FALCIPARUM MALARIA

• Pregnant women have an increased susceptibility to malaria infection.
• Malarial infection of the placenta by sequestration of the infected red blood cells leading to low birth weight and other effects.

FALCIPARUM Malaria fever

• There are four types of malaria caused by the protozoan parasite
• This fulminant disease often produces coma, shock, or sudden death.
• Falciparum malaria in which the brain is affected.
• Vital organ dysfunction may occur. Parasitemia may be — 3%.
• Mortality may be high in severe falciparum malaria.

Cerebral malaria

Cerebral malaria

• It is a serious form of falciparum malaria.
• There is coma with increased mortality despite treat­ment.
• Obtundation i.e. altered consciousness, delirium, ab­normal behaviour occur.
• Onset may be gradual or sudden. There may be convulsions.
• There is a diffuse symmetric encephalopathy.
• Focal neurologic signs and signs of meningeal irrita­tion are absent.
• Corneal reflexes are preserved. Tendon reflexes are variable.
• Plantar reflexes may be flexor or extensor. Abdominal reflexes are absent.
• Fundus may show retinal haemorrhages, papil­loedema.
• There may be residual neurologic deficit, blindness, deafness.

Hypoglycemia in malaria

Hypoglycemia in malaria

• Common in children and pregnant women.
• It is due to failure of hepatic gluconeogenesis. Quinine, used to treat malaria may cause increased pancreatic insulin secretion leading to hypoglycemia.
• There is sweating, tachycardia.

Lactic acidosis in malaria

• It may occur in severe malaria. There is lactic acido­sis with ketoacidosis, respiratory distress, circulatory ­failure, with poor prognosis.

Non cardiogenic pulmonary edema

• May occur in falciparum malaria or vivax malaria. Mortality is 80%.

Renal impairment in malaria

Renal impairment in malaria

• May occur in falciparum malaria in adults.
• It is due to erythrocyte sequestration, and acute tu­bular necrosis leading to ARF.
• Treatment is early dialysis.

Hematologic abnormalities in malaria

• There is anaemia, coagulation abnormalities, throm­bocytopenia with bleeding.
• There may be disseminated intravascular coagulation (DIe).

Liver dysfunction in malaria Hemolytic jaundice

Liver dysfunction in malaria Hemolytic jaundice

• Hepatic dysfunction
• Mild or deep jaundice
• Severe liver dysfunction occurs in falciparum malaria.

MALARIA IN PREGNANCY

MALARIA IN PREGNANCY

• Associated with low birth weight, increased mortal­ity, congenital malarial infection in children.
• In the pregnant mother, there is severe anaemia, hypoglycemia, acute pulmonary edema, premature labour.

MALARIA IN CHILDREN

• Convulsions, coma, hypoglycemia, severe anaemia is more common in children.

TRANSFUSION MALARIA

• Malaria can occur by blood transfusion, needle-prick, as in drug addicts, organ transplantation.

ALGID MALARIA

ALGID MALARIA

• Algid malaria may be due to adrenal crisis, absorp­tion of endotoxin from gut or TNF (tumor necrosis factor) from endotoxin-activated macrophages.
• There is sub-normal temperature, weakness, pros­tration, feeling of cold, vomiting, loose motions, rapid respiration and oliguria.
• Death may occur but patient is conscious till the end.

BLACK WATER FEVER

• After several bouts of falciparum malaria, there is occasionally abrupt onset of massive intravascular hemolysis with fever, chills and prostration.
• It is the result of red blood cell destruction and the release of hemoglobin.
• Bloody urine (hemoglobinuria) that occurs as a complication of falciparum malaria infection.
• It occurs most commonly in patients who have been treated with drugs derived from quinine.
• Hemoglobin escapes in urine turning it black, if the urine is acidic.
• The illness is marked by high fevers, dark urine, epigastric pain, vomiting, jaundice, and shock
• This is a serious condition with a bad prognosis.

Patient Care ––

• In such areas, suppressive and prophylactic drugs may be needed to control the disease.
• Health care providers in endemic areas need to work toward prompt detection and effective treatment of malaria.