An in depth review of this notorious parasite.


https://media.blubrry.com/coreem/content.blubrry.com/coreem/Malaria.mp3



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Tags: Infectious Diseases





Show Notes
Background

In 2017, there were 219 million cases and 435,000 people deaths from malaria
Five species: Falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi.
Falciparum, Vivax and Knowlesi can be fatal
History of recent travel to Africa (69% of cases in US), particularly to west-Africa should raise suspicion for malaria

Clinical Manifestations

Average incubation period for Falciparum is 12 days

95% will develop symptoms within 1 month


Clinical findings with high likelihood ratios include periodic fevers, jaundice, splenomegaly, pallor.
Can also have vomiting, headache, chills, abdominal pain, cough, and diarrhea
Severe malaria has a mortality of 5% to 30%, even with therapy
Diagnostic criteria for severe malaria:

[caption id="attachment_8759" align="aligncenter" width="417"] Ashley 2018[/caption]

Most common manifestations of severe malaria affect the brain, lungs, and kidneys

Patients with cerebral malaria can present encephalopathic or comatose, some severe enough to exhibit extensor posturing, or seizures
Can have acute lung injury with a quarter of these patients progressing to ARDS
Can have AKI from ATN and resultant acidosis


Labs may be unremarkable but watch for anemia and thrombocytopenia

Hgb <5 has an OR = 4.9 for death
Severe thrombocytopenia has an OR = 2.8
Anemia + Thrombocytopenia has an OR = 13.8 (Lampah 2015,