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MALARIA

Definition:
Infection due to plasmodium.
Aetiology
Plasmodium
Falciparum 90%
Vivax
Ovale
malariae
Epidemiology
Malaria attacks are very common in
infants and young children in endemic
area.
Attacks are rare below 3 months of age.
Peak is 6/12 -5yrs
Clinical features
Fever
General malaise
Fatigue
Sometimes diarrhoea and
vomiting
May become severe or
complicated.
Asymptomatic: older children that
have attained semi-immunity may
have asymptomatic malaria.
SEVERE AND COMPLICATED
MALARIA IN CHILDREN
1. CEREBRAL MALARIA
Mainly in children below 5 years of age.
Presents with:
Fever
Vomiting
Drowsiness
Convulsion

Deterioration can be with hours

Unconsciousness (coma)

Hypoglycaemia a major risk.


Complications
10% of the dirvivors get severe
neurological sequelae which include:
Hemiplegia (hemiparesis)
Epilepsy
Cortical blindness
2. Severe Anaemic
Peak age 1-2 yrs
During anaemia rapid deterioration
Probably caused by long standing
parasitaemia
3. Hyperparasitaemia
>5% of RBC infected or > 250,000
parasites/mm
4. Severe respiratory distress
Predicts high mortality
Caused by pulmonary oedema or
metabolic acidosis
5.Convulsion
Repeated convulsions
(generalised) more than 2 times
within 24 hrs.
May be the first sign of cerebral
malaria
However, 5% of all children get
febrile convulsions when they have
fever.
6. Hypoglycaemia
This is freatable.
Therefore hypoglycaemia must be
detected in all patients with severe
malaria and treated immediately.
6. Hyperthermia
Temperature of the body > 41c
7. Algid malaria
A combination of severe malaria
with gram negative septicaemia
Algid malaria presents with severe
hypotension and shock.
BP should be measured regularly
and septicaemia ruled out/treated.
8. Uncommon symptoms
Renal failure
Jaundice
Macroscopic haemoglobimeria
(black water fever)
Disseminated intravascular
coagulation (DIC) and other
bleeding disorders.
Diagnosis
1. Suspicion from clinical presentation
In endemic areas malaria should be
suspected in children with
symptoms listed above. This should
be confirmed by
2. B/S (blood film)- Thick and thin
A single negative blood slide does
not rule out malaria. Repeat a least
twice in case of high suspicion of
malaria
UNCOMPLICATED MALARIA

Artemether 20 coarterm
Lumefantrine 120 coartesian
ALU
Duo Cotecxin
Dihydroartemesinin 40
Piperaquine phosphate-320
Synestic combination
Active against asexual forms of
plasmodium, schizonts and
gametocytes.