The document discusses malaria diagnosis and treatment in Gambia. It notes that in 2005, the entire population of Gambia was at risk for malaria infection, and 40% of hospital deaths among children and pregnant women were due to malaria, making it the country's number one health problem. Differential diagnoses for malaria include typhoid fever, meningitis, dengue fever, influenza, and viral hepatitis. Laboratory tests for malaria diagnosis include examining Giemsa-stained thick and thin blood films to identify parasites, as well as rapid antigen detection tests and serological tests. Features of severe falciparum malaria can include renal problems, anemia, bleeding, low white blood cell counts, and thrombocytopenia. Liver dysfunction is also

1. WEEK 6 & 7

2. 2

3. 3

4. Diagnosis
• Gambia: in 2005, the entire population could be regarded
as being at risk of malaria infection
• 40% of hospital deaths among children and pregnant
women were because of malaria
• Country´s number 1 problem (2005)
Differential Diagnosis
• Typhoid fever
• Meningitis
• Dengue Fever
• Influenza
• Viral Hepatitis (A,B, C)
• HIV infection
• Drugs have ruptured

5. Laboratory tests
• Diagnosis can be made using the Giemsa-stainded thick
or thin blood film, on which the parasites can be identified
(3 films need to be examined)
• Rapid antigen detection test
• Serological tests are not providing diagnostic value
• Lumbar pucture to eliminate bacterial infection

6. Features of severe falciparum malaria
• Renal: Uraemia (serum creatinine above 250 micromol/L),
oliguria, haemoglobinuria)
• Blood: anaemia (< 50 g/L), disseminated intravascular
coagulation, bleeding

7. WBC and platelets
• WBC (normal or low)
• Thrombocytopenia (severity of which correlates with the
increasing parasite mass)

8. Liver function in malaria
• Severe infestation of the red blood cells by P. falciparum
and the haemolysis (that results from it) lead to rising
bilirubin
• Clogging of capillaries in important organs due to
sequestration of the parasite infested red blood cells can
result in organ systemic dysfunction (because of ischemia)
– in liver capillaries, this leads to hepatic dysfunction

9. Liver function in malaria (2)
• Besides the bilirubin being elevated, the other liver
enzymes being significantly elevated
• Malarial hepatitis is a hepatocytic dysfunction in
malaria(there is almost never an inflammation of the liver
parenchyma)
• In malarial hepatitis: serum bilirubin and serum glutamate
pyruvate transaminase levels are increased

10. Sources
• http://www.medicc.org/publications/medicc_review/0705/international-
cooperation-report.html
• http://www.news-medical.net/health/Malaria-Diagnosis.aspx
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2481386/
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656011/
• http://www.bioline.org.br/request?jp06108
• Kumar:
• p. 134(Clinical features)
• p.135(Diagnosis)
• p.811 (Influenza)
• p.144 (P. Falciparum infection)
• p.145(Management).