3. Arguin PM, Mali S. Infectious diseases related to travel. Yellow Book 2012. Centers for Disease
Control and Prevention
4. CLINICAL DIAGNOSIS
HIGH FEVER WITH CHILLS, RIGOR, SWEATS, AND HEADACHE
NAUSEA, VOMITING, DIARRHEA, COUGH, TACHYPNEA, ARTHRALGIA,
MYALGIA, AND ABDOMINAL AND BACK PAIN
BOTTIEAU E ET AL. FEVER AFTER A STAY IN THE TROPICS: DIAGNOSTIC PREDICTORS OF THE LEADING
TROPICAL CONDITIONS.
MEDICINE (BALTIMORE) 2007; 86:18.
5. LAB DIAGNOSIS
1. MICROSCOPY
THICK & THIN BLOOD SMEARS
2. RDT’S
HISTIDINE-RICH PROTEIN 2 (HRP2)
PLASMODIUM LACTATE DEHYDROGENASE (PLDH)
ALDOLASE
• BINAXNOW : DETECTS HRP2 AND ALDOLASE; 94, 84 % SENSITIVITY
#
#FARCAS GA ET AL. EVALUATION OF THE BINAX NOW ICT TEST VERSUS POLYMERASE CHAIN REACTION
AND MICROSCOPY FOR THE DETECTION OF MALARIA IN RETURNED TRAVELERS.
AM J TROP MED HYG 2003; 69:589.
6. TREATMENT OF UNCOMPLICATED FALCIPARUM
MALARIA
SYMPTOMATIC MALARIA, NO ORGAN DYSFUNCTION &
PARASITEMIA <5 %
YOUNG CHILDREN, NON-IMMUNE ADULTS, AND
IMMUNOCOMPROMISED PATIENTS DETERIORATE RAPIDLY
NEED FOR HOSPITALIZATION SHOULD BE DICTATED BY CLINICAL
MANIFESTATIONS AND PARASITE SPECIES
CHLOROQUINE - TOTAL 25 MG/KG
10 MG PO IMMEDIATE, FOLLOWED BY 5 MG/KG AT 6, 24, 48 HOURS
7. CHLOROQUINE RESISTANT FALCIPARUM
I. ARTEMETHER + LUMEFANTRINE (COARTEM)
II. ATOVAQUONE-PROGUANIL (MALARONE)
III. QUININE SULFATE + DOXYCYCLINE OR CLINDAMYCIN
IV. MEFLOQUINE + DOXY
8. ARTEMETHER + LUMEFANTRINE (COARTEM)
1 TABLET = 20 MG ARTEMETHER AND 120 MG LUMEFANTRINE
6 DOSES OVER 3 DAYS
INITIAL DOSE, FOLLOWED BY THE SECOND DOSE 8 HOURS LATER,
THEN 1 DOSE PO BID FOR THE FOLLOWING TWO DAYS
PREVENTS GAMETOCYTEMIA, WHICH MEDIATES TRANSMISSION
AND REINFECTION
SINGLE DOSE (0.25 MG BASE/KG) OF PRIMAQUINE ADDED AS AN
ADJUNCT IN AREAS THREATENED BY ARTEMISININ RESISTANCE
ADJUIK M ET AL. ARTESUNATE COMBINATIONS FOR TREATMENT OF MALARIA: META-
ANALYSIS.
LANCET 2004; 363:9
9. ATOVAQUONE-PROGUANIL (MALARONE)
ADULT TAB = 250 MG ATOVAQUONE/100 MG PROGUANIL
PEDS TAB = 62.5 MG ATOVAQUONE/25 MG PROGUANIL
• 5 TO 8 KG: 2 PEDS TABS PO ONCE DAILY X 3 DAYS
• 9 TO 10 KG: 3 PEDS TABS PO ONCE DAILY X 3 DAYS
• 11 TO 20 KG: 1 ADULT TAB PO ONCE DAILY X 3 DAYS
• 21 TO 30 KG: 2 ADULT TABS PO ONCE DAILY X 3 DAYS
WELL-TOLERATED AND EFFECTIVE
ATOVAQUONE SELECTIVELY INHIBITS PARASITE MITOCHONDRIAL
ELECTRON TRANSPORT
10. SEVERE MALARIA
PARASITEMIA >5 % AND/OR MAJOR SIGNS OF ORGAN DYSFUNCTION
:
●ALTERED CONSCIOUSNESS WITH OR
WITHOUT CONVULSIONS
●DEEP BREATHING, RESPIRATORY
DISTRESS
●METABOLIC ACIDOSIS (BICARBONATE
>15 MMOL/L OR LACTATE
>5 MMOL/L)
●CIRCULATORY COLLAPSE
●PULMONARY EDEMA OR ACUTE
RESPIRATORY DISTRESS SYNDROME
●RENAL FAILURE, HEMOGLOBINURIA
("BLACKWATER FEVER")
●CLINICAL JAUNDICE
●DISSEMINATED INTRAVASCULAR
COAGULATION
●SEVERE ANEMIA
●HYPOGLYCEMIA
11. ANTIMALARIAL THERAPY
QUINIDINE GLUCONATE
10 MG SALT/KG LD (MAX. 600 MG SALT) IN NORMAL SALINE OVER 1
HR, FOLLOWED BY 0.02 MG/KG/MINUTE CONTINUOUS INFUSION
ARTESUNATE
2.4 MG/KG IV AS 1ST DOSE, FOLLOWED BY 2.4 MG/KG AT 12 AND 24
HOURS, FOLLOWED BY 2.4 MG/KG ONCE DAILY FOR 2 DAYS
FOR PREGNANT WOMEN
2ND & 3RD TRIMESTERS - IV ARTESUNATE
1ST TRIMESTER - IV QUININE
12. EMPORIATRICS
CHEMOPROPHYLAXIS BEGUN BEFORE ARRIVAL IN THE ENDEMIC AREA
• 2 WEEK – MEFLOQUINE
• 1 WEEK – CHLOROQUINE
• 1-2 DAYS – DOXY, MALARONE, PRIMAQUINE
PRESUMPTIVE ANTIRELAPSE THERAPY (TERMINAL PROPHYLAXIS)
- PRIMAQUINE FOR 14 DAYS
13. PERSONAL PROTECTIVE MEASURES
1. USING INSECTICIDE-IMPREGNATED MOSQUITO NETS
2. REMAINING IN WELL-SCREENED AREAS
3. WEARING PROTECTIVE CLOTHING
4. USING MOSQUITO REPELLENTS CONTAINING DEET, PICARIDIN, OIL
OF LEMON EUCALYPTUS
