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Severe Complicated Falciparum Malaria- A Case Study

PUBLIC HEALTH INFORMATION:

Nigeria has a huge malaria burden

Malaria is preventable, treatable and curable by Proper harnessing of resources available and required in the fight against malaria.

No Child has to die again from malaria. Time is now right for rapid scale up to achieve impact

 

CASE FILES

An 8-year old female was brought in and admitted to the Children Emergency department of a Nigerian Teaching Hospital in October 2018, with repeated convulsions since the past two days, headache, giddiness, skin rash, muscle aches and recurring fever with chills.

On arrival, the patient was febrile with a temperature of 38.3°C, confused and unresponsive. Family members revealed 2 prior history of convulsions in the last 24 hours before presentation to the hospital.

Vital signs included a blood pressure of 100/75 mm of Hg, 20 breaths per minute and a pulse rate of 110 beats per minute. Chest examinations were normal and spleen was palpable 3 cm below the costal margin.

 

What Are Your Provisional Assessments?

 

 

INVESTIGATIONS

Laboratory investigations included the following results: hemoglobin = 6.8 g/dL (normal range:11.5-15.5 g/dL); platelets= 7100/μl (normal range:150,000-400,000 μl); total bilirubin = 2.9 mg/dL (normal range: 0.3- 1.9 mg/dL); serum creatinine = 1.2 mg/dL (normal range: 0.1- 1.0 mg/dL); total leukocyte count was 4900/μl with 30% neutrophils, 50% lymphocytes and 18% monocytes and serum electrolytes were within normal limits.

Blood cultures and biochemical tests for other co-morbidities like serology against hepatitis A, hepatitis E, HIV, leptospirosis and dengue were performed and were found to be negative. Absence of other co-morbidities like pneumonia, enteric fever, varicella-zoster virus, diabetes, hypertension etc. was also confirmed. Lumbar puncture (for exclusion of meningitis) and CT scans were performed without any pathological findings.

 

Microscopy and Rapid diagnostic tests (RDTs) confirmed the presence of P. falciparum in the blood sample.

 

DIAGNOSIS:

The tests confirmed that the patient was suffering from cerebral alaria and severe anaemia due to P. falciparum. Patient was treated with intravenous ceftriaxone and artesunate along with intravenous (IV) fluids. The patient made full recovery in three days.

 

 

DISCUSSION: WHAT IS MALARIA AND HOW IS IT TRANSMITTED?

Malaria is an infectious disease caused by infestation by parasites of the genus Plasmodium (falciparum, ovale, malariae, vivax and more recently discovered knowlesi).

To take a Full Course and Test on Malaria, Including Pathogenesis and Management, click here.

 

Malaria is one of the commonest reasons for hospital consultation in Nigeria. 3.3 million people are at risk globally and 216 million cases recorded in 91 countries in 2016. Malaria accounted for 446000 deaths globally, more in children under five living in sub-Saharan Africa. Nigeria Unfortunately accounted for 27% of malaria cases and 24% of malaria deaths globally.

Due to the nature of malaria being in the tropics, about 97% of the population of Nigeria are at risk of Malaria. About 50% of the population will have at least one attack/year with children under the age of 5, pregnant women, immune compromised and the elderly being more Vulnerable.

Unfortunately, about 300,000 children and 11% of pregnant women die of malaria in Nigeria,EACH YEAR

 

Mode Of Transmission: Malaria is transmitted following;

  • Bite from an infected female anopheles mosquito. (commonest)
  • Accidental e.g; Blood transfusion (rare)
  • Congenital malaria; Malaria seen within the first week of life

Transmission of Malaria

Types Of Malaria: Malaria can be classified as

  • Uncomplicated Malaria: This is described as symptomatic malaria without signs or evidence of vital organ dysfunction. Malaria here, is suspected on the basis of fever.
  • Complicated Malaria: This is symptomatic Malaria with signs or evidence of life threatening conditions or vital organ dysfunction.

 

People At Risk Of Malaria:

  1. Children under the age of 5
  2. Pregnant women especially in 1st Pregnancy
  3. People living or traveling to endemic areas
  4. Patients with Sickle cell disease

 

Clinical Features Of Malaria:

Clinical Features depends on the type (complicated severe malaria or uncomplicated). The features include:

  • fever.
  • headache,
  • chills or rigors,
  • general weakness,
  • Vomiting,
  • loss of appetite
  • profuse sweating.
  • In young children there may be abdominal pain, vomiting and poor feeding and diarrhea.

clinical features of malaria

Complicated Malaria can present with any of the following:

confusion

convulsion

child looking pale

too weak to sit or stand

– Respiratory distress (difficulty in breathing, fast deep breath)

 

Diagnosis: This is done by Microscopy (giemsa blood smear) and/or Rapid diagnostic tests (RDTs) which confirms the presence of P. falciparum in the blood sample.

 

Treatment: management of malaria is by;

  • ACTs-AL & AA for uncomplicated malaria.
  • Injection Artesunate for severe malaria
  • ACTs are used in children less than 5kg.
  • Younger children and neonates are given amodiaquine or quinine except in cases of complicated malaria.
  • Pregnant women less than 16 weeks gestation are given quinine and clindamycin for uncomplicated malaria and parenteral artesunate for complicated malaria.

 

Prevention/Control: This can be done using elements of the Roll back malaria initiative as follows:

  • Early detection
  • Rapid and Effective treatment
  • Use of Insecticide Treated nets to eliminate the mosquito vector
  • Use of Indoor residual spraying to eliminate the mosquito vector
  • Environmental management by discarding of all stagnant water which is the breathing place of the mosquito vector.
  • Intermittent Preventive therapy

 

To take a Full Course and Test on Malaria, Including Pathogenesis and Management, click here.

October 11, 2018

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