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Introduction: Malarial Epidemic in India Pathogens causing Malaria Malarial Life Cycle Clinical Features of Malaria Diagnosis Treatment Need of Combination Therapy Available Combinations in India Clinical Efficacy Studies Preventive Measures
75%
Of the 2.48 million malaria cases reported annually from South Asia of which 75% cases are contributed by India alone2.
1. U.S. Department of health and human services national institutes of health 2. Infectious Diseases Chapter, Indian Academy of Pediatrics
Approximately 95% of the countrys population lives in malariaendemic areas, 80% of malaria occurs among 20% of the population who are classified as high risk populations1.
1. Estimation of Malaria Disease Burden in India; Regional Office for South-East Asia WHO
P. vivax parasites infect only young RBCs, which means the number of parasites in the blood does not reach the same high levels as seen in P. falciparum infection.
S.No. 1.
2.
P. vivex
Back to Bloodstream
Malarial Complications
CNS Renal
Blood Respiratory Metabolic Gastrointestinal
Cerebral malaria (coma, convulsion) Haemoglobinuria (Black water fever, Oliguria, uremia) Severe anemia (Haemolysis and dyserthropoisis) Acute Respiratory distress syndrome
Hypoglycemia Diarrhea, Jaundice, splenic rupture
Ref: Kumar and Clark, Clinical Medicine 5th Edition; Page No. 100
Diagnosis of malaria
All clinically suspected malaria cases should be investigated immediately by microscopy and/or Rapid Diagnostic Test (RDT).
Microscopy
Malaria Parasites Amid Red Blood Cells The invasion has begun
Management of Malaria
Aim of the Malaria Management
Complete cure
Prevention of progression of uncomplicated malaria
to severe disease
Prevention of deaths Interruption of transmission Minimizing risk of selection and spread of drug resistant parasites.
Guidelines for diagnosis and Treatment of malaria in India 2009 (Government of India)
Treatment Goal
Balance between provision of early diagnosis and prompt treatment, and minimising the development of antimalarial drug resistance.
Goal: reduce morbidity and mortality Broad access to antimalarias Emphasis on community and household management Requires high sensitivity of diagnosis
Goal: reduce and delay resistance Restrictive access to antimalarial drugs Emphasis on regulation and control management of drug use Requires high specificity of diagnosis
to
current
WHO
pregnancy is quinine.
Artemisinin Combination Therapy can be given in the second and third trimester of pregnancy.
Guidelines for diagnosis and Treatment of malaria in India 2009 (Government of India)
Need of Combination
INFECTIOUS DISEASES CHAPTER, INDIAN ACADEMY OF PEDIATRICS
Emergence of Chloroquine resistant falciparum malaria Monotherapy with Artesunate will further increase the resistance
Artemether + Lumefantrine
Artemether Lumefantrine 80mg 480mg
Treatment = Artemether-Lumefantrine (n = 245) or Artesunate Mefloquine (AST MF) (n = 245) and were followed for 42 days. Result =
2. Lower Recrudescence
Lower Recrudescence with ARM- LM
10 5 0 ARM -LM AST -MF 2 8
Artesunate Lumefantrine achieves higher cure rate as well as Lowers recrudescence than Artesunate -Mefloquine.
Ref: Malaria Journal 2005, 4:46
GCT:
PCT
ARM -LM AST -MF
GCT
Parasite and Gametocyte clearance time was found to be shorter with the treatment of Artemether- Lumefantrine as compared to Artesunate Mefloquine therapy.
Ref: Tropical Medicine and International Health, 2004 Feb, 9 (2); 192199
ARM-LM
AST-SP
Artesunate Lumefantrine achieves higher cure rate than Artesunate- Sulphadoxine- Pyrimethamine.
Ref: Gutman, Julie (2009)
Result
0% ARM-LM AST-SP
Artesunate Lumefantrine shows less failure rate than Artesunate- Sulphadoxine- Pyrimethamine.
Ref: Best Practice, BMJ, 2008
Result
Recurrent parasitaemias
25%
0%
ARM-LM AST-SP
Artesunate Lumefantrine is associated with lower rate of recurrent parasitaemia as compared to Artesunate- SulphadoxinePyrimethamine.
Ref: Best Practice, BMJ, 2008
Malaria Prevention
Indoor Residual Spraying (IRS) is being carried out in identified High Risk villages. Two regular rounds of IRS are being carried out every year during transmission season. Weekly spraying of larvicides (Temephos, Fenthion, etc.) on mosquito breeding places is being carried out in urban areas. Use Guppy fish at suitable mosquito breeding places.
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