Malaria is a febrile illness characterized by fever and related symptoms that are related to the life cycle of the malaria parasite in red blood cells. The first symptoms after infection are called the primary attack and typically include fever, chills, and flu-like symptoms. Further attacks known as paroxysms occur regularly as the parasite invades new red blood cells and can cause anemia, enlarged spleen, coma, and other complications if severe. Cerebral malaria, severe anemia, acute renal failure, and other severe manifestations can occur. Pregnant women and children are more vulnerable to severe disease.

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

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

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