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3 Malaria Clinical Features
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3 Malaria Clinical Features

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  • 1. CLINICAL FEATURES OF MALARIA febrile illness characterized by fever and related symptoms
  • 2. Clinical Manifestations are related to cycle of events in relation to RBC
  • 3.
    • 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.
  • 4. Broad clinical manifestations of Malaria
    • Fever
    • Sweating
    • Anemia
    • Splenomagaly (enlarged spleen)
    • Irratability
    • Coma, Retinal Hemorrages 
    • Algid Malaria ( a shocklike syndrome)
    • Respiratory distress syndrome
  • 5.  
  • 6. 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.
  • 7. 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
  • 8. PATTERN OF FEVER
    • The fever paroxysm corresponds to the period of infected erythrocyte rupture and merozoite invasion.
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. Anemia
  • 13. Acute renal failure
  • 14. Metabolic acidosis
  • 15. Hypotension
  • 16. Pulmonary edema
  • 17. Hypoglycemia
    • MULTIFACTORIAL
    • Parasite utilises the glucose
    • Associated with hyperlactatemia
    • Due to hepatic failure gluconeogenesis and glcogenolyis are affected
    • Quinine – pancreatic beta cell stimulation
  • 18.  
  • 19. Black water fever
    • due to intravascular hemolysis at schizogony period
    • Predisposing factors
      • quinine
      • cold exposure
      • fatigue
      • trauma
      • pregnancy
      • parturition
  • 20.
    • Effects
      • Methaemoglobuminaemia
      • Hyperbilirubinaemia
      • Haemoglobinuria
    • Pigments
      • Oxyhaemoglobin
      • Methaemoglobin
      • Bilirubin
      • Methaemalbumin
  • 21.
    • 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
  • 22. 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
  • 23. MALARIA IN CHILDREN
    • Convulsions
    • Coma
    • Hypoglycemia
    • Metabolic acidosis
    • Severe anemia
    • Deep jaundice
    • Acute renal failure
    • Acute pulmonary edema
  • 24.