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8/2/2019 Malaria - Ilyani
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Nurul Ilyani bt Jamaluddin
41216
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A disease caused by the presence of the sporozoan
Plasmodium in human
transmitted by the bite of an infected female
Anopheles mosquito that previously sucked the blood
from a person with malaria.
4 important species of Plasmodium:
Plasmodium falciparum
Plasmodium vivax Plasmodium malariae
Plasmodium ovale
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In Malaysia,
Mainly in Perak, Pahang, Kelantan, Sabah and Sarawak.
But the incidence gradually declining over the year.
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Sporozoites (infective form) transmitted during the blood-
meal feeding of a female Anopheles mosquito on a human.
The sporozoites invade and reside within hepatocytes where
they multiply to large numbers.
An. maculatus P. Malaysia
An. balabacensis Sabah
An. donaldi Sarawak
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1 . uncomplicated malaria (all species) Fever, chill, headache, malaise and myalgia
Malarial paroxysm: rigor and fever followed byprofuse diaphoresis and exhaustion occuring at
regular interval tertian, quartan etc are seldomseen.
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3 Phases Total duration 8 - 12 hours1) Cold, chill stage 15 60 min, rigors and
chattering teeth.
2) Hot 2-6 hours temp 39 41 0C3) Sweating 2-4 hours drenching, profuse, feverdeclines, symptoms diminish and exhaustion.
The fever paroxysm corresponds to the period oferythrocyte rupture and
merozoite invasion.
Vivax\Ovale
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Severe anemia DIVC
ARF Urine < 0.5ml/kg/hr, failing to improve after
rehydration and creatinine > 265mmol/L
Pulmonary oedema
ARDS
Hypoglycemia Quinine and quinidine can induce hyperinsulinemia
Severe metabolic acidosis
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Hyperkalemia (K >5.5 mmol/l) Cerebral malaria
Dexamethasone and mannitol are contraindicated
Repeated generalized convulsion
Algid malaria Hypotension (systolic < 70mmhg), cold clammy
skin.. CVP, fluid resus, inotrope
? Possibility of complicating septicemia if +persistent hypotension > bld C+S and antiobiotic If pt is on IV quinine or quinidine, consider drug
induced cardiac depression.
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Hyperparasitemia P.falciparum in peripheral blood > 5% of
erythrocytes or > 250,000/ul
Worse prognosis, need IV chemotx or exchange
tranfusion Hyperpyrexia
Rectal temp > 40c
Tx : sponging, rectal PCM 0.5-1g every 4 hour
Jaundice Se.bilirubin > 50umol/l
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Visualization of parasite on Giemsa-stainedthin and thick smears.
May be undetected initially as parasitized redcells are often sequestered from the bloodstream
Require repeated smears twice daily for 3/7to fully exclude malaria
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FBC, ESR, BUSE, LFT, RP ABG, CXR, UFEME
G6PD screened before the use ofprimaquine
Blood c+s
UPT
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Chloroquine 10mg base/kg of BW (not exceed 600mg) followed
by 5mg/kg 6-8 hr later and 5mg for next 2/7 Usual adult regime : 600mg followed by 300mg 6hr
later and 300mg/day for next 2/7. In resistence case, add doxycyline/tetracycline plus
primaquine
Primaquine Eradicate hypnozoite
Usual adult dose : 15 mg daily for 2/52 G6PD deficeincy pt : 30-45mg weekly for 8/52 Contraindicated in pregnancy
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Chloroquine (as above) Fansidar
SDX/PYR (sulfadoxine 500mg/ pyrimethamine25mg per tab) given single dose, usually 3 tabs
Contraindicated in prengnant women n infant
Primaquine 30-45mg single dose in adult with normal G6PD for
gametocidal action
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Quinine (600mg tds for 1/52) with either; Fansidar : 3tabs as single dose
Doxycycline: 100mg salt daily for 1/52
Tetracycline: 250mg qid for 1/52
Primaquine (as above)
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Loading dose: IVI 20mg/kg quinine salt over4 hour
Initial maintaince: 10mg/kg quinine salt over4hr tds
Adjustment consideration: Pt remains seriously ill after 3/7 (reduce dose by
30-50%) QT interval prolonged by 25% Liver or renal impairment Hypotension n arrthymia Good oral intake give oral quinine
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Repeat blood smear daily (BD in severe infx) Within 48-72 hr after starting tx, pt usually
become afebrile and clinically improved
upon recovery, blood film should berepeated once/month to ensure norecrudescence.
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Leptospirosis is a zoonosis of worldwide
distribution High-risk areas include south-east asia. Seasonal outbreaks associated with changes
in local water levels have been described;
-flood Recreation; water sports, ingestion of water
and food contaminated with leptospirosis.
Inoculation through skin abrasions
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Caused by Leptospira interrogans (gramve).
Appears to be ubiquitious in wildlife andmany domestic animals, most frequent hostsare rodents.
The bacterium persists in convoluted tubulesof the kidney and are shed into the urine inmassive numbers
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Incubation period averages 1-2 weeks.
In 90% of cases, leptospirosis manifests asan acute febrile illness with a biphasic
course. 1st phase- Septicaemic phase 2nd phase- immune phase
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Occurs during the 1st week of infection Characterized by
Sudden onset of high and remittent fever with chillsand rigors (38-40c)
Retro-orbital headache Conjuctival congestion
Myalgia (paraspinal, calf and abdominal muscle)
Maculopapular skin rash
vomiting
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Usually 1st phase symptoms improve first(defervescence) before going into the nextphase
Occurs 1-4 weeks after infection
Immune phase characterized by asepticmeningitis (50%), and in severe cases Weilsdisease.
Systemic manifestation is common such as
nephritis, hepatitis, myocarditis and ARDS Mortality : 10-15%
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Pallor Conjuctival congestion
Jaundice
Muscle tenderness Rashes
Hepatosplenomegaly
lymphadenopathy
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http://images.google.com.my/imgres?imgurl=http://www.lph.go.th/lab/Image/lepto2.jpg&imgrefurl=http://www.lph.go.th/lab/html/leptospirosis2.html&h=177&w=256&sz=99&tbnid=o8I8kQt_D50J:&tbnh=73&tbnw=106&start=24&prev=/images?q=Leptospirosis&start=20&hl=en&lr=&sa=N8/2/2019 Malaria - Ilyani
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Serum/urine C & S test Can be cultured from blood during 1st week of
illness and from urine 2-4 weeks of illness
Microscopic examination
Thick smears stained by Giemsas technique will bepositive
Serology detection of leptospira antibodies
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TW maybe normal or as high as 50,000/ul.Thrombocytopenia is uncommonUfeme: urine may contain bile, protein, cast and red cellsLFT: bilirubin and liver enzymesRP: creatinine in 50% of caseCSF: polymorphonuclear or lymphocytic pleocytosis with [protein]
and normal glucose
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General Close T, BP, PR, RR and I/O charting
Adequate hydration, keep temp < 38c
Antibotics for 1/52 Mild dz: Doyclycline 100mg bd or
Ampicillin/amoxicllin 1g qid
Severe dz: IV Penicillin G 1.5 mU qid or Ceftriaxone1g OD
Beware of Jarisch-Herxheimer rxn
Supportive Dialysis, ventilatory support etc
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