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Title
Subheading goes
t of Severe
here
Malaria
cases
Learning Overview
Management
By 2015,
212 million new
cases of malaria
4,29,000 malaria
deaths
Malaria killed
3,03,000 under-
fives globally
Malaria
cases Malaria
deaths
If not available
If not available
A blood smear is made and
treatment started on the basis of
the clinical suspicion of severe
malaria.
Such a patient
It is possible
should not be
that antigen is recorded as severe
persisting from malaria, but may be
an earlier treated as such, if
infection the treating
In children, febrile convulsions, physicianrepeated deems it
vomiting and dehydration are absolutely
common necessary.
if the
temperature is high from any cause. Therefore,
these symptoms are not necessarily indicative
of severe malaria Guidelines
in children.
for Establishing Sentinel Surveillance
Hospitals and Management of Severe Malaria
Cases. NVBDCP (2009)
Challenges in severe malaria
Difficulty in diagnosis
ACT monotherapy
Quinine: 20mg
quinine salt/kg
body weight on
admission (IV Quinine 10 mg/kg
three times a day
infusion or divided
IM injection) with:
followed by doxycycline 100 mg
maintenance dose once a day or
of 10 mg/kg 8 clindamycin in
hourly; infusion rate pregnant women
should not exceed 5 and children under
mg/kg per hour. 8 years of age,
Loading dose of - to complete
Note: The parenteral treatment 7
in severe NVBDCP
2016
20mg/kg
malaria should
cases not
should be given for minimum of
24 hours once started
days of treatment.
Chemotherapy of severe
malaria (cont.)
Initial parenteral Follow-up
treatment for at treatment, when
least 48 hours: patient can take
oral medication
CHOOSE ONE of following
following four parenteral
options treatment
Artesunate: 2.4 mg/kg
i.v. or i.m. given on
admission (time=0), Full oral course of
then at 12 h and 24 h, Area-specific ACT:
then once a day. In NorthEastern
or states: Age-specific
Artemether: 3.2 ACT-AL for 3 days
mg/kg bw i.m. given on + PQ Single dose
admission then 1.6 on second day
mg/kg per day. In other states:
or Treat with: ACT-SP
Note: The parenteral treatment in days
for 3 severe
+malaria
PQ NVBDCP
Arteether: 150 mg
cases should be given for minimum of 24 hours 2016
once
dailystarted; Single
i.m for ACT-AL-Artemether
3 days in dose on
- Lumefantrine;
Specific
Supportive
Treatments in
Severe Malaria
Severe Malaria
Coma (Cerebral malaria)
Acute renal failure (ARF)
Severe anaemia
Jaundice
Shock/circulatory collapse
Hypoglycaemia
Pulmonary oedema/adult
respiratory distress syndrome
(ARDS)
Metabolic acidosis/acidaemia
Convulsions
Significant bleeding
Coma (Cerebral malaria)
B. Breathing
If tachypnoea, laboured respiration or acidotic
breathing is present,
patient may need oxygen inhalation and ventilatory
support.
C. Circulation
Check for dehydration by examining the pulse rate,
blood pressure, skin elasticity, jugular venous
pressure, moisture of the tongue, urinary volume
and colour.
If dehydration is present, infuse intravenous fluids.
Suspected infections must be treated with antibiotics
Severe anaemia
contributes 3-46% of
inpatient pediatric
fatalities.
The
pathophysiological
processes involve
direct and indirect
destruction of
parasitized and non-
parasitized RBCs,
inefficient and/or
suppression of
erythropoiesis, and
dyserythropoiesis.
Its incidence
varies between
11.5% to 62% in
epidemics
Association of
jaundice is 40%
and 9.09% with P.
falciparum and P.
vivax cases,
respectively
converse.
She withdrew her hand from a painful
stimulus.
No neck stiffness, jaundice, pallor or rash.
Axillary temperature is 39 C.
Pulse 90 beats/min.
and
Foetal heartbeats can be heard.
Parasite density.
Question 6.
What is the first question
that you would ask this
patient's relatives?
man.
C).
Thrombocyt
openia was
the most
frequent
complicatio
n in the
severe
cases.
ytopaenia is the MOST FREQUENT malaria-a
During malaria,
thrombocytopenia
is associated with
the binding of
parasite antigens
to the surface of
platelets to which
antimalarial
antibodies also
bind, leading to
the formation of
immune
complexes
Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 106(Suppl. I): 52-63, 2011
Drawbacks in treatment
of thrombocytopenia
The immunosuppressant effect of
corticosteroids might mask the severity
of the underlying condition and increase
the viremic load by virtue of its
immunosuppressive property.
Better
&
viable Decre
Palata
option ases
ble Cost
in
and Fewer the effecti Averti
fever
appro side cost ve ng the
associ
priatel effect of and mortal
ated
y s hospit acces ities
with
formul alizati sible
throm
ated on
bocyt
openi
a