Malaria

MALARIA (Ague) King of Tropical Disease Acute and chronic parasitic diseases Causative agent : Protozoa of genus Plasmodia 4 species of Protozoa: 1. Plasmodium falciparum ( malignant tertian) Most fatal ; common in the Philippines 2. Plasmodium vivax ( Benign tertian)

MALARIA (Ague) King of Tropical Disease 3. Plasmodium malariae (Quartan) Less frequently seen ; non life threatening , fever & chills usually occur q72H usually on the 4th day a

Plasmodium Life Cycle

Malaria
Transmission :
sporozoites, injected by anopheles mosquito

travel to human liver

mature to be released into a blood stream as merozoites

invade RBC as they undergo sexual reproduction to

PATHOPHYSIOLOGY :

RBC decreases deformability and oxygen transport, increase adhesion and fragility leading to anemia

produce zygotes

uncomplicated fever, chills, sweating every 24 36 hrs Complicated sporulation or segmentation and rupture of erythrocytes occurs in the brain and visceral organs. Cerebral malaria changes of sensorium, severe headache and vomiting seizures

Clinical Manifestation

MALARIA (Ague)
Clinical manifestations :

1. Cold stage
Chilling sensation of the body ( 10-15 mins) Chattering of lips, shakes Keep the patient warm Hot water bath Expose to heat Warm drinks Last about 10-15min 2. . Hot stage (3-4Hrs) Recurring high grade fever , headache , abdominal pain and vomiting

MALARIA (Ague)
Clinical manifestation :
I. Cold stage ( 10-15mins) II. Hot stage (3-4Hrs) III. Wet stage Profuse sweating Keep patient comfortable Keep them warm and dry Increase fluid intake

Diagnostics: 1. Malarial smear - Peripheral blood extraction (extract blood at the height of fever or 2 hrs before chilling ( AGUE) 2. Rapid diagnostic test ( RDT) blood test for malaria conducted outside the lab & in the fieldresult is within 10-15 mins. This is done to detect malarial parasite antigen in the blood. Pathonomonic sign: Stepladder fever

Medical Mgmt: A. IVFs B. Anti- Malarial Drugs Chloroquine ( less toxic); Premaquine For chloroquine resistant plasmodium quinine Prophylaxis chloroquine or mefloquine, pyrimethamine/sulfadoxine (fansidar) C. Erythrocyte exchange transfusion for rapid production of high levels of parasites in the blood.

Nursing Considerations
If entering an endemic area, travellers are advised to take chloroquine from 1-2 weeks at weekly interval. Protection is good for 1 year Patient must be closely monitored Soaking of mosquito nets in an insecticide solution Bio pond for fish On stream clearing cut vegetation overhanging stream banks to expose the breeding stream to sunlight Vectors peak biting is at night (9pm-3am)

 Planting of neem tree ( repellant effect) Zooprophylaxis ( deviate mosquito bite from man to animals Wear long sleeves/ pants/Socks Apply insect repellant on skin Screening of houses Notes: Malaria stricken mother can still breastfeed Chloroquine ca be given to a pregnant woman If there is drug resistance, give quinine SO4 BT in anemia Dialysis in renal failure Decreased fluids in cerebral edema No meds to destroy sporozoites

Category of provinces
Category A no significant improvement in malaria for the past 10 years. >1000 - Mindoro, isabela, Rizal, Zamboanga, Cagayan, Apayao, kalinga Category B - <1000/year - Ifugao, abra, mt. province, ilocos, nueva ecija, bulacan, zambales, bataan, laguna Category C significant reduction -pampanga, la union, batangas, cavite, albay