Definition of Malaria: Malaria is a life-threatening infectious disease caused by parasites of the Plasmodium genus. It is transmitted to humans through the bites of infected female Anopheles mosquitoes. 2. Causative Agent and Life Cycle: Plasmodium Species: The primary malaria parasites affecting humans are Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and Plasmodium knowlesi. Life Cycle: Mosquito Stage: The cycle begins when an infected female mosquito bites a human, injecting sporozoites into the bloodstream. Liver Stage: Sporozoites travel to the liver, where they mature into schizonts, releasing merozoites. Blood Stage: Merozoites invade red blood cells, leading to cycles of replication and causing symptoms. Some parasites develop into sexual forms (gametocytes), which can be taken up by mosquitoes during a blood meal, completing the cycle. 3. Symptoms: Febrile Paroxysms: Malaria typically presents with recurrent episodes of fever, chills, and sweating, known as paroxysms. Anemia: The destruction of red blood cells by the parasites can lead to anemia. Organ Dysfunction: Severe malaria, often caused by P. falciparum, can lead to organ dysfunction, including cerebral malaria affecting the brain, severe anemia, respiratory distress, and kidney failure. 4. Treatment: Antimalarial Drugs: Artemisinin-based Combination Therapies (ACTs) are the first-line treatment for uncomplicated malaria. Examples include artemether-lumefantrine and artesunate-amodiaquine. For severe malaria, intravenous artesunate is often recommended. Preventive Measures: Bed nets treated with insecticides are effective in preventing mosquito bites. Chemoprophylaxis with antimalarial drugs is recommended for individuals traveling to malaria-endemic regions. Vector Control: Mosquito control measures, such as insecticide spraying and environmental management, are crucial for malaria prevention.

1. CASE STUDY ON MALARIAL FEVER
BY,
SRIRAM THIRUNAVUKKARASU,
PHARM.D IIIRD YEAR,
380020514525,
PGP COLLEGE OF PHARMACEUTICAL SCIENCE AND
RESEARCH INSTITUTE,
NAMAKKAL.

2. CASE SUMMARY
• A 45 years old male patient was admitted with the chief complaints of high grade of fever and
chills for 3 days.
• He has no past medical and medication history.
• He has no social history and any known drug allergies.
• The patient was oriented, conscious and febrile. Physical examinations are normal. The specific
test USG ABDOMEN shows mild splenomegaly and peripheral smear study shows Normocytic
normochromic blood picture shows thrombocytopenia.
• The patient has decreased level of platelets and increased level of ALT and T.Bilirubin. The
patient was diagnosed with malarial fever with hemolysis, splenomegaly and
thrombocytopenia.
• Inj. Ceftriaxone + Sulbactam, Inj. Ondansetron, Cap. Domperidone+ esomeprazole, T.
Doxycycline , T. Artemether + lumefantrine, T. Primaquine were given to the patient during
hospitalization.
• The patient was discharged on 18.8.23.

3. MALARIAL FEVER
DEFINITION
• Malaria is a potentially life-threatening disease caused by parasites that are
transmitted to people through the bites of infected mosquitoes. It is very common
in tropical countries. Malaria is caused by Plasmodium parasites.
• Malaria is preventable and curable, and increased malaria prevention and control
measures are dramatically reducing the malaria burden globally.
• Plasmodium falciparum and Plasmodium vivax are the most common parasites
seen in India. Plasmodium falciparum is the most deadly.

4. PATHOPHYSIOLOGY

5. SUBJECTIVE
• A 45 years old male patient was admitted with the chief complaints of high grade
of fever and chills for 3 days.
• He has no past medical and medication history.
• He has no social history and any known drug allergies.
SOAP ANALYSIS

6. • The patient was conscious, oriented and febrile.
• No head injury
• Eye movement normal
• CVS - S1S2 Normal
• RS - NVBS Normal
• CNS – NFND
• GIT- ISAB (Integumented Secretory Area Before) and P/A - Soft.
OBJECTIVE
On Physical Examination,

7. S. NO PARAMETERS DAY 1 DAY 2 DAY 3
NORMAL
RANGE
1. Temperature ֯ F 100 97 99 97.2-98.8
2.
Blood pressure
mmHg
100/60 100/70 120/80 120/80
3.
Pulse rate
beats/min
96 82 100 60-100
4.
RESPIRATORY RATE
breaths/ min
20 20 20 12-16
5. SPO2 97% 96% 99% 95-100%
VITAL SIGNS:

8. LABORATORY TEST:
LAB INVESTIGATION DAY 1,2,3 NORMAL VALUES
FULL BLOOD COUNT
Hb 14.2 12-15 g/dL
RBC 4.62 4-5.65 million cells/cu.mm
Platelet 99000, 110000,120000 150000 - 450000 cells/µL
LIVER FUNCTION PROFILE
Total bilirubin 3.89 0-1 mg/dL
Direct bilirubin 1.10 0-0.25 mg/dL
Albumin 4.42 3.4- 5.2g/dL
ALP 83.6 1-104 U/L
ALT 42.6 0-31U/L
AST 26.6 0-31U/L

9. SPECIFIC TEST:-
1} USG ABDOMEN: mild splenomegaly. GB not visualized – post cholecystectomy.
Enlarged fatty liver.
2}Peripheral smear study: Normocytic normochromic blood picture with
Thrombocytopenia.
ASSESSMENT :-
Diagnosis,
Based on the Laboratory values and Vital signs monitored as per test on
15/08/2023, There are elevated values of S. Creatinine and ALT and
decreased level of platelets Thus, he was diagnosed with
• Malarial fever with hemolysis and Splenomegaly,
• Thrombocytopenia.

10. PLAN
Goals Of Therapy,
 To treat malarial infection with antimalarial drugs.
 To increase the level of platelets in blood.

11. THERAPHY :-
S.NO DRUG DOSE ROA FREQUENCY 15/08 16/08 17/08 18/08
1 Inj. Paracetamol 1 g IV SOS    
2
Inj. Ceftriaxone +
Sulbactam
1000 +
500 g
IV BD    
3 Inj. ondansetron 8 mg IV SOS    
4
Cap.
Domperidone+
esomeprazole
30+40
mg
P/O BD    
5 T. Doxycycline
100
mg
P/O BD    
6
T. Artemether +
lumefantrine
80+48
0 mg
P/O BD    
7 T. Primaquine 15mg P/O OD    

12. DRUG-DRUG INTERACTION
DRUG – 1 DRUG – 2 INTERACTION
artemether/lumefantrine ondansetron
artemether/lumefantrine and ondansetron both increase
QTc interval.
primaquine ondansetron
primaquine and ondansetron both increase QTc interval.
Avoid or Use Alternate Drug
doxycycline
ceftriaxone
doxycycline decreases effects of ceftriaxone by
pharmacodynamic antagonism. Use Caution/Monitor.
bacteriostatic agents may inhibit the effects of
bactericidal agents.
artemether/lumefantrine primaquine
artemether/lumefantrine and primaquine both increase
QTc interval. Use Caution/Monitor.

13. DISCHARGE MEDICATION
 Continue the medication until revisit after 15 days
S.NO DRUG DOSE FREQUENCY
1. T. Paracetamol 650mg SOS
2. T. Primaquine 15mg OD
3. Cap. Domperidone+ esomeprazole 30+40mg BD(BF)
4. T. Diet gold (multivitamin) - OD

14. PATIENT COUNSELLING
 Cap. Domperidone+ esomeprazole should be taken 30 minutes before food.
 Tab. Paracetamol can be taken if fever.
 Tablet primaquine should be taken once a day.
Disease based counselling:-
 Malaria is a life-threatening disease caused by parasites that are
transmitted to people through the bites of infected female Anopheles
mosquitoes. It is preventable and curable.
Diet based counselling,
 Take adequate quantity of water.
 Take vitamin C rich foods such as citrus fruits etc.
 Avoid intake of coffee, tea, cocoa, cola or any other caffeinated beverages.
 sauces and pickles shouldn’t be included anywhere in the diet.
 Eat a well balanced diet.
PATIENT COUNSELLING
Lifestyle based counselling,
 Keep your body hydrated.
 Take enough rest.
Drug based Counselling:-

15. PHARMACIST INTERVENTION
The given prescription is rational with some minor Drug-Drug interactions.

16. THANK YOU