28 yr old female , normal vagianal delivery, came in saudi oct 2011 Physical examination Lab investigation Diagnostic Points Treatment Prevention and control

1. Case study Of Malaria
Shisodia Harsh Vardhan Singh
Jonelta Foundation Of Medicine

3. Case
• A 28-years-old apparently healthy Indian female.Two months post
normal vaginal delivery, she came toSaudi Arabia for Hajj on October
2011.Two weeks later, she presented to a polyclinic with a 4 days
history of intermittent fever and shortness of breath and she was
drowsy and confused.Initially diagnosed and treated as community
acquired pneumonia.However, her condition didn’t improve and she
returned back next day with temperature of 40°C, respiratory distress,
hemodynamic instability and deterioration of renal function.

4. • CBC revealed normocytic normochromic anemia
• Chest X ray showed bilateral infiltrate
• Echocardiography showed EF 35%.
• Diagnostic impression ??
• She received supportive treatment with no improvement
• Five days later, she transferred to our hospital KAMC, non conscious
with severe hypotension.

5. Physical Examination
No consensus
Temperature 40 C
BP Decrease
Pulse increase
RR increase
HSM
No focal neurological signs

6. • Treatment started as
noradrenaline infusion
ARDS ventilation protocol
continuous renal replacement therapy (CRRT).

7. Lab Investigation

8. • Serology for Dengue fever proved negative.
• Septic screen sent.
• Came positive for MRSA. She started oral Meropenem, Vancomycin
and Levofloxacin and adjusted dose with CRRT.

9. Thick And Thin Blood Flims were Dome

11. Thin Film

12. Thin Film

13. Thin Flim

14. Thick Film

15. Diagnostic Points
• Red cells containing parasites are usually enlarged.
• Schuffner's dots are frequently present in the red cells as shown
above.
• The mature ring forms tend to be large and coarse.
• Developing forms are frequently present.

16. Diagnosis
Thick and Think Blood Film +ve P. vivax
Rapid Antigen Detection Test – positive P. vivax but Nigative P. falciparum
Anti falciparum antibodies Nigative

17. • Started Quinine in a dose of 600 mg and other medicine

18. • Improve neurologically
• Peripheral blood flims were repeatedly reviewed

19. 24/11/11 Patient had tonic clonic seizures Treated with midazolam and
phenytoin
27/11/11 MRI It was suggestive of extensive
vasculitis related to malaria
29/11/11 Transferred from ICU to Ward Started primaquine for 14days to
avoid relapse

20. Treatment
Chloroquine (4 Aminoquinolines)
Primaquine (8 Aminoquinolines)
Quinine, Mefloquine (Aryl-amino alcohols) Fansidar
(Drug Combination)= sulfadoxine 500 mg+
Pyremethamine 25 mg
Mefloquine
Artimesinine (derived from leeches)
Pyremethamine
Atovaquona

21. • Falciparum and Malariae malaria
Blood Schizonticidies Chloroquine
Chloroquine resistant
1. Quinine (650 mg/8hr for 10 days)
2. Quinine + fansidar ( to potentiate the action )
3. Melfloquine
4. Artimesinine

22. • Vivax and Oval Malaria
Chloroquine + primaquine ( chloroquine alone if inefficient)

23. Prevention and control
• Treatment of patients ( source of infection)
• Chemoprophylaxis
• Vector Controls
Insecticides
Destruction of breeding places
Avoid exposure to bite by:
a) Repellants
b) Clothes
c) Nets
• Vaccines trials

24. Chemoprophylaxis
• one week before travelling, during and 4 weeks after leaving endemic
area
• True prophylaxis = In healthy persons = Tissue schizonticides
• Pyremethamine (daraprim) 25mg/week (one tablet)
• Mefloquine (drug of choice)

25. • Clinical prophylaxis = Suppressant treatment
Elimination of asexual erythrocytic forms
• Chloroquine 600 mg/week, 1 week before travelling

26. Thank You