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3 Malaria Clinical Features
 

3 Malaria Clinical Features

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    3 Malaria Clinical Features 3 Malaria Clinical Features Presentation Transcript

    • CLINICAL FEATURES OF MALARIA febrile illness characterized by fever and related symptoms
    • Clinical Manifestations are related to cycle of events in relation to RBC
      • The first symptoms of malaria after the pre-patent period are called the  primary attack. 
      • Usually atypical (starts getting relapse of symptoms at regular intervals of 48-72 hours)
      •   short term relapses (recrudescences).  
      •   long term relapses  (after a gap of 20-60 days or more)
        • due to the reactivation of the hypnozoites in the liver in case of vivax and ovale malaria.
        • In falciparum and malariae infections, recrudescences can occur due to persistent infection in the blood.
    • Broad clinical manifestations of Malaria
      • Fever
      • Sweating
      • Anemia
      • Splenomagaly (enlarged spleen)
      • Irratability
      • Coma, Retinal Hemorrages 
      • Algid Malaria ( a shocklike syndrome)
      • Respiratory distress syndrome
    •  
    • MANIFESTATIONS OF ACUTE MALARIA
      • Fever and shivering . The attack begins with fever, with the temperature rising as high as 40ºC and falling again over a period of several hours.
      • A poor general condition , feeling unwell and having headaches like influenza.
      • Diarrhea, nausea and vomiting often occur as well.
    • MALARIAL PAROXYSM *typical features are seen after the infection gets established for about a week cold stage hot stage sweating stage
      • feeling of intense cold
      • vigorous shivering
      • lasts 15-60 minutes
      • intense heat
      • dry burning skin
      • throbbing headache
      • lasts 2-6 hours
      • profuse sweating
      • declining temperature
      • exhausted and weak -> sleep
      • lasts 2-4 hours
    • PATTERN OF FEVER
      • The fever paroxysm corresponds to the period of infected erythrocyte rupture and merozoite invasion.
    • ATYPICAL FEATURES
      • Atypical fever
      • Headache
      • Body ache, back ache and joint pains
      • Dizziness, vertigo
      • Altered behaviour, acute psychosis
      • Altered sensorium
      • Convulsions, coma
      • Cough
      • Breathlessness
      • Chest pain
      • Acute abdomen
      • Weakness
      • Vomiting and diarrhoea
      • Jaundice
      • Pallor
      • Puffiness of lids
    • SEVERE MALARIA
      • CEREBRAL MALARIA
      • SEVERE ANAEMIA
      • ACUTE RENAL FAILURE
      • PULMONARY OEDEMA OR ARDS
      • CIRCULATORY COLLAPSE OR SHOCK
      • SPONTANEOUS BLEEDING
      • GENERALIZED CONVULSIONS
      • METABOLIC ACIDOSIS
      • HYPOGLCEMIA
      • BLACK WATER FEVER
    • Cerebral Malaria
      • Coma
      • diffuse symmetric encephalopathy
      • Unusual focal neurological signs
      • Primitive reflexes absent
      • Retinal haemorrhage with puillary dilatations
      • Hemiplegia, CP
      • Blindness, deafness
      • Impaired cognition and learning
    • Anemia
    • Acute renal failure
    • Metabolic acidosis
    • Hypotension
    • Pulmonary edema
    • Hypoglycemia
      • MULTIFACTORIAL
      • Parasite utilises the glucose
      • Associated with hyperlactatemia
      • Due to hepatic failure gluconeogenesis and glcogenolyis are affected
      • Quinine – pancreatic beta cell stimulation
    •  
    • Black water fever
      • due to intravascular hemolysis at schizogony period
      • Predisposing factors
        • quinine
        • cold exposure
        • fatigue
        • trauma
        • pregnancy
        • parturition
      • Effects
        • Methaemoglobuminaemia
        • Hyperbilirubinaemia
        • Haemoglobinuria
      • Pigments
        • Oxyhaemoglobin
        • Methaemoglobin
        • Bilirubin
        • Methaemalbumin
      • Symptoms
        • rapid pulse
        • high fever and chills
        • extreme prostration
        • a rapidly developing anemia
        • the passage of urine that is
        • black or dark red in colour
        • Fever, rigor, aching pain in loin,
        • icterus, vomitting, circulatory collapse, acute renal failure
    • MALARIA IN PREGNANCY
      • Foetal
        • IUGR  LBW
        • Still birth
        • Prematurity  increased risk of neonatal death
        • Fetal distress
      • Maternal
        • Anaemia  risk of maternal mortality
      • Mortality due to cerebral malaria is higher
    • MALARIA IN CHILDREN
      • Convulsions
      • Coma
      • Hypoglycemia
      • Metabolic acidosis
      • Severe anemia
      • Deep jaundice
      • Acute renal failure
      • Acute pulmonary edema
    •