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Complications of P.

falciparum Malaria
Severe falciparum malaria is defined by the demonstration of asexual forms of P. falciparum in a patient with a potentially fatal manifestation or complication of malaria in whom other diagnoses have been excluded. Even though the complications are almost unique to P. falciparum infection, that DOES NOT mean that all cases of P. falciparum malaria invariably develop complications. The case fatality of P. falciparum malaria is around 1 per cent and this accounts form 1 to 3 million deaths per year all over the world. 80% of these deaths are caused by cerebral malaria. In 1990, the World Health Organization (WHO) established criteria for severe malaria and these were revised in the year 2000 to include other clinical manifestations and laboratory values that portend a poor prognosis based on clinical experience in semi-immune patients (Table 1). The major complications of severe malaria include cerebral malaria, pulmonary edema, acute renal failure, severe anemia, and/or bleeding. Acidosis and hypoglycemia are the most common metabolic complications. Any of these complications can develop rapidly and progress to death within hours or days.[1] The presentation of severe malaria varies with age and geographical distribution. In areas of high malaria transmission, severe malaria mainly affects children under five years of age. The mortality rate is higher in adults than in children but African children develop neuro-cognitive sequelae following severe malaria more frequently. In children, the complications include metabolic acidosis (often caused by hypovolaemia), hypoglycaemia, hyperlacticacidaemia, severe anaemia, seizures and raised intracranial pressure and concomitant bacterial infections occur more frequently. In adults, renal failure and pulmonary oedema are more common causes of death.[2] In many patients, several of these complications exist together or evolve in rapid succession within a few hours. In clinical practice, patients must be assessed for any of these signs or symptoms that suggest an increased risk for developing complications and must be treated immediately. In various studies risk factors for severe malaria and death include age greater than 65 years, female sex (especially when associated with pregnancy), nonimmune status, coexisting medical conditions, no antimalarial prophylaxis, delay in treatment, and severity of the illness at admission (coma, acute renal failure, shock, pulmonary edema, coagulation disorders). In tropical countries with a high transmission of malaria (hyperendemic areas), severe malaria is predominantly a disease of young children (1 month to 5 years of age).[1] Predisposing factors for complications and death from P. falciparum malaria: In various studies, risk factors for severe malaria and death include age greater than 65 years, female sex (especially when associated with pregnancy), nonimmune status, coexisting medical conditions, no antimalarial prophylaxis, delay in treatment, and severity of the illness at admission (coma, acute renal failure, shock, pulmonary edema, coagulation disorders). In tropical countries with a high transmission of malaria (hyperendemic areas), severe malaria is predominantly a disease of young children (1 month to 5 years of age).[1] Lab. abnormalities: Thrombocytopenia is the most common laboratory abnormality (60% of cases), followed by hyperbilirubinemia (40%), anemia (30%), and elevated hepatic aminotransferase levels (25%). The leukocyte count is usually normal or low, but neutrophilia with a marked increase in band forms (left shift) is present in the majority of cases. The erythrocyte sedimentation rate, C-reactive protein, and procalcitonin are almost invariably elevated. The severity of malaria corresponds to the degree of the laboratory abnormalities. In one study of travelers who returned from the tropics, thrombocytopenia and hyperbilirubinemia had a positive predictive value of 95% for malaria.[1] Severe manifestations and complications of P. falciparum malaria In a patient with falciparum malaria in whom other diseases have been excluded, the presence of one or more of the following manifestations is sufficient for a diagnosis of severe falciparum malaria. Table 1: Indicators of severe malaria and poor prognosis [1,3-5]
Manifestation 1. Cerebral malaria: 2. Severe anemia 3. Renal failure Features Unarousable coma not attributable to any other cause, with a Glasgow Coma Scale score ≤9; Coma should persist for at least 30 min after a generalized convulsion Hematocrit <15% or hemoglobin < 50 g/l in the presence of parasite count >10000/µl Urine output <400 ml/24 hours in adults (<12 ml/kg/24 hours in children) and a serum creatinine >265 µmol/l (> 3.0 mg/dl) despite adequate volume repletion Initial World Health Organization criteria from 1990 [3]

4. Metabolic (Lactic) Metabolic acidosis is defined by an arterial blood pH of <7.35 with a plasma bicarbonate concentration Acidosis/acidosis of <22 mmol/L; hyperlactatemia is defined as a plasma lactate concentration of 2-5 mmol/L and lactic acidosis is characterized by a pH <7.25 and a plasma lactate >5 mmol/L. 5. Pulmonary edema or acute respiratory distress syndrome (ARDS) Breathlessness, bilateral crackles, and other features of pulmonary oedema. The acute lung injury score is calculated on the basis of radiographic densities, severity of hypoxemia, and positive end-expiratory pressure

peripheral schizontemia. Aspiration bronchopneumonia. gastrointestinal tract. If the fibrosis became very extensive then it change to cirrhosis. urinary tract infection etc. Jaundice Serum bilirubin of more than 43m mol/l (2. clinical evidence of hypovolemia Patients with persistent vomiting may have to be admitted for parenteral therapy. prospective autopsy study of children dying with cerebral malaria in Malawi found malarial retinopathy to be a better indicator of malarial coma. (Hyperbilirubinemia) Other 16. Liver cirrhosis Liver cancer Liver failure Glomerulonephritis Cryoglobulinemia Hepatic encephalopathy Portal hypertension Porphyria Other viral co-infection . not associated with effects of oxidant drugs or enzyme defects (like G6PD deficiency) Added World Health Organization criteria from 2000 [4] 11. Repeated generalised convulsions ≥3 generalized seizures within 24 hours 10. Hypoglycemia Whole blood glucose concentration of less than 2. retinal haemorrhages and/or and/or disseminated laboratory evidence of disseminated intravascular coagulation.6. low antithrombin III levels. needs support Core body temperature above 400C 13. Abnormal bleeding Spontaneous bleeding from the gums. papilloedema/retinal oedema 20. Complicating or associated infections Dehydration. intavascular coagulation 9. Fluid and electrolyte disturbances [5] 17. Haemoglobinuria Macroscopic black. Hypotension and Systolic blood pressure <50 mmHg in children 1-5 years or <70 mm Hg in patients ≥5 years. Hyperpyrexia Various levels of impairment may indicate severe infection although not falling into the definition of cerebral malaria. high CSF lactate (>6 mmol/l)and low CSF glucose. Malarial Retinopathy A large. increased plasma 5'-nucleotidase. Hepatitis complications are:  Liver fibrosis Liver cirrhosis  Liver cancer Liver failure  Glomerulonephritis Cryoglobulinemia  Hepatic encephalopathy Portal hypertension  Porphyria Other viral co-infection Liver fibrosis The damage liver cells are usually replaced by new health liver cells. nose. Other indicators Leukocyte count >12. more than 3-fold of poor prognosis [5] elevation of serum enzymes (aminotransferases). septicemia.5 mg/dl). These patients are generally arousable Extreme weakness. Hyperparasitemia 5% parasitized erythrocytes or > 250 000 parasites/µl (in nonimmune individuals) 15. damage cell caused by inflammation are replaced by scar liver tissue that is called fibrosis. or be complicated by other diseases. 7. Impaired consciousness 12. Hepatitis complications Hepatitis can lead to. In fibrosis case. Similar retinopathy in an adult has also been reported. 19.000/cumm. postural hypotension.2 mmol/l (less than 40 mg/dl). Prostration 14. Vomiting of oral drugs 18. cold and shock (algid malaria) clammy skin or a core-skin temperature difference >100C 8. brown or red urine.

9% have appendicitis. peritoneum. When skin lesions or anal fissure. and finally the formation of ulcers or abscesses. but if that were to happen in critical condition. Appendicitis: amoebic enteropathy due to a good position in the cecum. Easily be mistaken for anorectal cancer. or other disorders that are caused by Leprosy. anal crypt inflammation and lesions go far when you can direct invasive Entamoeba trophozoites skin around the anus caused by amoebiasis. such as performance. Intestinal perforation: Acute intestinal perforation occurred in patients with severe enteropathy of the amoeba. and then often penetrated through the formation of local abscess or fistula formation near the organ. a result of shock due to hemorrhage. basal cell carcinoma or skin tuberculosis. urinary system. vomiting. generally occurred in patients with amoebic dysentery or granuloma. However. symptoms. Complications of Leprosy: Worldwide. colorectal cancer is not easy with distinction. colon amoebiasis autopsy found 6. female reproductive system can be invaded Complications list for Leprosy: The list of complications that have been mentioned in various sources for Leprosy includes:  Skin ulcers (type of Ulcer) Infection of skin ulcers  Eye damage Blindness  Cataract Necrosis of skin nodules  Painful neuritis Amyloidosis Related Leprosy Info Related Pages 1. Complications discussion Doctors & Specialists 3. very like cancer.Bacterial Dysentery Complications Complications of bacterial gastroenteritis include:  Pseudomembranous colitis Gastrointestinal bleeding  Dehydration Electrolyte imbalance:  Hypokalemia Shock Sepsis Intestinal complications of Amebic dysentery: 1.9% of appendectomy. often accompanied by pain. or damage caused by granuloma. In many cases the distinction between symptoms of Leprosy and complications of Leprosy is unclear or arbitrary. persons receiving antibiotic treatment or having completed treatment are considered free of active infection. sometimes disease can be linked to the method of secondary treatment of hemorrhoids fistula after amebic trophozoites dual infection through anal blood around the body like the size of brown appear miliary rash. About complications: Complications of Leprosy are secondary conditions. internal report. More than a small amount of bleeding ulcers as a result of bleeding caused by superficial. amebic liver abscess is the most see. and consideration should be given to this disease. but also in the transverse colon. pleura. skin. the more opportunities for involving the appendix. Enteric cavity stenosis: chronic patients. rectum and anus. the rash uplift flat. but if history of amoebic dysentery and obviously right lower quadrant tenderness. Leprosy: Introduction Complications List 2. Chronic perforation of the formation of intestinal adhesion first. (Source: excerpt from Hansen's Disease (Leprosy): DBMD) You may also want to research other symptoms in our Symptoms Center. perforation of the site was particularly prevalent in the cecum. Although a large number of unusual bleeding. the invasion of great vessels. abdominal distension and obstructive symptoms. and the emergence of abdominal cramps. have acute and chronic. involving only 0. 1-2 million persons are permanently disabled as a result of Hansen's disease. Complications and sequelae of Leprosy from the Diseases Database include:  Acid fast bacillus Tuberculoid leprosy Lepromatous leprosy Source: Diseases Database See also the symptoms of Leprosy and Leprosy: Introduction. 4.2% ~ 40. gastro-intestinal ulcer repair of fibrous tissue can form a scar and narrow. Increases tumor can cause intestinal obstruction. Its symptoms similar to appendicitis and bacterial. Misdiagnosis Deaths See also the symptoms of Leprosy and Leprosy: Introduction. appendix and ascending colon. Prognosis Treatments 4. due to ulcers caused by vascular invasion of the intestinal wall. perforation of bowel disease can make the contents into the abdominal cavity mesocaval lead limitations or diffuse peritonitis. 5. . gallbladder. 6. brain. the edge of confusion. rupture and discharge pus discharge. Because the result of massive bleeding in the submucosa of ulcers. Parenteral complications of Amebic dysentery: Amebic trophozoites from the intestinal tract by the blood flow to the lymphatic spread of a distant organ complications arising from a variety of parenteral. Amebic tumor: a large amount of granulation tissue wall to form a mass reach. followed by such as the lung. pericardium. Amoebiasis around the anus: the disease is less often misdiagnosed clinically. Intestinal bleeding: the incidence of less than 1%. the Department of intestinal amoebiasis most serious life-threatening complications. Occur in the caecum. 2. stomach. 3.

and surgery is necessary to repair the hole within the digestive organ. trouble breathing. In children. chills. myocarditis can resolve on its own.edu/patiented/articles/how_serious_a_urinary_tract_infection_000036_5. antibiotics may be prescribed to help destroy any bacteria that leads to myocarditis. 2010 | By Lisabetta DiVita The Mayo Clinic says that typhoid fever is a condition that results from infection with the Salmonella typhi bacteria. In other cases. The Mayo Clinic says that myocarditis refers to an inflammation of the heart's middle layer (myocardium). A doctor can insert a device (endoscope) to stop any bleeding in the esophagus region.co. UTIs can develop into very serious and potentially life-threatening kidney infections (pyelonephritis) that can permanently scar or damage the kidneys. recurrent UTIs may cause scarring in the kidneys.livestrong. Typically. metoprolol. Myocarditis Typhoid fever can affect the heart and lead to myocarditis. fainting. large intestine. Medications such as lisinopril. crampy stomach pain and shortness of breath. The National Digestive Diseases Information Clearinghouse (NDDIC) says that signs of gastrointestinalbleeding include black or tarry stools. UTIs that occur during pregnancy pose a higher than average risk of developing into kidney infections. However. myocarditis can lead to trouble breathing. this affects 5 percent of people suffering from typhoid fever. stomach or small intestine. Having Knee Arthritis? Take Saicra GLME From New Zealand Offered Competitive Prices In India www. urinary tract infections are annoyances that cause urinary discomfort. Gastrointestinal Bleeding The Mayo Clinic says that one of the most serious complications of typhoid fever include gastrointestinal bleeding. Recurrent urinary tract infections. almost never lead to progressive kidney damage in otherwise healthy women. even in the kidney. a fever and blue or grey skin. diarrhea and a headache. nausea and a fever. Read more: http://www. Left untreated. a fast or irregular heartbeat. Symptoms of typhoid fever include a fever. headache.Typhoid Fever Complications Mar 23. a heart transplant may be necessary. injecting certain medications into the bleeding site can help control the bleeding. Many doctors recommend that women receive periodic urine testing throughout their pregnancies to check for signs of bacterial infection. Sometimes. Myocarditis also causes body aches. Symptoms of gastrointestinal perforation include severe stomach pain. loss of consciousness. Other signs of this condition include dizziness. vomiting. diarrhea and a rash. Read more: http://www. which over time can lead to renal hypertension and eventual kidney failure. The infection may also spread into the bloodstream (called sepsis) and then elsewhere in the body. diarrhea. Symptoms of myocarditis include chest pain.htm#ixzz1pAcbj WYV . surgery is necessary to manage gastrointestinal bleeding. Sometimes. Gastrointestinal bleeding can also lead to paleness. Any pregnant women who suspects she has a urinary tract infection should immediately contact her doctor.saicra. Other treatments involve receiving intravenous (through the vein) medications and having a pump placed in the heart's large blood vessels (intra-aortic balloon pump). a loss of appetite. furosemide or digoxin may be needed to manage myocarditis. a viral infection. In fact. Sometimes. typhoid fever complications can result. antibiotic medications may be given when the perforation has closed on its own. Sometimes. Most of these adults with kidney damage have other predisposing diseases or structural abnormalities. vomiting bright red blood blood and having stool mixed with either dark or bright red blood. a portion of the small intestine is removed. joint pain and a sore throat. a sore throat. UTIs in pregnant women pose serious health risks for both mother and child. constipation.com/article/86532-typhoid-fever-complications/#ixzz1pAbfWyuE UTI Complications: In most cases. Typhoid fever can also lead to stomach pain. weakness.umm. In some adults.nz/india Sponsored Links Gastrointestinal Perforation Gastrointestinal perforation is another serious complication of typhoid fever. MedlinePlus says this condition refers to a hole that actually forms in the gallbladder. if left untreated. Scarring and future kidney problems are also concerns for children who experience severe or multiple kidney infections. In fact. fatigue and weakness. This is a medical emergency.

Drug Resistance Some forms of TB become resistant to the medications used to treat the infection. affecting all organ systems. Complications of Tuberculosis Mar 31. 2010 | By Abigail Adams Photo Credit medicine image by Pali A from Fotolia. Damage to the entire body may occur if the bacteria continue to invade the tissues of the body.Gonorrhea Complications By Mayo Clinic staff Untreated gonorrhea can lead to significant complications. it may lead to infertility. including your joints. skin sores. Proper medical treatment is necessary to prevent permanent damage to the brain or spinal cord or death from the infection. The bacteria Mycobacterium tuberculosis attacks the tissue in the lungs and may spread to other locations in the body. a headache and a stiff neck. Symptoms associated with TB include a severe cough that may produce blood or bloody mucous. PID is a serious infection that requires immediate treatment.  Infection that spreads to the joints and other areas of your body. Death is more common for individuals with compromised immune systems and for individuals who receive no treatment for the infection Read more: http://www. This damage can make breathing difficult for the affected individual. but if left untreated. fever. Some of the drugs may cause damage to the liver. This whole body involvement is referred to as military TB. causing pelvic inflammatory disease (PID). according to Medline Plus. Death: A TB infection without treatment leads to death for the infected individual. swelling and stiffness are possible results. Captain Cook thru to Dragonflys Pain: When the TB bacteria enter the bones. such as:  Infertility in women. Pro Hart Paintings Wide Range of Rare Paintings. Medication Side Effects: The medications used to treat TB infections can be detrimental to the body. the virus that leads to AIDS. according to experts at the Mayo Clinic. Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV). according to the Mayo Clinic.com Tuberculosis (TB) is a bacterial infection in the lungs. the infection spreads and does not respond to first-line medications normally used to treat the condition. Miliary TB:Without treatment. Untreated gonorrhea can spread into the uterus and fallopian tubes. greater risk of pregnancy complications and infertility. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners. Not taking the medicines correctly or physicians prescribing the incorrect medications can lead to the drug resistant type of TB. such as blurry vision and orange-colored tears. night sweats and fatigue.  Complications in babies.com/article/100187-complications. When the drug resistance occurs. the bacterial infection may cause permanent damage to the lung tissue with pulmonary TB. rash. Tuberculosis is contagious and can transfer easily when an infected individual coughs. Other complications involving the medications include vision changes. The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body. Babies who contract gonorrhea from their mothers during birth can develop blindness. Epididymitis is treatable. pain accompanies the infection. joint pain. which may result in scarring of the tubes. The bacteria can cause abscesses or destruction of the tissue in the joints. TB continues to spread throughout the body.  Infertility in men.livestrong. Meningitis: If the bacteria enter the brain or the spinal canal. This is especially true for individuals with previous liver damage. Damage to the lungs may appear on an X-ray of the chest. The damage to the tissue causes the severe pain. Symptoms of meningitis include a high fever. but complications may still occur. sneezes or talks closely with another person and droplets move through the air. Meningitis is an inflammation or infecting involving the lining of the brain and spinal cord. Fever. Men with untreated gonorrhea can experience epididymitis — inflammation of the rear portion of the testicles where the sperm ducts are located (epididymis). A combination of medications helps treat cases of TB.tuberculosis/#ixzz1pAbq61aI . Lung Damage Without prompt treatment. meningitis can occur as a complication.  Increased risk of HIV/AIDS. sores on the scalp and infections. according to the Centers for Disease Control and Prevention.

or stillbirths. Strong evidence shows the increased odds of getting and transmitting HIV in the presence of sexually transmitted diseases (STDs). causing the lungs to collapse. there is build-up of the fluid between the pleural membranes that lubricates the lung. It can also cause death of newborn babies. Abscesses can cause hemorrhage (bleeding) in the lungs if untreated. (Ordinarily the thin zone between the 2 membranes contains only a small amount of fluid. ears. Untreated babies with congenital syphilis can have deformities. but antibiotics that target them have significantly reduced their danger.Syphilis Complications Pregnancy Syphilis can cause miscarriages. . particularly in persons with other lung problems such as cystic fibrosis. Complications of Pneumonia Complications of pneumonia that could occur include build-up of fluid in the space between the lung and chest walls (pleural effusion). Abscesses are most common with Staphylococcus aureus or Klebsiella pneumoniae. a condition called pneumothorax. although it rarely spreads to others sites. Bacteremia: Bacteremia (bacteria in blood) is the most and prevalent complication of pneumococcus infection. and infection of the heart muscle or the sac surrounding the heart (endocarditis or pericarditis). the symptoms of syphilis may go unseen in infants and they develop the symptoms of late-stage syphilis. Abscesses: Abscesses in lung are thick-walled. teeth. but most develop symptoms later. Other Complications of Pneumonia: : In unique cases. in about 20% of pneumonia cases. secondary infection.to five-fold increase risk of getting infected with HIV. pus-filled cavities that are formed when infection has destroyed lung tissue. infection may spread from the lungs to the heart and can even spread throughout the body. Failure could occur if pneumonia leads to mechanical changes in the lungs (called ventilatory failure) or O2 loss in the arteries (called hypoxemic respiratory failure). fever. eyes. premature births. Bacteremia is a frequent-occuring complication of infection from other gram-negative organisms. and uncommon with Streptococcus pneumonia.) Collapsed Lung: In few cases. frequently. delays in development. including damage to their bones. and jaundice.  Chest wall are covered by parietal pleura.infection of a joint caused by spread of bacteria through the bloodstream (septic arthritis). They. Empyema and Pleural Effusions: The pleura are 2 thin membranes:  Lungs are covered by visceral pleura. Rarely. that can result in breathlessness and acute chest ache when breathing. pockets of pus that accumulate in the space between the lung and chest wall (empyema) or in the lung itself (lung abscess). sometimes causing abscesses in the brain and other organs. including Haemophilus influenzae. the pleura become inflamed. along with many other problems such as rash. HIV infection People infected with syphilis have a two. anemia. because of antibiotic therapy. bacteria in the bloodstream (bacteremia) or throughout the body (septicemia). such as a vaginal infection or infections of the digestive system. Coughing up blood (severe hemoptysis) is another potentially serious complication of pneumonia. infection caused by swelling of the covering of the spinal cord (meningitis). and brains. In few cases of pneumonia. are a result of aspiration pneumonia if a mixture of organisms is carried into the lung. You should discuss this and other STDs with your healthcare provider. swollen liver and spleen. ARDS (Acute respiratory distress syndrome) is the specific condition that occurs when the lungs are unable to function and O2 is so severely reduced that the person’s life is at risk. air may fill up the space between the pleural membranes. Some infants with congenital syphilis have symptoms at birth. or seizures. Respiratory Failure: Respiratory failure is one of the main causes of death in people with pneumococcal pneumonia. secondary bacterial lung infection after a viral infection. Sores on infected babies are infectious. It can be a complication of pneumonia (specifically Streptococcus pneumoniae) or of some of the invasive procedures used to treat pleural effusion. And.