATMENT GIVEN
 Blood Transfusion II
 Inj Arteethar 150 mg daily for three
days
 Inj Cefotaxim 1 gm bd
 Inj metrogyl 500 mg 8 hourly
 Symptomatic & Supportive Treatment
 He responded to treatment & became
afebrile on 3rd day remained in the
hospital for 10 days, recovered and
then discharged.

 On 4/10/2008 he again admitted to private Hospital with H/O
Fever, Vomiting where he was again investigated
1. CBP Hb 8 gm %
 TWBC 9,300 P- 70%
 L- 20%
 M- 3%
 E- 3%
 B- 4%

2. PS for MP -ve
3. Urine Routine Microscopic Test / NAD
4. X- Chest – NAD
5. S. Bilirubin 3.0 mg % SGOT & SGPT
30 40
6. Reticulocyte count – 3%
7. G6PD deff – Not Detected
8. Sickling Test- -ve
9. Coomb’s Test- -ve
10. Hb Electrophoresis (N)
11. USG-Hepatosplenomegaly
12. ECG Within normal limit ( WNL)

TREATMENT GIVEN
 IV Ceftrixone 1 gm bd ..
 IV GM 80 mg IV bd..
 IV Artesunate 120 gm IV Stat than
60 mg IV daily for Four Day
 Remained in the Hospital for 5
days than discharged

 Again he came to my clinic on 16/12/08
with H/O Fever, vomiting
 O/E
 Hb – 4.0 gm %
 TWBC -2800
 P- 50%
 L- 47%
 M- 02
 E- 01
 PS- MP -VE
 S. Bilirubin – 3.6 mg %

Bone Marrow Examination
 CELLULARITY- Hypercellular
 M: E Ratio:- 1:3 (reversal)
 ERYTHROPOISIS: Show marked erythrorid
hyperplasia with many precursors and few
macronormoblasts with feature of dyserythropoisis
few trophozoits and schizoni of P. Vivax seen.
 LYMPHOPOISIS :- Shows mild increase in
lymphocytes..
 MEGAKARYOCYTES:- Normal in number but
functioning
 IMPRESION :- Macronormoblastic erythrorid
hyperplasia secondary to P.Vivax

 Blood Transfusion II
 INJ – chloroquine
 TAB- Primaquine
 Symptomatic & supportive

Drug Indication Adverse side Dose
effects
Chloroquine Treatment of all GI intolerance, Oral: 600 mg
Phosphate forms of malaria pruritus, stat then 300
except for dizziness, mg base after 6
infection due to anorexia, hours then 300
resistant strains malsise rare- mg ODx2 days.
of P. falciparum psychosis Injectable in a
convulsions, dose of 10 mg
blood dyscrasia per kg by slow
infusion over a
period of 8 hrs
followed by 5
mg/kg every 8
hrs until a total
dose of 25
mg/kg IM : 3.5
mg (base)/kg
every 6 hours

Mefloquine Used for oral GI Adults: 15-25
hydrochloride prophylaxis intolerance, mg/kg
and treatment dizziness, Children:
of chloroquin extrasystole, 25mfg / kg
resistant and syncope rarely
multidrug neuropsychiat
resistant ric symptoms
P.falciparum
malaria

Quinine Resistant falciparum Cinchonism, Adults: 300-600
Suphate malaria acute hemolytic mg thrice daily
anemia, tinnitus, 5-7 days
headache, GI Children: 25 mg/
intolerance kg/day 8 hourly
for 7 days
Artesonate Servere malaria Transient and Adults:
including cerebral reversible Parenteral: 120
malaria. reticulocytopena mg first day;
Second line , drug fever, 60mg next 4
treatment of drug rash, days.
chloroquin resistant bradycardia, Oral: 100 mg BD
falciparum malaria transient first first day; 50 mg
degree heart BD x 4 days
block Children: 1.2
mg /kg x 5 days

Artemether Server falciparum Recticulocytopenia Adults: 80 mg (1
(Latrither) malaria cerebral amp) IM BD on
malaria multidrug day 1. followed
resistant malaria by 80 mg IM OD
X 4 days.
Children's: 1.6
mg/kg BDx3
days
Mepacrine Drug resistant Dizziness GI For prophylaxis:
falciparum disturbances 0.6-0.7 g/week
malaria. yellow For treatment
Prophylaxis discoloration of 0.9 gm on first
chloroquin skin on prolonged day
resistant use
falciparum malaria 0.6 gm on second
and third day
0.3 gm on fourth,
fifth, and sixth
day

THANK YOU