Malaria: quick review

30 Aug

BASICS:

-1500 Malaria cases reported in the US each year with around 13 deaths, almost all from Plasmodium Falciparum

Incubation period varies, with most patients being symptomatic within 1 month

-consider Malaria with recent travel to an endemic area with influenza-like symptoms

 

Symptoms

Inluenza-like symptoms including fever, headaches, diaphoresis

-Symptoms often wax and wane

-“Cerebral malaria”- more common in pediatric patients- headache/vomiting/Altered mental status/seizures.

-Pulmonary complications ranging from cough to ARDS

Renal dysfunction

 

Diagnosis

Thick and thin blood smear examination is gold standard

Thrombocytopenia is the most common labwork finding (60%), followed by hyperbilirubinemia (40%) and anemia (30%).  Elevated liver enzymes and LDH levels are also common.

-In combination, thrombocyoptenia and hyperbilirubinemia has high positive predictive value of malaria

 

 

Differential

Dengue Fever should also be in differential

-Shorter incubation period (4-7 days)

-sudden high fever, headaches, nausea/vomiting, MYALGIAS (“Break Bone Fever”), and a morbilliform rash on the trunk and spreads to the extremities and face

-Does NOT usually have lymphadenopathy like West Nile Fever

-Labwork Findings: Leukopenia, thrombocytopenia

-Acute Schistosomiasis

-Shorter incubation period (median 11 days)

-Check Eosinophil count

African tick bite fever

 

Severe Malaria

-Generally caused by Plasmodium Falciparum

-Greater than 10% parasitemia

-Associated with renal failure and acute respiratory failure in adults and severe anemia, seizures, increased intracranial pressure in children.

-Management is mostly supportive care in combination with antimalarial agents

-Some debate regarding the use of exchange transfusion

 

Submitted by J. Grover.

 

References: D’Acremont V, Landry P, Mueller I et al.  “Clinical and Laboratory Predictors of Imported Malaria in an Outpatient Setting:  An Aid to Medical Decision Making in Returning Travelers with Fever.  Am J Trop Med Hyg 2002;66:481-486.; Newman RD, Parise ME et al.  “Malaria-Related deaths among U.S. Travelers 1963-2001.  Ann Intern Med 2004;141:547-555.; Sarkar PK, Ahluwalia MD, et al.  “Critical Care Aspects of Malaria.”  Journal of Intensive Care Medicine.  2010.  25(2) 93-103.; Sandhu G, Ranade A, et al.  “Influenza-Like Illness as an Atypical Presentation of Falciparum Malaria in a Traveler from Africa.”  Journal of Emergency Medicine 2011.  (41)1: 35-38.; Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th Edition.; picture

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