2. Introduction
• Malaria is the most important parasitic disease
of humans
• The disease is endemic in most of the tropics
• Malaria is transmitted by the bite of infected
female anopheline mosquitoes
6. P falciparum
• Most malignant form
• High levels of parasitemia (>5% RBCs infected)
• Sequestration is a specific property of P
falciparum
7. P vivax
• 50% experience a relapse within a few weeks
to 5 years after the initial illness
• Only immature RBCs ---limited parasitemia
8. P ovale
• Resolves without treatment
• Infects only immature RBCs, and parasitemia
is usually less
9. P malariae
• Remain asymptomatic for a much longer
period of time
• Associated with a nephrotic syndrome ---
deposition of antibody-antigen complex on
the glomeruli
10. Etiology
• Endemic area following a mosquito bite
• Secondary to transfusion of infected blood---
extremely rare
• Congenital
11. Symptoms
• Headache (noted in virtually all patients with malaria)
• Cough
• Fatigue
• Malaise
• Shaking chills
• Arthralgia
• Myalgia
• Paroxysm of fever, shaking chills, and sweats (every
48 or 72 hours, depending on species)
13. Severe malaria
• Characterized by signs of severe illness
• Organ dysfunction, or
• A high parasite load (peripheral parasitemia
greater than 5% or greater than 200,000
parasites/mcL)
14. Organ damage
• Neurologic abnormalities progressing to
alterations in consciousness, repeated seizures,
and coma (cerebral malaria)
• Severe anemia
• Hypotension and shock
• Non cardiogenic pulmonary edema
• Acute respiratory distress syndrome
• Acute kidney injury
15. • Severe hemolysis
• Hypoglycemia
• Lactic acidosis
• Hepatic dysfunction
• Retinal hemorrhages
• Coagulopathy
• Disseminated intravascular coagulation
• Secondary bacterial infections, including
pneumonia and Salmonella bacteremia
21. Poor prognosis
• High parasitemias (especially greater than 10-
20% of erythrocytes infected
or
• The presence of malarial pigment (a
breakdown product of hemoglobin) in more
than 5% of neutrophils
22. Species Management
Plasmodium vivax
and
Plasmodium ovale
Infections
Chloroquine
sensitive P
falciparum and P
malariae
Chloroquine phosphate,
1 g at 0, followed by 500 mg at
6, 24, and 48 hours
then (if G6PD normal)
Primaquine, 30 mg base daily for 14 days
Chloroquine phosphate,
1 g at 0, followed by 500 mg at
6, 24, and 48 hours
Uncomplicated
infections
P falciparum
(Coartem) Artemether 20 mg,
lumefantrine 120 mg,
four tablets twice daily for 3 days
Or Malarone 4 tablets (1g of atovaquone,
400mg of proguanil) daily for 3 days.
23. Species Management
Contn.
Severe or
complicated
infections with
P falciparum
Or Quinine sulfate 650mg three times
daily for 3-7 days plus one of the
following (when quinine given for
<7days):
Doxycycline 100mg twice daily for
7days OR Clindamycin 600mg twice
daily for 7days.
Artesunate
2.4 mg/kg intravenously every 12 hours
for
1 day, then daily
26. Prognosis
• Most patients with uncomplicated malaria –
prognosis good
• P falciparum infection ---poor prognosis ---
high mortality rate if untreated
