Malaria

 

* Plasmodium vivax, P. malariae. P. ovale never give a pernicious and are still susceptible to antimalarial drugs.

* The duration of erythrocytes cycle explains the frequency of febrile illness (48 hours for all species except P. malariae that lasts 72 hours -> quartan).

* In a subject having stayed in endemic areas malaria should be suspected in any table regardless of the associated symptoms.

* Incubation may be several months for P. vivax and P. ovale.

* Intermittent plustres Access: move in 3 phases, rigors (1h), high fever (4h), profuse sweating and remission.

Periodically repeating: mild fever thirds (every 2 days); quartan (every 3 days).

Blood smear showing plasmodium falciparum within red blood cells

Blood smear showing plasmodium falciparum within red blood cells

* For P. falciparum periodicity is often less clear (third malignant fever).; there is no real forgiveness between the peaks.

* The renaissance of access may subsequently reappear after a few years (to 20 years for P. malariae) for all species except P. falciparum (no re-experiencing).

* The pernicious (neuropalustre) is manifested by neurological signs (acute encephalitis); anemia; jaundice (hemolysis); renal failure;cytolysis; metabolic acidosis; DIC; hypoglycemia …

* Severity criteria for access plustre: ground; vomiting +; fever ++ tray;rate of erythrocytes parasitized ≥ 5%; severe anemia and hemoglobinuria; clinical jaundice; hypoglycemia; the rest is obvious.

* The thin film is the examination of emergency referral (MGG staining).

The thick film is more sensitive than smear but requires 12 to 24 hours drying before staining

* On smear P. falciparum is suggested by the following: faux-shaped gametocytes; exclusive presence of ring trophozoites (no schizont or rosette body) a red blood cell invasion by several trophozoites (polyparasitism)parasitaemia can be intense (> 5%).

Anopheles gambiae; Malaria vector mosquito

Anopheles gambiae; Malaria vector mosquito

* In a strong clinical suspicion treatment is instituted emergency even if negative smears.

* Thrombocytopenia is not a sign of seriousness (even important); leukopenia.

* All antimalarials are schizontocidal (active only on intra-GR shape); Quinine is the only one that is natural.

* Antimalarial curative treatment only: quinine, Fansidar (sulfadoxine pyrimethamine);

* The AP prophylactic and curative treatment: mefloquine, halofantrine, chloroquine (Nivaquine®).

* Cyclins and macrolides have antimalarial action and can be used in combination with quinine in some pernicious.

* Chemoprophylaxis prevents clinical access, but does not prevent the malaria infection.

Should be started the day before departure and continued four weeks after the return (if chloroquine).

The malaria situation in the world

The malaria situation in the world

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