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Malaria
Malaria is an infectious disease which
is transmitted by the bite of female
anopheline mosquitoes.
Human malaria can be caused by
four species of the genus
Plasmodium: P. falciparum, P. vivax,
P. ovale, P. malariae.
Among all the stated genuses, P.
falciparum is the most deadly.
Clinical Features
Fever
Headache
General malaise
Shivering
Myalgia
Clinical Examination
Tachycardia
Fever
Anemia
Splenomegaly
Definition
Affected renal function draws a wide
picture in red blood cell
abnormalities with the activation of
TH1 and TH2.
It includes hemodynamic which
direct to acute tubular necrosis.
LITERATURE REVIEW
Definition
Malaria caused by parasite in tropical
area transmitted by female
anopheline mosquitoes.
Malaria is known as the main cause
of acute kidney injury in South East
Asia, Vietnam, Peninsular India, and
Africa.
Clinical manifestations
Fever at first the fever may be continual or
erratic: the classical tertian or quartan fever
only appears after some daysn and it is
accompanied by rigors and drenching sweats.
Physical examination: tachycardia, fever,
anemia, hepatomegaly and splenomegaly.
P. falciparum infected: anemia, diarrhoea,
jaundice, acute kidney injury, acute coma
respiratory distress, disseminated
intravascular coagulation (DIC), breathlessnes.
Pathophysiology
Glomerulonephritis
Histological patterns: mononuclear
cell in infiltration, ( mesangial
hyperplasia and endothelial) , and
the thickness of basal membrane.
Immunological Mechanism
Clinical Manifestation
ATN microcircular destruction.
Massive hemolysis from
intravascular.
Imunne reaction towards the
parasites.
Fluid and electrolit disturbances.
Pathophysiology
Labarotorium Examination
Parasitology
Microscopic examination
QBC (semi quantitative buffy coat)
Rapid Manual Test
PCR ( Polymerase Chain Reaction)
Immunological Examination
C3 and C4 almost low in most
patients in early 2 weeks.
C3 loss in P. falciparum, around 44
60%, 20-40mg/dl (normal: 80-170
mg %)
Radiologic Examination
Chest X-ray cardiomegaly, %), lung
congestion, and pleural effusion.
Albar study: cardiomegaly (84,1%),
congested circulation (68,2%), pleura
effusion (65,9%) and lungs edema
(48,9%).
Diagnosis
Originated or living in an endemic
area.
Fever or history of high fever
Manifestations of affected renal; fluid
and electrolit disturbances,
glomerulonephritis
Malaria parasites findings in blood
culture
Other causes eliminated
Differential Diagnosis
APSGN occurs after certain latent period
Management
Mild P. falciparum without
complication :
first line treatment - combined
artesunate and amodiaquin.
Second line - kina and tetracycline or
doxycycline
Severe malaria depends on
artemeter and injection of kina.
Amodiaquin
Antipirectic and anti inflamatory
Not recommended for prophylaxis
treatment
Present in 200-600mg per tablet of
amodiaquin hidroclorida or 151,1 mg
amodiaquin clorohidrat.
Amodiaquin dosage 10 mg /kg /3
days.
Artemisinin derivatives or
qinghaosu
Antimalaria for P. falciparum and P.
vivax
Derivatives: artesunat, artemeter,
dihidroartemisinin, artemisinin,
arteeter, and artelinic acid.
Mechanism interact with Fe and
heme in malaria hemozoin
Recommendation of WHO
2001
Combination of:
Artemeter and Lumefantrine
Artesunat and Amodiaquine
Artesunat and PirimetaminSufadoksin
Amodiaquine and PirimetaminSufadoksin
Artesunat and Meflokuin
Artesunate or artesunic
acid
Present in :
Tablet - 50 mg of artesunat
Ampule - 60 mg of artesunat
Artesunate is used 4 mg/kg /3 days
per dosage
Hyponatremia
Sodium < 130 mEq/L
Common : overload of previous fluid
restriction
Dosage : (140-Na serum)x BW x 0,6=
mEq
Another opinion : Na=(125-Na
serum) x 0,6 x BW
Hypocalcemia
Does not need therapy unless tetanic
If tetanic: Ca-gluconase 10% dosage
0.5-1 ml/kgBW iv slowly
Diuretic challenge:
Furosemid 1 mg/kg BW
Increases urine output in kidney
failure
Anemia
Transfusion is needed if Hb<6g% or
Ht < 20%
PRC (10cc/kgBW) is given to increase
blood volume
FOLLOW UP
Days 4,7,14,28
Parasitemia might increased in first
12-24 hours after receving
antimalaria therapy
Diuresis monitoring : ureum and
creatinine rate 2-3 x/week, Na+, K+,
HCO3, PH.
ECG and Xray on indication
Prognosis
Morbidity : increase 45% if kidneys
affected, hence increasing mortality
rate by three times