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
Severe thrombocytopenia has an OR = 2.8
Anemia + Thrombocytopenia has an OR = 13.8 (Lampah 2015,