| Symptoms
are mainly fever, body ache and headache. Severe and complicated
malaria may present as follows:
a)
Cerebral Malaria - Patient becomes unconscious and is an ominous
sign.
Sometimes the patient
behaves erratically and delirium may be the early sign
of cerebral involvement.
b) Hypoglycaemia - blood sugar level comes down
c) Anaemia: Haemoglobin level reduces.
d) Renal Failure there may be acute suppression of urine
e) Spontaneous bleeding from Mouth, Genitalia, Rectum
f) Pulmonary oedema - fluid comes out within the lungs causing
breathing
difficulty
g) ARDS - Acute Respiratory Distress causing inadequate oxygenation
of tissue
h) Circulatory collapse and shock
i) Hepatitis
These severe manifestation may occur singly or in combination
making treatment very difficult.
General
management
- Anti-malarial
medicine to start as early as possible. Initially these
are given Parentally but switched to oral medicine as soon
as patient becomes fit.
- Heck
blood glucose frequently and to give glucose accordingly
- Check
blood for Hb level Platelets and Arterial Blood Gas regularly
- Antipyretics
for fever
- Oxygen
inhalation by ventimask/binasal canula and if required BiPAP
Ventilation ( noninvasive method of ventilation) should
be started to prevent hypoxemia.
- Unconscious
patient should receive meticulous nursing care. Indwelling
catheter given to measure urine output. Ryles tube given
to start nutrition and to give other medicine. Frequent
change of posture necessary to prevent bedsore. To check
BP, Pulse, Rectal Temperature frequently. If Quinine is
given then to check at intervals in EKG to prevent fatal
arrhythmia.
- Blood
Urea, Creatinine, Electrolyte, Liver function test, should
be checked frequently.
- Prompt
treatment of associated infection by proper antibiotics
- Haemodialysis
for Acute Renal Shut Down
- Fresh
blood transfusion if required
- If
ARDS develops then to consider artificial Ventillation
Medicine
Malaria is treated with any of the following drugs:
1)
Chloroquine is the first line of drug to be started.
It can be given intramuscularly initially provided the patient
is not in a circulatory collapse state and followed by oral
route as soon as patient can swallow. The side effects are
nausea, vomiting, headache, pruritis, blurred vision.
2)
Quinine is the drug of choice which can be given as
above. Side effects are Hypoglycaemia, tinnitus, hearing loss,
nausea, vomiting, restlessness, blurring of vision, cardiac
arrhythmia.
3)
Primaquine - is given along with above drugs on the
first day only as it prevents transmission of malaria ( by
destroying the gametocytes).
4)
Mefloquine - it resembles Quinine and is given orally
in multi drug resistant cases.
5)
Artemether - new medicine which is rapid in action,
relatively safe and effective in all cases of malaria. These
should be kept reserve to treat complicated cases.
6)
Sulfadoxine - pyrimethaminne combination can be given
along with chloroquine
7)
Sometimes Doxycycline orally is given along with Quinine.
Initiation of treatment by any of the above drugs depends
upon the condition of the patient and judgement of the treating
doctor.
Prevention
of Malaria:
a) By using mosquito net while sleeping
b) Daily changing of stored water in the household
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