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Background
Malaria is a life-threatening infectious disease caused by parasites of the genus Plasmodium. It is transmitted to humans through the bites of infected female Anopheles mosquitoes. Malaria is a primary global health concern, particularly in tropical and subtropical regions, with sub-Saharan Africa bearing the highest disease burden. The most common and dangerous form of malaria is caused by the parasite Plasmodium falciparum.
However, other species, such as Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale, can also cause the disease. When an infected mosquito bites a person, the parasite enters the bloodstream and travels to the liver, where it multiplies and matures. It then re-enters the bloodstream, infecting and destroying red blood cells, leading to the characteristic symptoms of malaria.
Epidemiology
Malaria is endemic in over 90 countries, mainly sub-Saharan Africa, Southeast Asia, and Latin America. In 2019, there were an estimated 229 million malaria cases worldwide, with approximately 409,000 deaths. Most malaria-related deaths occur in sub-Saharan Africa, and children under five are particularly vulnerable.
Regional Variation: Malaria burden varies across regions and countries. Sub-Saharan Africa bears the highest malaria burden, accounting for about 94% of malaria cases and deaths globally. Within Africa, countries like Nigeria, the Democratic Republic of the Congo, and Uganda have the highest number of cases. Southeast Asia, particularly India, also has a significant malaria burden.
Anatomy
Pathophysiology
The pathophysiology of malaria involves a complex interaction between the Plasmodium parasites and the human host. Here’s a general overview of the key stages and processes involved:
Transmission: Malaria is transmitted to humans by biting an infected female Anopheles mosquito. The mosquito injects sporozoites, the infective form of the Plasmodium parasite, into the bloodstream during a blood meal.
Liver Stage: Once in the bloodstream, sporozoites quickly travel to the liver, infecting hepatocytes (liver cells). Inside hepatocytes, the sporozoites undergo asexual replication, multiplying into thousands of merozoites.
Blood Stage: The merozoites are released from infected hepatocytes and invade red blood cells (RBCs). The parasites undergo further replication and development within the RBCs, destroying the infected RBCs. This process releases new merozoites into the bloodstream, which can infect more RBCs.
Clinical Manifestations: The destruction of RBCs during the blood stage leads to the characteristic symptoms of malaria. These symptoms include recurring fever, chills, headache, muscle aches, fatigue, nausea, and vomiting. The timing and severity of symptoms depend on the species of Plasmodium causing the infection.
Severe Malaria: Malaria can sometimes become severe, particularly with Plasmodium falciparum infection. Severe malaria is characterized by complications such as severe anemia, organ failure (such as kidney or liver failure), acute respiratory distress syndrome (ARDS), cerebral malaria (infection of the brain), and other neurological abnormalities.
Immune Response: The immune response of the infected individual plays a crucial role in the pathophysiology of malaria. The immune system controls infection by producing antibodies and activating immune cells. However, Plasmodium has developed various mechanisms to evade the immune response, allowing the parasite to persist and continue the infection.
Etiology
The etiology of malaria is primarily attributed to the infection by parasites of the genus Plasmodium. Plasmodium parasites are single-celled organisms that belong to the phylum Apicomplexa. Several species of Plasmodium can cause malaria in humans, including:
Plasmodium falciparum (P. falciparum): This species is responsible for most malaria-related deaths worldwide. It is prevalent in sub-Saharan Africa but is also found in other regions.
Plasmodium vivax (P. vivax): P. vivax is the second most common species found primarily in Asia and Latin America. It can cause relapses of malaria months or years after the initial infection due to the presence of dormant liver-stage parasites called hypnozoites.
Plasmodium malariae (P. malariae): P. malariae is less common but has a broader distribution. It is found in Africa, Asia, and parts of South America. Infections with P. malariae can persist for long periods, and the parasite can cause a chronic low-level infection.
Plasmodium ovale (P. ovale): P. ovale is geographically restricted to West Africa and Pacific islands. It also has dormant liver-stage parasites that can lead to relapses.
Plasmodium knowlesi (P. knowlesi): P. knowlesi primarily infects monkeys but can also infect humans. It is found in Southeast Asia and has recently been recognized as a cause of human malaria.
Genetics
Prognostic Factors
Prognostic factors in malaria refer to various indicators that can help predict the clinical outcomes and severity of the disease in individual patients. These factors can assist healthcare providers in assessing the risk and prognosis of malaria cases. Here are some critical prognostic factors in malaria:
Parasite species: The species of malaria parasite causing the infection can influence the severity and prognosis of the disease. Plasmodium falciparum is generally associated with more severe manifestations and a higher risk of complications than other species like Plasmodium vivax or Plasmodium malariae.
Parasite density: The number of malaria parasites (parasite density) in the patient’s bloodstream is often correlated with disease severity. Higher parasite densities are generally associated with more severe symptoms and an increased risk of complications.
Age: Age can be a significant prognostic factor in malaria. Young children, particularly those under the age of five, and elderly individuals are at higher risk of developing severe forms of the disease and experiencing poor outcomes.
Immune status: Immune status plays a role in determining the severity and prognosis of malaria. Individuals with limited or no prior exposure to malaria, such as non-immune travelers or individuals residing in non-endemic regions, are at higher risk of severe disease if infected. Immune-compromised individuals, such as those with HIV/AIDS or immunosuppressive conditions, may also experience more severe malaria.
Pregnancy: Pregnant women are at increased risk of complications from malaria, especially if infected with P. falciparum. Malaria infection during pregnancy can lead to adverse outcomes for the mother and the fetus, including maternal anemia, preterm birth, low birth weight, and infant mortality.
Comorbidities: The presence of underlying health conditions, such as chronic diseases (e.g., diabetes, cardiovascular disease) or co-infections (e.g., HIV), can influence the prognosis of malaria. These conditions can complicate the disease course and increase the risk of severe outcomes.
Delayed or missed diagnosis and treatment: Early diagnosis and prompt initiation of appropriate treatment are crucial in preventing severe malaria. Delayed or missed diagnosis and inadequate treatment can contribute to disease progression and poorer prognosis.
Drug resistance: In areas with drug-resistant malaria parasites, such as artemisinin-resistant P. falciparum, the prognosis may be worse due to limited treatment options and increased risk of treatment failure.
Clinical History
CLINICAL HISTORY
Non-specific signs & symptoms
Systemic signs & symptoms
Age Group:
Physical Examination
PHYSICAL EXAMINATION
The aspects that may be evaluated during a physical examination for malaria:
Vital Signs: The patient’s vital signs, including body temperature, heart rate, blood pressure, and respiratory rate, are assessed. Fever is a common finding in malaria, and the degree of fever can provide initial clues.
General Appearance: The general appearance of the patient is observed. Signs of fatigue, malaise, weakness, or altered consciousness may indicate the severity of the disease.
Skin Examination: The skin is examined for signs such as pallor (indicating anemia), jaundice (indicating liver dysfunction), or rashes that can occur in some types of malaria.
Lymph Nodes: The lymph nodes may be palpated to check for enlargement, indicating an inflammatory response to the infection.
Abdominal Examination: The abdomen is assessed for tenderness, enlarged liver (hepatomegaly), or enlarged spleen (splenomegaly). An enlarged spleen is common in malaria, particularly in cases caused by Plasmodium falciparum and Plasmodium vivax.
Neurological Examination: In severe cases or when cerebral malaria is suspected, a neurological examination is performed to assess mental status, level of consciousness, and the presence of neurological deficits such as abnormal reflexes or focal neurological signs.
Respiratory Examination: The respiratory system is evaluated for signs of respiratory distress, such as increased respiratory rate, use of accessory muscles, or abnormal breath sounds.
Age group
Associated comorbidity
Associated Comorbidity or Activity:
Associated activity
Acuity of presentation
The Acuity of Presentation:
The acuity of presentation refers to the speed at which symptoms develop and the severity of the symptoms when a person is diagnosed with malaria. The acuity of malaria presentation can vary depending on factors such as the infecting Plasmodium species, the individual’s immunity, and the presence of complications. Here are some scenarios regarding the acuity of malaria presentation:
Acute Presentation: In some cases, malaria can present with a sudden onset of symptoms. The individual may experience a high fever, severe chills, headache, muscle aches, and fatigue. This acute presentation is more common in uncomplicated malaria caused by Plasmodium falciparum, known for its rapid replication and potential to cause severe illness.
Subacute Presentation: In other cases, the symptoms of malaria may develop over a few days. The individual may initially experience mild symptoms such as fatigue, headache, and low-grade fever, progressively worsening. This subacute presentation can occur with various Plasmodium species and may indicate a slower parasite replication rate.
Chronic Presentation: In some instances, particularly with Plasmodium malariae infection, malaria can present with a chronic low-level infection. The symptoms may be milder and more intermittent, with fever and fatigue occurring irregularly over an extended period.
Severe Presentation: Severe malaria is characterized by the rapid onset of severe symptoms and complications. This can include high fever, altered consciousness, seizures, respiratory distress, organ failure, and other life-threatening manifestations. Severe malaria requires immediate medical attention and can be associated with a higher mortality risk.
Differential Diagnoses
DIFFERENTIAL DIAGNOSIS
Dengue fever
Chikungunya
Meningitis
Pneumonia
Sepsis due to bacteremia
Typhoid fever
Leptospirosis
Viral hemorrhagic fever
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The treatment of malaria involves the use of antimalarial medications to eliminate Plasmodium parasites from the body and relieve symptoms. The specific choice of treatment depends on factors such as the infecting Plasmodium species, the severity of the infection, the geographic location, and the individual’s age, pregnancy status, and medical history.
TREATMENT PARADIGM
The treatment paradigm for malaria involves several components, including prompt diagnosis, appropriate antimalarial therapy, supportive care, and preventive measures.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
prevention-of-malaria-by-not-allowing-the-water-to-stagnate
Stagnant water serves as a breeding ground for mosquitoes. Mosquito breeding sites can be eliminated or reduced by properly draining stagnant water and clearing water-holding containers, such as discarded tires, flowerpots, and water storage containers.
Prevention of malaria by managing the environment and controlling the vegetation
Modifying the environment to minimize mosquito breeding sites includes filling in potholes, leveling ground depressions, and maintaining proper sanitation and waste management. These measures help reduce the availability of standing water and create an unfavorable environment for mosquito breeding.
Proper water management practices can be implemented where water bodies are necessary for various purposes, such as agriculture or domestic use. This can involve intermittent irrigation or adjusting water levels to minimize mosquito breeding opportunities. Overgrown vegetation can provide resting sites and shelter for mosquitoes. Regular trimming and maintaining vegetation in and around residential areas can help reduce mosquito populations.
prevention-of-malaria-in-the-household-infrastructure-by-various-setups-and-techniques
Indoor residual spraying (IRS): It involves the application of insecticides to the interior walls of houses and buildings. This helps kill mosquitoes that come into contact with the treated surfaces, reducing the risk of malaria transmission. Outdoor space spraying or fogging may also be conducted in certain situations to control adult mosquito populations.
Bed Nets: Using insecticide-treated bed nets (ITNs) is preventive. ITNs act as physical barriers and insecticide delivery systems, protecting individuals from mosquito bites while they sleep. Distribution and promotion of ITNs are essential components of malaria control programs.
Housing Improvement: Housing improvements can contribute to malaria control efforts. Simple measures such as installing window screens, sealing gaps, and using eave tubes or nets can prevent mosquitoes from entering houses and reduce human-mosquito contact.
Environmental Surveillance: Regular monitoring and surveillance of mosquito populations and their breeding sites provide valuable information for targeted interventions and control strategies. This helps identify high-risk areas and focus efforts where they are most needed.
Antimalarial treatment in the areas with artemisinin resistance
Treating malaria requires specific considerations to ensure adequate disease management in areas with known artemisinin resistance. Artemisinin-based combination therapies (ACTs) are still considered the first-line treatment for uncomplicated malaria caused by Plasmodium falciparum, even in areas with artemisinin resistance. However, additional measures may be implemented to overcome the challenges of resistance.Â
Artesunate is an antimalarial medication used in the treatment of malaria. It belongs to a class of drugs known as artemisinin derivatives derived from the plant Artemisia annua (sweet wormwood). Artesunate is highly effective against Plasmodium falciparum, the most dangerous malaria parasite species. Â
When used as a treatment for malaria, artesunate is typically administered in combination with other antimalarial drugs to form an artemisinin-based combination therapy (ACT).  Â
Artesunate disrupts the malaria parasite’s development within the red blood cells. It has a rapid onset of action and is known for its ability to quickly reduce the number of parasites in the bloodstream, alleviating symptoms and preventing severe complications of malaria.Â
In areas with established artemisinin resistance, such as some parts of Southeast Asia, quinine may be used as an alternative treatment option for uncomplicated malaria. Artemisinin resistance has been observed primarily in Plasmodium falciparum malaria, while Plasmodium vivax malaria is usually still sensitive to artemisinins. Quinine is effective against both Plasmodium falciparum and Plasmodium vivax.Â
Mefloquine is an alternative to chloroquine for the prevention and treatment of malaria. It is used in areas with chloroquine resistance. Mefloquine is usually taken as a weekly dose.Â
This combination drug is often used to prevent and treat malaria. It is effective against chloroquine-resistant parasites.Â
Primaquine treats the dormant liver stage of the malaria parasite (Plasmodium vivax or Plasmodium ovale). It is essential for preventing relapses of these malaria species.Â
Treatment of Malaria in rural endemic areas
One of the primary challenges in rural endemic areas is limited access to healthcare facilities. Efforts should be made to improve access to healthcare services, including setting up local health centers or mobile clinics and training healthcare workers to diagnose and treat malaria.Â
It is usually available in fixed-dose tablets, and the dosage is based on the patient’s body weight. The treatment course typically lasts three days, with a specific number of tablets to be taken at each dose. The medication should be taken with food or milk to enhance absorption. Artemether-lumefantrine has shown high efficacy in treating uncomplicated P. falciparum malaria, including cases with artemisinin resistance. It rapidly clears the parasites from the bloodstream, leading to a faster resolution of symptoms.Â
Artesunate-amodiaquine is another artemisinin-based combination therapy (ACT) used to treat uncomplicated malaria caused by Plasmodium falciparum. It combines the artemisinin derivative, artesunate, with the antimalarial drug amodiaquine. Artesunate provides a rapid reduction in parasite load, while amodiaquine helps to eliminate the remaining parasites and prevent the development of resistance.Â
intervention-with-a-procedure
In the context of malaria, interventions involving procedures typically refer to medical interventions aimed at treating complications or severe cases of the disease. These procedures are usually performed in a healthcare facility under the supervision of trained healthcare professionals. Here are a few examples of procedures that may be involved in the management of malaria:Â
the-phase-of-management
Treatment and management of malaria typically involve several phases, each with specific goals and interventions. They include:Â
Medication
Relapse prevention after acute P vivax infection treatment:
300
mg
Tablet
Orally 
Single dose
Initial dose- 200mg orally every day for three days
3 days before travel to the malarious area
Maintenance dose-200mg orally once weekly after seven days of the initial dose
Terminal dose-200mg orally once every week after seven days of the maintenance dose
After exiting from the malarious area
Relapse prevention after acute P vivax infection treatment:
300
mg
Tablet
Orally 
Single dose
Initial dose- 200mg orally every day for three days
3 days before travel to the malarious area
Maintenance dose-200mg orally once weekly after seven days of the initial dose
Terminal dose-200mg orally once every week after seven days of the maintenance dose
After exiting from the malarious area
Uncomplicated malaria due to Plasmodium falciparum
648 mg of quinine orally every 8 hours for 7 days
Chloroquine resistant malaria due to Plasmodium falciparum
648 mg of quinine orally every 8 hours for 3-7 days, along with doxycycline, clindamycin, or doxycycline
Chloroquine resistant malaria due to Plasmodium vivax
648 mg of quinine orally every 8 hours for 3-7 days, along with tetracycline, doxycycline, or oral primaquine
Continue the therapy for 7 days if the infection took place in Southeast Asia, otherwise 3 days for anywhere else
Indicated to treat mild-to-moderate acute malaria due Plasmodium falciparum (chloroquine-susceptible & resistant strains both included) or by Plasmodium vivax
1250 mg orally once as a loading dose
Malaria Prevention
Indicated for the prevention of malaria
250 mg orally each week
Start over a couple of weeks before the arrival of the strain in the endemic area
Continue the medication for weeks after leaving the endemic-prone area
Dosing Consideration
If the treatment of mefloquine does not respond within 48-72 hours, stop the medication, and utilize an alternate therapy
The treatment with mefloquine in acute P.Vivax patients may cause relapse as in these patients; exoerythrocytic parasites are not eliminated
For more than 35 kg- 4 tablets orally every 8 hours for the first day
4 tablets orally twice daily on the second and third day
Additional comments
Take medicine with food
If vomiting occurs, administer another dose within 1-2 hours
30 mg base (with 52.6 mg salt) orally each day for 14 days
Alternatively, 45 mg base with 78.9 mg salt, orally every week for 8 weeks
primaquine removes any dormant hypnozoites that are present in the liver causing malarial relapse
Administer the drug with other antimalarial agents as it is inactive against plasmodial asexual erythrocytic forms
Uncomplicated Malaria
(Off-Label)
30 mg orally each day for 14 days in combination with hydroxychloroquine chloroquine
Also, for moderate G6PD deficiency as a substitute
45 mg orally every week for 8 weeks
Chemoprophylaxis
(Off-label)
In P. ovale and P.vivax malaria, 30 mg orally each day for 14 days after leaving the endemic area
P. jiroveci Pneumonia
(Orphan)
15-30 mg orally each day for 21 days (combined with oral or intravenous clindamycin)
As prophylaxis for malaria in the areas where chloroquine resistance is not present
Do not exceed 500 mg salt (with 300 mg base) each week on the same day
Initiate the medicine 1-2 weeks before/during traveling
and 4 weeks later, leaving the endemic area
Treatment-
Indicated for acute malarial attacks due to P.vivax, P.ovale, P.malariae and a few strains of P.falciparum
Acute attack-
1000 mg salt (with 600 mg base) orally, then
500 mg salt (with 300 mg base) orally after 6-8 hours, later
500 mg salt (with 300 mg base) orally at 1st and 2nd day after the initial dose
A total dose of 2500 mg (with 1500 mg base) in 3 days is indicated
Extraintestinal Amebiasis
1000 mg salt (with 600 mg base) orally each day for 2 days
500 mg salt (with 300 mg base) each day for 14-21 days
Indicated for malaria caused due to Plasmodium falciparum
For 11-20 kg- 250 mg with 100 mg proguanil
For 21-30 kg- 500 mg with 200 mg proguanil
For 31-40 kg- 750 mg with 300 mg proguanil
The dose should be taken each day orally for 3 days
25 mg orally every 2-3 days as an extract
200 mg orally each day or 400 mg orally each day as powder
for Regimen I:
Dose of 24 mg/kg as loading dose of quinidine gluconate diluted in 250 ml which infused up to 4 hours
Initiate maintenance dose within 24 hours of 12 mg/kg of quinidine gluconate diluted in 250 ml over 4 hours each 8 hours for 1 week
for Regimen II:
Dose of 10 mg/kg as loading dose of quinidine gluconate diluted in 250 ml which infused over 1 to 2 hours
Administer maintenance dose of 0.02 mg/kg/min of quinidine gluconate for up to 3 days
Administer 20 to 35 mg/kg orally for three days
500 mg orally every 6 hours
Give 3 doses and repeat in a week
artesunate, sulphadoxine and pyrimethamineÂ
1 tablet taken orally once a day
Oral administration of 2 g is needed every 6 hours for 7 to 10 days, which is used as an adjunctive therapy in chloroquine-resistant Plasmodium falciparum
Dose Adjustments
Not Available
480 mg is given orally as Initial dose and then Repeated after every 8,24,36,48 & 60 hours
Take a dose of 1200 mg orally divided into four doses for three days
Two doses given on the initial day at 4 to 6 hours intervals followed by a single dose daily for the next two days
2-3 mg/kg is taken orally once a day
Indicated for P. Falciparum malaria
In vivo, data suggests an injection of 4.8 mg of artemotil/kg of body weight is administered to each of the two anterior thighs as the first dose
After six, twenty-four, forty-eight, and seventy-two hours, 1.6 mg/kg body weight is administered in alternating thighs as the follow-up doses
Take a dose of 2 g orally once followed by 1 g every 8 hours up to 7 to 10 days
Administer 80mg/ml of one ampoule intramuscularly.
Do not administer intravenously.
If less than 1 milliliter is needed, use a 1-milliliter syringe with a 0.01-milliliter graduation.
(off-label)
Take a dose of 500 mg orally for three consecutive days
Relapse prevention after acute P vivax infection treatment
<16 years: Not established in terms
>16 years: 300 mg orally in a single dose
Uncomplicated malaria due to Plasmodium falciparum
30 mg/kg each day orally divided three times daily for 3-7 days
Do not exceed the usual adult dose
Chloroquine resistant malaria due to Plasmodium falciparum
30 mg/kg orally divided every 8 hours for 3-7 days with concomitant doxycycline, tetracycline, or clindamycin
Chloroquine resistant malaria due to Plasmodium vivax
30 mg/kg orally every 8 hours for 3-7 days, accompanied by doxycycline and oral primaquine
Indicated to treat mild-to-moderate acute malaria due to Plasmodium falciparum (chloroquine-susceptible & resistant strains both included) or by Plasmodium vivax
For more than 6 months, 20-25 mg/kg orally in a single dose or may be divided into 2 doses
Malaria Prevention
For 5-10 kg- 31.25 mg orally every week
10-20 kg- 62.5 mg orally every week
20-30 kg- 125 mg orally every week
30-45 kg- 187.5 mg orally every week
For more than 45 kg- 250 mg orally every week
Start over from 1-2 weeks before arrival in the endemic area
Continue upto 4 weeks after coming from endemic area
Safety and efficacy are not seen in children below 2 years and less than 5 kg
For more than 2 years
5-15kg
6 tablets for 3 days
Initially 1 tablet, after 8 hours 1 tablet twice daily for 2 days
15-25 kg
12 tablets for 3 days
Initially 2 tablets and 8 hours later 2 tablets twice daily
25-35 kg
18 tablets for 3 days
Initially, 3 tablets and again 8 hours later 3 tablets twice daily for 2 days
More than 35 kg
24 tablets for 3 days
Initially, 4 tablets, and then 8 hours later 4 tablets twice daily for 2 days
Additional comments
Take medicine with food
If vomiting occurs, administer another dose within 1-2 hours
Prophylaxis of Malaria
0.5 mg/kg base with 0.8 mg/kg salt orally each day
Keep 30 mg as the base dose
As a prevention, take the dose 1-2 days prior to traveling to a malaria-prone area until 7 days post leaving the area
Utilized mainly for P. vivax infection
Pneumocystis Pneumonia
0.3 mg/kg base with 0.526 mg/kg salt orally each day
30 mg base should be kept as the maximum dose
Continue the medication for 21 days
Chemoprophylaxis
0.5 mg/kg each day; start the medication 1-2 days before traveling to the malaria-prone area and continue for 7 days after departure
Uncomplicated Malaria
(Off-Label)
0.5 mg/kg each day for 14 days in combination with hydroxychloroquine or chloroquine
As prophylaxis for malaria in the areas where chloroquine resistance is not present
5 mg/kg orally each week
Do not exceed 500 mg salt (with 300 mg base) each week on the same day
Initiate the medicine 1-2 weeks before/during traveling
and 4 weeks later, leaving the endemic area
Treatment-
Indicated for acute malarial attacks due to P.vivax, P.ovale, P.malariae, and a few strains of P.falciparum
Acute attack-
1st dose- 10 mg base/kg (do not exceed 600 mg base/dose)
2nd dose- 6 hours later, 5 mg base/kg (do not exceed 300 mg base/dose)
3rd dose- 24 hours later the first dose, 5 mg base/kg (do not exceed 300 mg base/dose)
4th dose- 36 hours after the first dose, 5 mg base/kg (do not exceed 300 mg base/dose)
Total dose- 25 mg base/kg
Dose Modifications
Use chloroquine cautiously in hepatically impaired people who are alcoholic or conjunct with hepatotoxic drugs
for Regimen I:
Dose of 24 mg/kg as loading dose of quinidine gluconate diluted in 250 ml which infused up to 4 hours
Initiate maintenance dose within 24 hours of 12 mg/kg of quinidine gluconate diluted in 250 ml over 4 hours each 8 hours for 1 week
for Regimen II:
Dose of 10 mg/kg as loading dose of quinidine gluconate diluted in 250 ml which infused over 1 to 2 hours
Administer maintenance dose of 0.02 mg/kg/min of quinidine gluconate for up to 3 days
Indicated for acute malaria
For less than 37 kg: 8 mg/kg orally every 6 hours
Give 3 doses and repeat in a week
For more than 37 kg: 500 mg orally every 6 hours
Give 3 doses and repeat in a week
Neonates: 15 mg/kg is given orally as Initial dose, then repeated after 8 hours, 24 hours and 48 hours of first dose
5 to 14 kg child: 120 mg is given orally as Initial dose and then Repeated after every 8,24,36,48 & 60 hours
15 to 24 kg child: 240 mg is given orally
25 to 34 kg child: 360 mg is given orally
Administer 3.2 mg/kg intramuscularly and continue with a daily dose of 1.6 mg/kg.
Administer 3.2 mg/kg intramuscularly and continue with a daily dose of 1.6 mg/kg.
Administer 3.2 mg/kg intramuscularly and continue with a daily dose of 1.6 mg/kg.
Future Trends
Malaria is a life-threatening infectious disease caused by parasites of the genus Plasmodium. It is transmitted to humans through the bites of infected female Anopheles mosquitoes. Malaria is a primary global health concern, particularly in tropical and subtropical regions, with sub-Saharan Africa bearing the highest disease burden. The most common and dangerous form of malaria is caused by the parasite Plasmodium falciparum.
However, other species, such as Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale, can also cause the disease. When an infected mosquito bites a person, the parasite enters the bloodstream and travels to the liver, where it multiplies and matures. It then re-enters the bloodstream, infecting and destroying red blood cells, leading to the characteristic symptoms of malaria.
Malaria is endemic in over 90 countries, mainly sub-Saharan Africa, Southeast Asia, and Latin America. In 2019, there were an estimated 229 million malaria cases worldwide, with approximately 409,000 deaths. Most malaria-related deaths occur in sub-Saharan Africa, and children under five are particularly vulnerable.
Regional Variation: Malaria burden varies across regions and countries. Sub-Saharan Africa bears the highest malaria burden, accounting for about 94% of malaria cases and deaths globally. Within Africa, countries like Nigeria, the Democratic Republic of the Congo, and Uganda have the highest number of cases. Southeast Asia, particularly India, also has a significant malaria burden.
The pathophysiology of malaria involves a complex interaction between the Plasmodium parasites and the human host. Here’s a general overview of the key stages and processes involved:
Transmission: Malaria is transmitted to humans by biting an infected female Anopheles mosquito. The mosquito injects sporozoites, the infective form of the Plasmodium parasite, into the bloodstream during a blood meal.
Liver Stage: Once in the bloodstream, sporozoites quickly travel to the liver, infecting hepatocytes (liver cells). Inside hepatocytes, the sporozoites undergo asexual replication, multiplying into thousands of merozoites.
Blood Stage: The merozoites are released from infected hepatocytes and invade red blood cells (RBCs). The parasites undergo further replication and development within the RBCs, destroying the infected RBCs. This process releases new merozoites into the bloodstream, which can infect more RBCs.
Clinical Manifestations: The destruction of RBCs during the blood stage leads to the characteristic symptoms of malaria. These symptoms include recurring fever, chills, headache, muscle aches, fatigue, nausea, and vomiting. The timing and severity of symptoms depend on the species of Plasmodium causing the infection.
Severe Malaria: Malaria can sometimes become severe, particularly with Plasmodium falciparum infection. Severe malaria is characterized by complications such as severe anemia, organ failure (such as kidney or liver failure), acute respiratory distress syndrome (ARDS), cerebral malaria (infection of the brain), and other neurological abnormalities.
Immune Response: The immune response of the infected individual plays a crucial role in the pathophysiology of malaria. The immune system controls infection by producing antibodies and activating immune cells. However, Plasmodium has developed various mechanisms to evade the immune response, allowing the parasite to persist and continue the infection.
The etiology of malaria is primarily attributed to the infection by parasites of the genus Plasmodium. Plasmodium parasites are single-celled organisms that belong to the phylum Apicomplexa. Several species of Plasmodium can cause malaria in humans, including:
Plasmodium falciparum (P. falciparum): This species is responsible for most malaria-related deaths worldwide. It is prevalent in sub-Saharan Africa but is also found in other regions.
Plasmodium vivax (P. vivax): P. vivax is the second most common species found primarily in Asia and Latin America. It can cause relapses of malaria months or years after the initial infection due to the presence of dormant liver-stage parasites called hypnozoites.
Plasmodium malariae (P. malariae): P. malariae is less common but has a broader distribution. It is found in Africa, Asia, and parts of South America. Infections with P. malariae can persist for long periods, and the parasite can cause a chronic low-level infection.
Plasmodium ovale (P. ovale): P. ovale is geographically restricted to West Africa and Pacific islands. It also has dormant liver-stage parasites that can lead to relapses.
Plasmodium knowlesi (P. knowlesi): P. knowlesi primarily infects monkeys but can also infect humans. It is found in Southeast Asia and has recently been recognized as a cause of human malaria.
Prognostic factors in malaria refer to various indicators that can help predict the clinical outcomes and severity of the disease in individual patients. These factors can assist healthcare providers in assessing the risk and prognosis of malaria cases. Here are some critical prognostic factors in malaria:
Parasite species: The species of malaria parasite causing the infection can influence the severity and prognosis of the disease. Plasmodium falciparum is generally associated with more severe manifestations and a higher risk of complications than other species like Plasmodium vivax or Plasmodium malariae.
Parasite density: The number of malaria parasites (parasite density) in the patient’s bloodstream is often correlated with disease severity. Higher parasite densities are generally associated with more severe symptoms and an increased risk of complications.
Age: Age can be a significant prognostic factor in malaria. Young children, particularly those under the age of five, and elderly individuals are at higher risk of developing severe forms of the disease and experiencing poor outcomes.
Immune status: Immune status plays a role in determining the severity and prognosis of malaria. Individuals with limited or no prior exposure to malaria, such as non-immune travelers or individuals residing in non-endemic regions, are at higher risk of severe disease if infected. Immune-compromised individuals, such as those with HIV/AIDS or immunosuppressive conditions, may also experience more severe malaria.
Pregnancy: Pregnant women are at increased risk of complications from malaria, especially if infected with P. falciparum. Malaria infection during pregnancy can lead to adverse outcomes for the mother and the fetus, including maternal anemia, preterm birth, low birth weight, and infant mortality.
Comorbidities: The presence of underlying health conditions, such as chronic diseases (e.g., diabetes, cardiovascular disease) or co-infections (e.g., HIV), can influence the prognosis of malaria. These conditions can complicate the disease course and increase the risk of severe outcomes.
Delayed or missed diagnosis and treatment: Early diagnosis and prompt initiation of appropriate treatment are crucial in preventing severe malaria. Delayed or missed diagnosis and inadequate treatment can contribute to disease progression and poorer prognosis.
Drug resistance: In areas with drug-resistant malaria parasites, such as artemisinin-resistant P. falciparum, the prognosis may be worse due to limited treatment options and increased risk of treatment failure.
CLINICAL HISTORY
Non-specific signs & symptoms
Systemic signs & symptoms
Age Group:
PHYSICAL EXAMINATION
The aspects that may be evaluated during a physical examination for malaria:
Vital Signs: The patient’s vital signs, including body temperature, heart rate, blood pressure, and respiratory rate, are assessed. Fever is a common finding in malaria, and the degree of fever can provide initial clues.
General Appearance: The general appearance of the patient is observed. Signs of fatigue, malaise, weakness, or altered consciousness may indicate the severity of the disease.
Skin Examination: The skin is examined for signs such as pallor (indicating anemia), jaundice (indicating liver dysfunction), or rashes that can occur in some types of malaria.
Lymph Nodes: The lymph nodes may be palpated to check for enlargement, indicating an inflammatory response to the infection.
Abdominal Examination: The abdomen is assessed for tenderness, enlarged liver (hepatomegaly), or enlarged spleen (splenomegaly). An enlarged spleen is common in malaria, particularly in cases caused by Plasmodium falciparum and Plasmodium vivax.
Neurological Examination: In severe cases or when cerebral malaria is suspected, a neurological examination is performed to assess mental status, level of consciousness, and the presence of neurological deficits such as abnormal reflexes or focal neurological signs.
Respiratory Examination: The respiratory system is evaluated for signs of respiratory distress, such as increased respiratory rate, use of accessory muscles, or abnormal breath sounds.
Associated Comorbidity or Activity:
The Acuity of Presentation:
The acuity of presentation refers to the speed at which symptoms develop and the severity of the symptoms when a person is diagnosed with malaria. The acuity of malaria presentation can vary depending on factors such as the infecting Plasmodium species, the individual’s immunity, and the presence of complications. Here are some scenarios regarding the acuity of malaria presentation:
Acute Presentation: In some cases, malaria can present with a sudden onset of symptoms. The individual may experience a high fever, severe chills, headache, muscle aches, and fatigue. This acute presentation is more common in uncomplicated malaria caused by Plasmodium falciparum, known for its rapid replication and potential to cause severe illness.
Subacute Presentation: In other cases, the symptoms of malaria may develop over a few days. The individual may initially experience mild symptoms such as fatigue, headache, and low-grade fever, progressively worsening. This subacute presentation can occur with various Plasmodium species and may indicate a slower parasite replication rate.
Chronic Presentation: In some instances, particularly with Plasmodium malariae infection, malaria can present with a chronic low-level infection. The symptoms may be milder and more intermittent, with fever and fatigue occurring irregularly over an extended period.
Severe Presentation: Severe malaria is characterized by the rapid onset of severe symptoms and complications. This can include high fever, altered consciousness, seizures, respiratory distress, organ failure, and other life-threatening manifestations. Severe malaria requires immediate medical attention and can be associated with a higher mortality risk.
DIFFERENTIAL DIAGNOSIS
Dengue fever
Chikungunya
Meningitis
Pneumonia
Sepsis due to bacteremia
Typhoid fever
Leptospirosis
Viral hemorrhagic fever
The treatment of malaria involves the use of antimalarial medications to eliminate Plasmodium parasites from the body and relieve symptoms. The specific choice of treatment depends on factors such as the infecting Plasmodium species, the severity of the infection, the geographic location, and the individual’s age, pregnancy status, and medical history.
TREATMENT PARADIGM
The treatment paradigm for malaria involves several components, including prompt diagnosis, appropriate antimalarial therapy, supportive care, and preventive measures.
Hematology
Infectious Disease
OB/GYN and Women\'s Health
Pediatrics, General
Stagnant water serves as a breeding ground for mosquitoes. Mosquito breeding sites can be eliminated or reduced by properly draining stagnant water and clearing water-holding containers, such as discarded tires, flowerpots, and water storage containers.
Prevention of malaria by managing the environment and controlling the vegetation
Modifying the environment to minimize mosquito breeding sites includes filling in potholes, leveling ground depressions, and maintaining proper sanitation and waste management. These measures help reduce the availability of standing water and create an unfavorable environment for mosquito breeding.
Proper water management practices can be implemented where water bodies are necessary for various purposes, such as agriculture or domestic use. This can involve intermittent irrigation or adjusting water levels to minimize mosquito breeding opportunities. Overgrown vegetation can provide resting sites and shelter for mosquitoes. Regular trimming and maintaining vegetation in and around residential areas can help reduce mosquito populations.
Infectious Disease
OB/GYN and Women\'s Health
Pediatrics, General
Other Clinical
Indoor residual spraying (IRS): It involves the application of insecticides to the interior walls of houses and buildings. This helps kill mosquitoes that come into contact with the treated surfaces, reducing the risk of malaria transmission. Outdoor space spraying or fogging may also be conducted in certain situations to control adult mosquito populations.
Bed Nets: Using insecticide-treated bed nets (ITNs) is preventive. ITNs act as physical barriers and insecticide delivery systems, protecting individuals from mosquito bites while they sleep. Distribution and promotion of ITNs are essential components of malaria control programs.
Housing Improvement: Housing improvements can contribute to malaria control efforts. Simple measures such as installing window screens, sealing gaps, and using eave tubes or nets can prevent mosquitoes from entering houses and reduce human-mosquito contact.
Environmental Surveillance: Regular monitoring and surveillance of mosquito populations and their breeding sites provide valuable information for targeted interventions and control strategies. This helps identify high-risk areas and focus efforts where they are most needed.
Infectious Disease
Treating malaria requires specific considerations to ensure adequate disease management in areas with known artemisinin resistance. Artemisinin-based combination therapies (ACTs) are still considered the first-line treatment for uncomplicated malaria caused by Plasmodium falciparum, even in areas with artemisinin resistance. However, additional measures may be implemented to overcome the challenges of resistance.Â
Artesunate is an antimalarial medication used in the treatment of malaria. It belongs to a class of drugs known as artemisinin derivatives derived from the plant Artemisia annua (sweet wormwood). Artesunate is highly effective against Plasmodium falciparum, the most dangerous malaria parasite species. Â
When used as a treatment for malaria, artesunate is typically administered in combination with other antimalarial drugs to form an artemisinin-based combination therapy (ACT).  Â
Artesunate disrupts the malaria parasite’s development within the red blood cells. It has a rapid onset of action and is known for its ability to quickly reduce the number of parasites in the bloodstream, alleviating symptoms and preventing severe complications of malaria.Â
In areas with established artemisinin resistance, such as some parts of Southeast Asia, quinine may be used as an alternative treatment option for uncomplicated malaria. Artemisinin resistance has been observed primarily in Plasmodium falciparum malaria, while Plasmodium vivax malaria is usually still sensitive to artemisinins. Quinine is effective against both Plasmodium falciparum and Plasmodium vivax.Â
Mefloquine is an alternative to chloroquine for the prevention and treatment of malaria. It is used in areas with chloroquine resistance. Mefloquine is usually taken as a weekly dose.Â
This combination drug is often used to prevent and treat malaria. It is effective against chloroquine-resistant parasites.Â
Primaquine treats the dormant liver stage of the malaria parasite (Plasmodium vivax or Plasmodium ovale). It is essential for preventing relapses of these malaria species.Â
Infectious Disease
Public/Community Health
One of the primary challenges in rural endemic areas is limited access to healthcare facilities. Efforts should be made to improve access to healthcare services, including setting up local health centers or mobile clinics and training healthcare workers to diagnose and treat malaria.Â
It is usually available in fixed-dose tablets, and the dosage is based on the patient’s body weight. The treatment course typically lasts three days, with a specific number of tablets to be taken at each dose. The medication should be taken with food or milk to enhance absorption. Artemether-lumefantrine has shown high efficacy in treating uncomplicated P. falciparum malaria, including cases with artemisinin resistance. It rapidly clears the parasites from the bloodstream, leading to a faster resolution of symptoms.Â
Artesunate-amodiaquine is another artemisinin-based combination therapy (ACT) used to treat uncomplicated malaria caused by Plasmodium falciparum. It combines the artemisinin derivative, artesunate, with the antimalarial drug amodiaquine. Artesunate provides a rapid reduction in parasite load, while amodiaquine helps to eliminate the remaining parasites and prevent the development of resistance.Â
Infectious Disease
In the context of malaria, interventions involving procedures typically refer to medical interventions aimed at treating complications or severe cases of the disease. These procedures are usually performed in a healthcare facility under the supervision of trained healthcare professionals. Here are a few examples of procedures that may be involved in the management of malaria:Â
Infectious Disease
Treatment and management of malaria typically involve several phases, each with specific goals and interventions. They include:Â
Malaria is a life-threatening infectious disease caused by parasites of the genus Plasmodium. It is transmitted to humans through the bites of infected female Anopheles mosquitoes. Malaria is a primary global health concern, particularly in tropical and subtropical regions, with sub-Saharan Africa bearing the highest disease burden. The most common and dangerous form of malaria is caused by the parasite Plasmodium falciparum.
However, other species, such as Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale, can also cause the disease. When an infected mosquito bites a person, the parasite enters the bloodstream and travels to the liver, where it multiplies and matures. It then re-enters the bloodstream, infecting and destroying red blood cells, leading to the characteristic symptoms of malaria.
Malaria is endemic in over 90 countries, mainly sub-Saharan Africa, Southeast Asia, and Latin America. In 2019, there were an estimated 229 million malaria cases worldwide, with approximately 409,000 deaths. Most malaria-related deaths occur in sub-Saharan Africa, and children under five are particularly vulnerable.
Regional Variation: Malaria burden varies across regions and countries. Sub-Saharan Africa bears the highest malaria burden, accounting for about 94% of malaria cases and deaths globally. Within Africa, countries like Nigeria, the Democratic Republic of the Congo, and Uganda have the highest number of cases. Southeast Asia, particularly India, also has a significant malaria burden.
The pathophysiology of malaria involves a complex interaction between the Plasmodium parasites and the human host. Here’s a general overview of the key stages and processes involved:
Transmission: Malaria is transmitted to humans by biting an infected female Anopheles mosquito. The mosquito injects sporozoites, the infective form of the Plasmodium parasite, into the bloodstream during a blood meal.
Liver Stage: Once in the bloodstream, sporozoites quickly travel to the liver, infecting hepatocytes (liver cells). Inside hepatocytes, the sporozoites undergo asexual replication, multiplying into thousands of merozoites.
Blood Stage: The merozoites are released from infected hepatocytes and invade red blood cells (RBCs). The parasites undergo further replication and development within the RBCs, destroying the infected RBCs. This process releases new merozoites into the bloodstream, which can infect more RBCs.
Clinical Manifestations: The destruction of RBCs during the blood stage leads to the characteristic symptoms of malaria. These symptoms include recurring fever, chills, headache, muscle aches, fatigue, nausea, and vomiting. The timing and severity of symptoms depend on the species of Plasmodium causing the infection.
Severe Malaria: Malaria can sometimes become severe, particularly with Plasmodium falciparum infection. Severe malaria is characterized by complications such as severe anemia, organ failure (such as kidney or liver failure), acute respiratory distress syndrome (ARDS), cerebral malaria (infection of the brain), and other neurological abnormalities.
Immune Response: The immune response of the infected individual plays a crucial role in the pathophysiology of malaria. The immune system controls infection by producing antibodies and activating immune cells. However, Plasmodium has developed various mechanisms to evade the immune response, allowing the parasite to persist and continue the infection.
The etiology of malaria is primarily attributed to the infection by parasites of the genus Plasmodium. Plasmodium parasites are single-celled organisms that belong to the phylum Apicomplexa. Several species of Plasmodium can cause malaria in humans, including:
Plasmodium falciparum (P. falciparum): This species is responsible for most malaria-related deaths worldwide. It is prevalent in sub-Saharan Africa but is also found in other regions.
Plasmodium vivax (P. vivax): P. vivax is the second most common species found primarily in Asia and Latin America. It can cause relapses of malaria months or years after the initial infection due to the presence of dormant liver-stage parasites called hypnozoites.
Plasmodium malariae (P. malariae): P. malariae is less common but has a broader distribution. It is found in Africa, Asia, and parts of South America. Infections with P. malariae can persist for long periods, and the parasite can cause a chronic low-level infection.
Plasmodium ovale (P. ovale): P. ovale is geographically restricted to West Africa and Pacific islands. It also has dormant liver-stage parasites that can lead to relapses.
Plasmodium knowlesi (P. knowlesi): P. knowlesi primarily infects monkeys but can also infect humans. It is found in Southeast Asia and has recently been recognized as a cause of human malaria.
Prognostic factors in malaria refer to various indicators that can help predict the clinical outcomes and severity of the disease in individual patients. These factors can assist healthcare providers in assessing the risk and prognosis of malaria cases. Here are some critical prognostic factors in malaria:
Parasite species: The species of malaria parasite causing the infection can influence the severity and prognosis of the disease. Plasmodium falciparum is generally associated with more severe manifestations and a higher risk of complications than other species like Plasmodium vivax or Plasmodium malariae.
Parasite density: The number of malaria parasites (parasite density) in the patient’s bloodstream is often correlated with disease severity. Higher parasite densities are generally associated with more severe symptoms and an increased risk of complications.
Age: Age can be a significant prognostic factor in malaria. Young children, particularly those under the age of five, and elderly individuals are at higher risk of developing severe forms of the disease and experiencing poor outcomes.
Immune status: Immune status plays a role in determining the severity and prognosis of malaria. Individuals with limited or no prior exposure to malaria, such as non-immune travelers or individuals residing in non-endemic regions, are at higher risk of severe disease if infected. Immune-compromised individuals, such as those with HIV/AIDS or immunosuppressive conditions, may also experience more severe malaria.
Pregnancy: Pregnant women are at increased risk of complications from malaria, especially if infected with P. falciparum. Malaria infection during pregnancy can lead to adverse outcomes for the mother and the fetus, including maternal anemia, preterm birth, low birth weight, and infant mortality.
Comorbidities: The presence of underlying health conditions, such as chronic diseases (e.g., diabetes, cardiovascular disease) or co-infections (e.g., HIV), can influence the prognosis of malaria. These conditions can complicate the disease course and increase the risk of severe outcomes.
Delayed or missed diagnosis and treatment: Early diagnosis and prompt initiation of appropriate treatment are crucial in preventing severe malaria. Delayed or missed diagnosis and inadequate treatment can contribute to disease progression and poorer prognosis.
Drug resistance: In areas with drug-resistant malaria parasites, such as artemisinin-resistant P. falciparum, the prognosis may be worse due to limited treatment options and increased risk of treatment failure.
CLINICAL HISTORY
Non-specific signs & symptoms
Systemic signs & symptoms
Age Group:
PHYSICAL EXAMINATION
The aspects that may be evaluated during a physical examination for malaria:
Vital Signs: The patient’s vital signs, including body temperature, heart rate, blood pressure, and respiratory rate, are assessed. Fever is a common finding in malaria, and the degree of fever can provide initial clues.
General Appearance: The general appearance of the patient is observed. Signs of fatigue, malaise, weakness, or altered consciousness may indicate the severity of the disease.
Skin Examination: The skin is examined for signs such as pallor (indicating anemia), jaundice (indicating liver dysfunction), or rashes that can occur in some types of malaria.
Lymph Nodes: The lymph nodes may be palpated to check for enlargement, indicating an inflammatory response to the infection.
Abdominal Examination: The abdomen is assessed for tenderness, enlarged liver (hepatomegaly), or enlarged spleen (splenomegaly). An enlarged spleen is common in malaria, particularly in cases caused by Plasmodium falciparum and Plasmodium vivax.
Neurological Examination: In severe cases or when cerebral malaria is suspected, a neurological examination is performed to assess mental status, level of consciousness, and the presence of neurological deficits such as abnormal reflexes or focal neurological signs.
Respiratory Examination: The respiratory system is evaluated for signs of respiratory distress, such as increased respiratory rate, use of accessory muscles, or abnormal breath sounds.
Associated Comorbidity or Activity:
The Acuity of Presentation:
The acuity of presentation refers to the speed at which symptoms develop and the severity of the symptoms when a person is diagnosed with malaria. The acuity of malaria presentation can vary depending on factors such as the infecting Plasmodium species, the individual’s immunity, and the presence of complications. Here are some scenarios regarding the acuity of malaria presentation:
Acute Presentation: In some cases, malaria can present with a sudden onset of symptoms. The individual may experience a high fever, severe chills, headache, muscle aches, and fatigue. This acute presentation is more common in uncomplicated malaria caused by Plasmodium falciparum, known for its rapid replication and potential to cause severe illness.
Subacute Presentation: In other cases, the symptoms of malaria may develop over a few days. The individual may initially experience mild symptoms such as fatigue, headache, and low-grade fever, progressively worsening. This subacute presentation can occur with various Plasmodium species and may indicate a slower parasite replication rate.
Chronic Presentation: In some instances, particularly with Plasmodium malariae infection, malaria can present with a chronic low-level infection. The symptoms may be milder and more intermittent, with fever and fatigue occurring irregularly over an extended period.
Severe Presentation: Severe malaria is characterized by the rapid onset of severe symptoms and complications. This can include high fever, altered consciousness, seizures, respiratory distress, organ failure, and other life-threatening manifestations. Severe malaria requires immediate medical attention and can be associated with a higher mortality risk.
DIFFERENTIAL DIAGNOSIS
Dengue fever
Chikungunya
Meningitis
Pneumonia
Sepsis due to bacteremia
Typhoid fever
Leptospirosis
Viral hemorrhagic fever
The treatment of malaria involves the use of antimalarial medications to eliminate Plasmodium parasites from the body and relieve symptoms. The specific choice of treatment depends on factors such as the infecting Plasmodium species, the severity of the infection, the geographic location, and the individual’s age, pregnancy status, and medical history.
TREATMENT PARADIGM
The treatment paradigm for malaria involves several components, including prompt diagnosis, appropriate antimalarial therapy, supportive care, and preventive measures.
Hematology
Infectious Disease
OB/GYN and Women\'s Health
Pediatrics, General
Stagnant water serves as a breeding ground for mosquitoes. Mosquito breeding sites can be eliminated or reduced by properly draining stagnant water and clearing water-holding containers, such as discarded tires, flowerpots, and water storage containers.
Prevention of malaria by managing the environment and controlling the vegetation
Modifying the environment to minimize mosquito breeding sites includes filling in potholes, leveling ground depressions, and maintaining proper sanitation and waste management. These measures help reduce the availability of standing water and create an unfavorable environment for mosquito breeding.
Proper water management practices can be implemented where water bodies are necessary for various purposes, such as agriculture or domestic use. This can involve intermittent irrigation or adjusting water levels to minimize mosquito breeding opportunities. Overgrown vegetation can provide resting sites and shelter for mosquitoes. Regular trimming and maintaining vegetation in and around residential areas can help reduce mosquito populations.
Infectious Disease
OB/GYN and Women\'s Health
Pediatrics, General
Other Clinical
Indoor residual spraying (IRS): It involves the application of insecticides to the interior walls of houses and buildings. This helps kill mosquitoes that come into contact with the treated surfaces, reducing the risk of malaria transmission. Outdoor space spraying or fogging may also be conducted in certain situations to control adult mosquito populations.
Bed Nets: Using insecticide-treated bed nets (ITNs) is preventive. ITNs act as physical barriers and insecticide delivery systems, protecting individuals from mosquito bites while they sleep. Distribution and promotion of ITNs are essential components of malaria control programs.
Housing Improvement: Housing improvements can contribute to malaria control efforts. Simple measures such as installing window screens, sealing gaps, and using eave tubes or nets can prevent mosquitoes from entering houses and reduce human-mosquito contact.
Environmental Surveillance: Regular monitoring and surveillance of mosquito populations and their breeding sites provide valuable information for targeted interventions and control strategies. This helps identify high-risk areas and focus efforts where they are most needed.
Infectious Disease
Treating malaria requires specific considerations to ensure adequate disease management in areas with known artemisinin resistance. Artemisinin-based combination therapies (ACTs) are still considered the first-line treatment for uncomplicated malaria caused by Plasmodium falciparum, even in areas with artemisinin resistance. However, additional measures may be implemented to overcome the challenges of resistance.Â
Artesunate is an antimalarial medication used in the treatment of malaria. It belongs to a class of drugs known as artemisinin derivatives derived from the plant Artemisia annua (sweet wormwood). Artesunate is highly effective against Plasmodium falciparum, the most dangerous malaria parasite species. Â
When used as a treatment for malaria, artesunate is typically administered in combination with other antimalarial drugs to form an artemisinin-based combination therapy (ACT).  Â
Artesunate disrupts the malaria parasite’s development within the red blood cells. It has a rapid onset of action and is known for its ability to quickly reduce the number of parasites in the bloodstream, alleviating symptoms and preventing severe complications of malaria.Â
In areas with established artemisinin resistance, such as some parts of Southeast Asia, quinine may be used as an alternative treatment option for uncomplicated malaria. Artemisinin resistance has been observed primarily in Plasmodium falciparum malaria, while Plasmodium vivax malaria is usually still sensitive to artemisinins. Quinine is effective against both Plasmodium falciparum and Plasmodium vivax.Â
Mefloquine is an alternative to chloroquine for the prevention and treatment of malaria. It is used in areas with chloroquine resistance. Mefloquine is usually taken as a weekly dose.Â
This combination drug is often used to prevent and treat malaria. It is effective against chloroquine-resistant parasites.Â
Primaquine treats the dormant liver stage of the malaria parasite (Plasmodium vivax or Plasmodium ovale). It is essential for preventing relapses of these malaria species.Â
Infectious Disease
Public/Community Health
One of the primary challenges in rural endemic areas is limited access to healthcare facilities. Efforts should be made to improve access to healthcare services, including setting up local health centers or mobile clinics and training healthcare workers to diagnose and treat malaria.Â
It is usually available in fixed-dose tablets, and the dosage is based on the patient’s body weight. The treatment course typically lasts three days, with a specific number of tablets to be taken at each dose. The medication should be taken with food or milk to enhance absorption. Artemether-lumefantrine has shown high efficacy in treating uncomplicated P. falciparum malaria, including cases with artemisinin resistance. It rapidly clears the parasites from the bloodstream, leading to a faster resolution of symptoms.Â
Artesunate-amodiaquine is another artemisinin-based combination therapy (ACT) used to treat uncomplicated malaria caused by Plasmodium falciparum. It combines the artemisinin derivative, artesunate, with the antimalarial drug amodiaquine. Artesunate provides a rapid reduction in parasite load, while amodiaquine helps to eliminate the remaining parasites and prevent the development of resistance.Â
Infectious Disease
In the context of malaria, interventions involving procedures typically refer to medical interventions aimed at treating complications or severe cases of the disease. These procedures are usually performed in a healthcare facility under the supervision of trained healthcare professionals. Here are a few examples of procedures that may be involved in the management of malaria:Â
Infectious Disease
Treatment and management of malaria typically involve several phases, each with specific goals and interventions. They include:Â
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