Malaria: Diagnosis, clinical aspects

No single clinical sign permits the diagnosis of malaria. Yet malaria must always be considered in cases of fever in the tropics. Since the symptoms can be quite diverse, a clinical diagnosis is unreliable in itself. Microscopic confirmation of the diagnosis is often not possible in many regions and situations. It is of the greatest importance that other important diagnoses are ruled out before instituting a blind anti-malaria therapy. All too often fever is considered as malaria without considering alternative diagnoses.

The presence of parasites does not rule out an additional diagnosis: e.g. someone with fever may well have some malaria parasites in a thick smear, but this does not rule out meningitis or pyelonephritis. Chronic carriers are people who, in spite of the fact that they have malaria parasites in their blood, have no symptoms of this. When such people develop another infection their symptoms are often attributed to the malaria parasites in their blood, although these are not responsible. The absence of parasites in a single preparation does not rule out malaria, but does make the diagnosis of P. falciparum highly improbable. Where there is strong clinical suspicion it is best to repeat the test 12h later.

Category: Medicine Notes