Malaria Treatment Guidelines

This essay is related to malaria and information gained whilst working in Guinea as a medic on a remote site for International SOS.
I do not claim the work as originally mine but have compiled it as a guide for myself.

1. Introduction

In the Republic of Guinea malaria is hyper-endemic and one of the principle causes of morbidity.
Malaria is an extremely dangerous and unpredictable disease especially in the non immune population and in certain high risk groups. Prevention is the key to the management of malaria although even good preventative activity could result in a malaria infection.
Early diagnosis and appropriate treatment are the mainstays in achieving the objectives in the treatment of malaria.

2. Objectives

The objectives for the treatment of malaria are as follows:

• The prevention of mortality.
• The prevention of complications.
• The elimination of parasitaemia to minimize transmission.
• To limit the emergence and spread of drug resistance.

3. Parasites species

Over 85% of human malaria infections in Republic of Guinea are due to Plasmodium falciparum, while the rest of the infections are due to Plasmodium ovale, vivax and malariae. Mixed infections can occur.
Infections due to P.falciparum are the most important as they can be severe and lead to serious complications and death. These complications occur almost invariably as a result of delay in treating an uncomplicated attack, the use of ineffective treatment or under-dosing with effective treatment.

4. Risk groups

High risk groups for the development of severe P. falciparum malaria include:
• All non immune travelers to malaria areas
• Residents in seasonally endemic area and other areas with relatively low 1endemicity
• Pregnant women
• Young children
• Splenectomised and immunosuppressed individuals.

5. Diagnosis

• Signs and Symptoms Symptoms of malaria include:

Initially symptoms resemble those of a minor viral flu like illness. These include:

• Lack of sense of well being
• Headache
• Fatigue
• Abdominal discomfort
• Muscle, joint aches followed by fever
• Nausea/ vomiting
• Diarrhea
• Cough

These may be followed by typical malaria picture:

• Fever spikes (sudden rise and fall in temperature)
• Chills
• Rigors

In Young children malaria may present with:

• Fever
• Lethargy
• Poor feeding
• Vomiting, diarrhea
• Cough

-Cold stage-

As the temperature begins to rise, there is intense headache and muscular discomfort. The patient feels cold, clutches blankets, and curls up shivering and uncommunicative.
(The chill). Within minutes the limbs begin to shake and teeth chatter, and the temperature climbs rapidly to a peak. The rigor usually lasts 10-30 minutes but can last up to 90 minutes. It can be accompanied by tachycardia, nausea, vomiting and frequent urination.

-Hot stage-

By the end of rigor there is peripheral vasodilatation and the skin feels hot and dry. The temperature is high and can last 3-8 hours accompanied by headache, often delirium, epigastric pain, further nausea and vomiting.

-Sweating- (Wet stage)

Profuse sweat then breaks out. It lasts for 2-4 hours. The patient is soaked in sweat and the temp falls. The blood pressure is relatively low. The patient feels exhausted and may sleep. Fever is irregular at first with temperature exceeding 39 degrees centigrade. It may rise up to 40oC.

• Laboratory diagnosis

Since the clinical presentation is non specific and may mimic many other diseases, patient blood should be examined immediately to confirm or exclude the diagnosis.
A malaria test should be done irrespective of the time of year or whether the patient has or has not taken prophylaxis.

a. Blood films (Universal precautions must apply during the sampling and handling of the specimen.)

Type of Blood film

- Thin Film: The thin film consists of a single layer of red corpuscles