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Plasmodium Disease (Malaria)

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Summary

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Key Points

  • Plasmodium Disease: Malaria
    • Presentation
      • Malaria
        • Etymology: “mal aire” = bad air (swamp air, where mosquitos were prevalent)
        • Relapsing (episodic) fevers
          • Headache, tachycardia, sweating also seen
          • Caused by RBC lysis in life cycle of malaria
          • 48 hour cycles (every other day)
            • seen with P. falciparum (may be irregular), P. vivax/ovale
          • 72 hour cycles (every third day)
            • Seen with P. malariae
        • Splenomegaly
          • Occurs in acute malaria, due to splenic sequestration of infected RBCs
        • Hemolysis
          • Anemia may be seen
          • Jaundice is fairly common
        • Parasitized RBCs can adhere to capillaries, causing infarcts
          • Altered mentation (CNS ischemia)
          • Cardiovascular collapse (microinfarcts in heart)
          • Renal failure (“blackwater fever”)
            • dark colored urine due to hemoglobin presence
          • Hepatic failure
          • Respiratory distress
    • Diagnosis
      • Blood smear with Giemsa staining
        • Trophozoite (ring-shaped parasites) visualized within RBC
        • Schizont containing merozoites may also be seen
      • Rapid diagnostic tests (RDTs) for malaria are becoming more widespread
    • Treatment
      • Chloroquine is first-line (for sensitive species)
      • For chloroquine-resistant species:
        • Artemisinins
          • First-line for chloroquine-resistant P. falciparum malaria
          • Given in artemisinin combination therapies (ACT)
            • Combinations include artesunate–mefloquine, artemether–lumefantrine, and dihydroartemisinin–piperaquine
        • Atovaquone-Proguanil
          • Second-line for chloroquine-resistant P. falciparum malaria
        • Mefloquine
          • Generally not administered as a monotherapy; instead combined with artesunate
      • Primaquine is needed (to kill hypnozoites) in P. vivax/ovale