2. MALARIA
an intermittent and remittent fever caused by a protozoan parasite (Ex:- P.
falciparum, P. vivax, P. ovale, P. Malaria) which invades the red blood cells and is
transmitted by the bite of female anopheles mosquito in many tropical and
subtropical regions.
Each year approximately 2.5 million cases and 4,000 deaths are reported in south east
asia.
India reported the highest number of malaria cases in the Region and the second highest
number of deaths due to malaria.
PATHOPHYSIOLOGY
3. SUBJECTIVE EVIDENCE
Age: 40 yrs. Sex: MALE
DOA: 07-11-2017 DOD: 12-07-2017
Complaints on admission:
C/O Fever since 10 days with chills.
C/O dry cough since 2 days.
C/O generalized weakness since 5 days.
C/O body ache since 1 week.
4. PERSONAL HISTORY
PAST MEDICAL HISTORY:- Nothing significant
MEDICATION HISTORY :- Nothing significant
SOCIAL HISTORY:-
Appetite:- DECREASED
DIET:- Mixed
Bowel and bladder:- Normal
Sleep :- decreased
FAMILY HISTORY :- Nothing significant
5. OBJECTIVE EVIDENCE
PHYSICAL EXAMINATION:
P I C C L E : NEGATIVE
PR- 100 bpm
BP-130/90 mmHg
temp – 102.6*F
SYSTEMIC EXAMINATION:
CVS: S1, S2 normal
RS : NVBS B/L (+)
CNS: Conscious and oriented
PELVIC ABDOMEN(PA): Soft
PROVISIONAL DIAGNOSIS : ????MALARIA
6. LAB INVESTIGATION
Biochemical investigation
Test Observed value Reference value
HAEMATOLOGY
Red Blood Corpuscles 4.0 miilion cells/ul (4.2-5.4 million cells/ul.)
platelets 0.32 lakhs /mm3 (1.5-4 lakhs /mm3 )
PCV(packed cell volume) 37.8% (40-54%)
Neutrophills 74% (45-73%)
ESR 17 mm/hr (1-15mm/hr)
RAPID DIAGNOSTIC TEST(RDT) FOR MALARIAL PARASITE
Blood smear:- Positive for all stages.ie; ring forms, schizonts and gametocytes of malarial
parasite plasmodium vivax.
7. FINAL DIAGNOSIS
From the subjective and objective evidence, The patient was diagnosed as:
MALARIAE (PLASMODIUM.VIVAX)
8. GOAL OF THERAPY
Patient specific:
To relieve from the symptoms such as fever, dry cough, weakness, body ache.
Disease specific:
To prevent further progression of disease.
To eradicate the malarial parasite.
9. ASSESMENT OF CURRENT THERAPY
Brand name Generic name DOSE ROA FRE Indication TOA
(BF/AF/WF/WW)
Start
date
End
date
IV. fluid fluids 2*NS
2*RL
2*DNS
27-11-17 01-12-17
Inj.pantodac Inj. Pantoprazole 40mg IV 1-0-0 It decrease amount of acid
produced in stomach to
protect from erosive stomach
BF 27-11-17 02-11-17
inj.ALZONE Inj. ceftriaxone 1gm IV 1-0-1 cephalosporin antibiotic
which used to suppress or to
kill harmful bacterial growth
AF 27-11-17 02-11-17
T. PCT paracetamol 650 mg PO 1-0-1 Antipyretics which used to
decrease the body
temperature.
AF 27-11-17 02-11-17
Inj. falcigo artesunate 120 mg IV 1-0-1 Anti malarials medication
used to treat malaria . Often
it is used as part of
combination therapy
AF 27-11-17 29-11-17
T. malirid primaquine 15 mg PO 1-0-0 Anti malarial medication used
to treat and
prevent malaria. Specifically
it is used for malaria due
to P
.vivax and P.ovale
AF 01-12-17 02-11-17
T. emeset ondesteron 4mg PO 1-0-0 Prevention of nausea and
vomiting
AF 01-12-17 01-12-17
Syp.tuspel Turbutaline-1.25 mg
Bromehexine- 4 mg
2 tspn PO 1-1-1 used for Coughing, Cough,
Bronchitis, Asthma, Breathing
problems, Chest tightness and
AF 01-12-17 02-11-17
11. PLANNING
DAY 1 DAY 2 DAY 3 DAY 4 DAY 5
PROBLEMS • Bacterial
infection
Rx:
ceftriaxone
• FEVER
Rx: paracetamol
For cough
Rx:
turbutaline and
bromhexine syrup
Gastric irritation
Rx :
inj. Pantodac
For M.parasite
Rx: artesunate and
Repeated all Repeated all Repeated all Repeated all
12. DISCHARGE MEDICATION
GENERIC
NAME
DOSE
( mg)
FREQUENCY DAYS INDICATION ROUTE TIME
T. dolo acetaminop
hen
650 mg SOS Antipyretics PO After food
T.emeset ondensteron 4 mg 1-1-1 7 days Anti emetic PO After Food
Pantodac pantaprazol
e
40mg 1-0-1 2 weeks PPI PO before food
Tab. malirid primaquine 15 mg 1-0-0 9 days antimalarials PO afterfood
Syp.tuspel Turbutaline
and
bromhexine
2 tspn SOS For cough PO afterfood
13. PHARMACIST INTERVENTION
All the drugs prescribed were screened for adverse drug
reactions and found no adverse drug reactions.
15. PATIENT COUNSELLING
DRUG SPECIFIC:
ONDANSERTON:-
Instruct patient to report signs or symptoms of serious cardiac arrhythmias.
Advise patient to report hypersensitivity reactions, including anaphylaxis and
bronchospasm .
PANTOPRAZOLE:-
Take each dose at the same time each day.
Swallow the tablet whole.
Avoid alcohol.
Report any persistent side effects to your doctor.
Administer 30 minutes before food in order to avoid gastric irritation.
Ceftriaxone:-
Instruct the patient to report any sign or symptoms like serum sickness
like reactions(rash,urticaria,arthralgia,fever,malaise)
Primaquine:-
It should be taken with food to avoid GI upset.
Inform the patient that the drug may turn urine colour to brown.
16. DISEASE SPECIFIC:
Personal protection to avoid mosquito bites includes use of clothes
extending upto the wrists and ankles.
Use insect-repellant creams.
Use biological methods to decrease the vector density.
Prophylaxis should be started 1-2 weeks before exposure and
continued for 4 weeks after returning from the endemic area.
