Malaria

• Malaria is very common; a very important cause of mortality and morbidity

• Four different parasites: Plasmodium falciparum, P. vivax, P. ovale, P. malariae

• Transmission via female Anopheles mosquitoes which bite at night

• Symptoms: atypical, fever, coma, anaemia, kidney failure, splenomegaly

• Infections often asymptomatic in semi-immune people (generally low parasitaemia)

• Clinical diagnosis not reliable

• Result is over-diagnosis of malaria and under-diagnosis of other disorders

• Thick smear and thin smear positive => problem of chronic carriers with another disorder

• Treatment of P. malariae: chloroquine

• Treatment of P. vivax and P. ovale: chloroquine with or without primaquine (hypnozoites)

• Treatment of P. falciparum: often insufficient response to chloroquine or Fansidar

• Better: quinine + vibramycin; atovaquone with proguanil (Malarone), artemether/artesunate with or without mefloquine or lumefantrine

• Progressive increasing multidrug resistance of P. falciparum

• Isolated cases of chloroquine resistance of P. vivax

• Resistance of mosquitoes to various insecticides

Category: Medicine Notes