This document summarizes information about childhood malaria. It discusses the etiology, pathogenesis, clinical presentation, diagnosis, treatment, and prevention of malaria in children. The key points are: - Malaria is caused by Plasmodium parasites and transmitted via mosquito bites. It causes fever, anemia, and splenomegaly. - The parasite's lifecycle involves stages in the human and mosquito. It causes pathology through fever, anemia, immune responses, and tissue hypoxia. - Common symptoms in children include fever, anemia, GI issues, and splenomegaly. Severe cases can involve cerebral malaria, respiratory distress, seizures, and more. - Diagnosis involves

1. Childhood Malaria

2. ETIOLOGY
• Malaria is an acute and chronic illness characterized by paroxysms of
fever, chills, sweats, fatigue, anemia and splenomegaly.
• Malaria cause by intracellular plasmodium protozoa.
• 5 species: falciparum, malariae, ovale, vivax and knowlesi>
• Transmitte by anaphoeles mosquitos, aeabinenses, gambiae, funstus.
• Blood products transmission

3. PATHOGENESIS
• Life cycle:
• Asexual->human
• Sexual->mosquito
• Exoerythrocytic cycle (hepatic) inoculation of sporozoites into blood stream
by infected mosquito ->hepatocytes->schizonts->merozoites->circulation.
• Tissue schizonts of falcioarum and malariae rupture once and and donot
persist in live cells.
• Schizonts of vivax and ovale remain dormant in liver cells-> hypnozoites.
• Erythrocytic cycle-> merozoites-> trophozoites->ring stage merozoites-
>gametocytes

4. • Four important pathologic processes have been identified in patients
with malaria:
• Fever
• Anemia
• Immunopathologic events/cytokines/cytoadherence
• Tissue anoxia

5. CLINICAL PRESENTATION
• Incubation period: 9-14 days
• Non specific symptoms
• Classic malariae (seldom noted) paroxysms of fever alternating with
fatigue
• Children >2 m fever, anemia, GIT symptoms, splenomegaly
• Severe high risk malaria
• Congenital malaria

6. DIAGNOSIS
• Malaria must be suspected in any child presented with febrile illness
(exclude other causes of fever, eg, ear infection, tonsillitis, resp
infection, meningitis)
• Clinical malaria
• Lab malaria when +ve thick, thin film stain by Giemsa showing ring
stage, (merozoites,trophozoites)
• Repeat test 5 hourly if –ve and suspicious
• ICT-> rapid diagnostic test
• PCR
• Differential diagnosis

7. • ICT for p. falciparum for histidine rich protein (HRP2) and aldolase is
approved for testing P. falciparum and P. vivax
• Sensitivity and specificity for p. falciparum (94-99% and 94-99%
respectively) and vivax (87-93% and 99% respectively) are good but
sensitivity for ovale and malariae is lower.
• Sensitivity for p. falciparum decreases at lower levels of parasitemia
so microscopy is still advised in areas where expert microscopy is
available.

8. Sudan Malaria Treatment Protocol 2017
• The communicable and non communicable disease control
directorate CNCDCD.
• Studies showed decreasing efficacy of artesunate + sufadoxine-
pyrimethamine but high efficacy to artemether-lumefantrine AL &
dihydroartemisinin-piperaquine DHAP.
• So the malaria advisory committee recommended the use of AL as
first line and DHAP as second line.
• Meeting order banning use of IM artemether in Sudan.

9. Treatment of uncomplicated malaria
• Sudan is considered as chloroquine resistant country for treatment of
simple uncomplicated malaria
• No monotherapy, always use recombinant therapy.
• The first line treatment in sudan is AL (coartem)
• 2nd line is DHAP and use of quinine tabs as alternative 2nd line

10. First line treatment:
• Artemether (20mg) + lumifanterene(120 mg), for adults 80/480
• Side effects: dizziness, fatigue, vomiting, abd pain, skin rash
• Give in 6 doses, twice per day for 3 days
• The total recommended dose for artemether 5-24mg/kg and 29-144mg/kg
for lumifantriene
• The dose regimen is six doses, two doses/day for 3 days
• 5-15 kg : 1 tablet
• 15-25: 2 tablets
• 25-35: 3 tablets
• 35- : 4 tablets

11. 2nd line treatment DHAP
• DHAP given in one dose/day for 3 consecutive days
• Dihydroartemisinin 4mg/day (2-10)
• Piperaquine 18mg/kg(16-27)
• Two strengths available:
• 20/160 for children
• 40/320 for adults
• Qunine orally 10 mg/kg 8 hourly for 7 days
• cases where vivax +ve use primaquine .25mg/kg

12. SEVERE MALARIA
• Case definition: malaria due to p. falciparum that is severe to be an
immediate threat to life
• It is a medial emergency and require hospitalization
• Fatility rate 30% in non-immune children

13. Clinical presentation of severe malaria:
• Cerebral malaria
• Resp distress
• Severe anemia
• Repetitive convulsions (more than 1 in 24 hours)
• Pulmonary edema
• Circulatory collapse
• Jaundice
• Hemoglobinuria + abnormal bleeding
• Abnormal bleeding (DIC)
• Acidosis and increased lactic acid
• Continuous vomiting

14. Lab findings in severe malaria
• Hypoglycemia: glucose less 40 mg
• Hemoglobin less than 5b/dl or PCV less than 15%
• Acidosis
• Hyperparasitemia , more than 5%
• Renal impairment
• Hyponatremia

15. Patients who are at higher risk to develop
sever anemia
• Children less than 5 years
• People returning to endemic areas
• Visitors
• Pregnant women
• Splenectomised individuals
• Patients on steroids and immunosuppressing drugs

16. Management of severe malaria
• Resuscitation ABC, O2, shock, convulsions, hypoglycemia, DIC
• Ask for relevant investigations
• Start quinine 10 mg/8hourly/slowly in glucose over minimum 4 hours
for 7 days.
• 10% glucose, monitor RBS & ECG
• Give IV quinine until parasitemia less than 1% in 48 hours
• OR: artesunate 3.0 mg/kg start followed by an other dose 12 hourly
then daily dose
• NO place for corticosteroids

17. • Clinical presentation with high fever, high parasitemia, impaired
consciousness, hyperreflexia, contracted or unequal pupils
• CSF shows increased pressure, proteins minimal, normal glucose &
WBCs

18. PREVENTION
• Reducing exposure to infected mosquitoes
• Indoors from dusk to dawn
• Permethrin treated nets/spray insecticides
• Wear protective closing/ mosquito replents
• Chemoprophylaxis
• 1-2 weeks before entering endemic are and 4 weeks after leaving
• Mefloquine/malarone (atovaquone+proguanil), Fansidar/doxycycline

19. Vaccine
• There are currently no licensed vaccines against malaria or any other
human parasite.
• One research vaccine against p. falciparum known as RTS,S/AS01 is
most advanced. This vaccine is being evaluated.
• Numerous other vaccines are also in current clinical trials and it is
hoped that future vaccines will improve upon the efficacy of RTS.S
vaccine
• There is currently NO vaccine with sufficient efficacy to be considered
for prevention of malaria in travelers

20. Thank you

21. ‫األماني‬ ‫من‬ ‫أنت‬ ُ
‫ء‬‫وتشا‬
‫نجمة‬
‫ناولك‬ُ
‫ي‬ ‫أن‬ َ
‫ك‬ّ
‫ب‬‫ر‬ ‫ويشاء‬
‫القمر‬