Diferencia entre revisiones de «Malaria»

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==Background==
==Background==
*Caused by parasitic protozoa species of the genus Plasmodium (P ovale, P vivax, P malariae, P knowlesi, and P falciparum) carried by the Anopheles mosquito
*Caused by parasitic protozoa species of the genus Plasmodium (''P ovale, P vivax, P malariae, P knowlesi'', and ''P falciparum'') carried by the Anopheles mosquito
**P falciparum most severe
**''P falciparum'' most severe
*Failure to consider for febrile illness following travel, even if seemingly temporally remote, can result in significant morbidity or mortality, especially in children and pregnant or immunocompromised patients
*Failure to consider for febrile illness following travel, even if seemingly temporally remote, can result in significant morbidity or mortality, especially in children and pregnant or immunocompromised patients
*Chemoprophylaxsis does not guarantee protection
*Chemoprophylaxsis does not guarantee protection
*CDC Malaria Hotline: 770-488-7788
*'''CDC Malaria Hotline''': 770-488-7788
*Malaria is a US nationally notifiable disease and all cases should be reported
*Malaria is a US nationally notifiable disease and all cases should be reported


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==Clinical Features==
==Clinical Features==
*[[Fever]] + exposure to [http://wwwnc.cdc.gov/travel/destinations/list.htm endemic country]
*[[Fever]] + exposure to [http://wwwnc.cdc.gov/travel/destinations/list.htm endemic country]
**Cyclic only after chronic infection
**Cyclic fever only after chronic infection
* HA, cough, GI
*Headache, cough, GI symptomx
 
===Classification===
'''Severe'''
*Any one of the following:
**AMS/coma
**Severe normocytic anemia [hemoglobin < 7]
**Renal failure
**ARDS
**Hypotension
**DIC
**Spontaneous bleeding
**Acidosis
**Hemoglobinuria
**Jaundice
**Repeated generalized seizures
**Parasitemia >5%
 
'''Uncomplicated'''
*None of the above


==Differential Diagnosis==
==Differential Diagnosis==
{{Fever in Traveler DDX}}
{{Fever in Traveler DDX}}


==Diagnosis==
==Diagnostic Evaluation==
''High index of suspicion if fever + travel to endemic region''
''High index of suspicion if fever + travel to endemic region''
*Check thick and thin smear initially and if neg, repeat in 12- 24 hrs
*Check thick and thin blood smear (if neg, repeat in 12- 24 hrs)
*[[Thrombocytopenia]] and splenomegaly common
*[[Thrombocytopenia]] and splenomegaly common


===Classification===
==Management<ref>World Health Organization. Guidelines for the treatment of malaria. Second edition. Geneva: World Health Organization; 2009:1-194</ref>==
'''Severe'''
*Mixed infections involving more than one species of Plasmodium may occur in areas of high endemicity (have a low threshold for including treatment for ''P falciparum'')
Any one of the following:
*AMS/coma
*Severe normocytic anemia [hemoglobin < 7]
*Renal failure
*ARDS
*Hypotension
*DIC
*Spontaneous bleeding
*Acidosis
*Hemoglobinuria
*Jaundice
*Repeated generalized seizures
*Parasitemia >5%
'''Uncomplicated'''
*None of the above
 
==Treatment<ref>World Health Organization. Guidelines for the treatment of malaria. Second edition. Geneva: World Health Organization; 2009:1-194</ref>==
*Mixed infections involving more than one species of Plasmodium may occur in areas of high endemicity (have a low threshold for including treatment for P falciparum)
*[[Hyponatremia]] in the setting of hypovolemia does not require treatment beyond rehydration
*[[Hyponatremia]] in the setting of hypovolemia does not require treatment beyond rehydration
*Treat [[hypoglycemia]]
*Treat [[hypoglycemia]]
*Check HIV status (coinfection can lead to worse clinical outcomes)
*Check HIV status (coinfection can lead to worse clinical outcomes)
*Exchange transfusion for patients with:
*Exchange transfusion for patients with:
**P falciparum malaria with a parasitemia greater than 10%  
**''P falciparum'' malaria with a parasitemia greater than 10%  
**Life-threatening complications (ie, coma, respiratory failure, coagulopathy, fulminant kidney failure)
**Life-threatening complications (ie, coma, respiratory failure, coagulopathy, fulminant kidney failure)


;For specific dosing see the [http://www.cdc.gov/malaria/resources/pdf/treatmenttable.pdf CDC Recommendations] or call the Malaria CDC Hotline(855) 856-4713
;For specific dosing see the [http://www.cdc.gov/malaria/resources/pdf/treatmenttable.pdf CDC Recommendations] or call the Malaria CDC Hotline(855) 856-4713


===Uncomplicated Malaria===
===Uncomplicated Malaria===
*[[Atovaquone-proguanil]] or
*[[Atovaquone-proguanil]] '''OR'''
*Arthemeter-lumefantrine or
*Arthemeter-lumefantrine '''OR'''
*[[Quinine]] plus [[Tetracycline]], [[doxycycline]], or [[clindamycin]]
*[[Quinine]] '''plus''' [[Tetracycline]], [[doxycycline]], or [[clindamycin]]


===Severe Malaria===
===Severe Malaria===
*Intravenous quinidine plus tetracycline, or doxycycline or clindamycin  
*Intravenous quinidine plus tetracycline, '''or''' doxycycline '''or''' clindamycin  


===Cerebral Malaria===
===Cerebral Malaria===
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==Disposition==
==Disposition==
===Admission===
*Admit for:
*Patients with suspected or confirmed P falciparum or P knowlesi infection
**Patients with suspected or confirmed ''P falciparum'' or ''P knowlesi'' infection
*Children
**Young children
*Pregnant women
**Pregnant women
*Immunodeficient individuals
**Immunocompromised patients


===ICU===
*Admit to ICU for:
*Severe complications (e.g.coagulopathy or end-organ failure)
**Severe complications (e.g.coagulopathy or end-organ failure)
*Cerebral malaria (e.g. [[AMS]], repeated [[seizures]], coma)
**Cerebral malaria (e.g. [[AMS]], repeated [[seizures]], coma)
*Parasitemia
**Parasitemia
**>2% in pts non-immune (i.e. travelers)
***>2% in pts non-immune (i.e. travelers)
**>5% in pts semi-immune (i.e. locals)
***>5% in pts semi-immune (i.e. locals)


==See Also==
==See Also==
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==References==
==References==
<references/>
<references/>
[[Category:ID]]
[[Category:ID]]
[[Category:TropMed]]
[[Category:TropMed]]

Revisión del 03:56 7 sep 2015

Background

  • Caused by parasitic protozoa species of the genus Plasmodium (P ovale, P vivax, P malariae, P knowlesi, and P falciparum) carried by the Anopheles mosquito
    • P falciparum most severe
  • Failure to consider for febrile illness following travel, even if seemingly temporally remote, can result in significant morbidity or mortality, especially in children and pregnant or immunocompromised patients
  • Chemoprophylaxsis does not guarantee protection
  • CDC Malaria Hotline: 770-488-7788
  • Malaria is a US nationally notifiable disease and all cases should be reported

Traveler Precautions

The CDC recommends travelers to malaria-endemic regions take the following precautions:[1]

  • Chemoprophylaxis
  • Use of insecticide-treated bed nets
  • Use of DEET-containing insect repellents
  • Wear long-sleeve shirts and pants

Clinical Features

  • Fever + exposure to endemic country
    • Cyclic fever only after chronic infection
  • Headache, cough, GI symptomx

Classification

Severe

  • Any one of the following:
    • AMS/coma
    • Severe normocytic anemia [hemoglobin < 7]
    • Renal failure
    • ARDS
    • Hypotension
    • DIC
    • Spontaneous bleeding
    • Acidosis
    • Hemoglobinuria
    • Jaundice
    • Repeated generalized seizures
    • Parasitemia >5%

Uncomplicated

  • None of the above

Differential Diagnosis

Fever in traveler

Diagnostic Evaluation

High index of suspicion if fever + travel to endemic region

  • Check thick and thin blood smear (if neg, repeat in 12- 24 hrs)
  • Thrombocytopenia and splenomegaly common

Management[2]

  • Mixed infections involving more than one species of Plasmodium may occur in areas of high endemicity (have a low threshold for including treatment for P falciparum)
  • Hyponatremia in the setting of hypovolemia does not require treatment beyond rehydration
  • Treat hypoglycemia
  • Check HIV status (coinfection can lead to worse clinical outcomes)
  • Exchange transfusion for patients with:
    • P falciparum malaria with a parasitemia greater than 10%
    • Life-threatening complications (ie, coma, respiratory failure, coagulopathy, fulminant kidney failure)
For specific dosing see the CDC Recommendations or call the Malaria CDC Hotline(855) 856-4713

Uncomplicated Malaria

Severe Malaria

  • Intravenous quinidine plus tetracycline, or doxycycline or clindamycin

Cerebral Malaria

  • Insufficient evidence for or against giving antiepileptics
  • For severe cerebral edema, mannitol and steroids have not show a demonstrable benefit

Disposition

  • Admit for:
    • Patients with suspected or confirmed P falciparum or P knowlesi infection
    • Young children
    • Pregnant women
    • Immunocompromised patients
  • Admit to ICU for:
    • Severe complications (e.g.coagulopathy or end-organ failure)
    • Cerebral malaria (e.g. AMS, repeated seizures, coma)
    • Parasitemia
      • >2% in pts non-immune (i.e. travelers)
      • >5% in pts semi-immune (i.e. locals)

See Also

References

  1. ↑ WHO Malaria Policy Advisory Committee and Secretariat. Malaria Policy Advisory Committee to the WHO: conlusionsions and recommendations of September 2013 meeting. Malar J. 2013;12(1):456
  2. ↑ World Health Organization. Guidelines for the treatment of malaria. Second edition. Geneva: World Health Organization; 2009:1-194
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