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Management of Severe Falciparum Malaria: DR SK Mishra, MD
Management of Severe Falciparum Malaria: DR SK Mishra, MD
Dr SK Mishra,MD
Ispat General Hospital,
Rourkela 769005
India
Falciparum malaria is a
potentially fatal disease
Successful treatment
completely cures without
disability
2. Laboratory diagnosis 3
* Drug history
* Anti malarials
* Blood transfusion
History of
- haemoglobinopathy
- diabetes
- alcoholism/ jaundice
4
Specifically ask / look for
- fever with duration
- headache
- vomiting, diarrhoea
- urine output and colour
- cough / dyspnoea/ bleeding
- altered sensorium / seizures
- pregnancy 5
Clinical examination
Pallor, icterus
bleeding signs
early signs of pulm oedema
consolidation
arrhythmia
hepatosplenomegaly
uterus 6
CNS Examination
Sensorium /coma score
- Glasgow coma score
- Blantyre coma score
- decerebration
Pupils, Fundus examination
Neck stiffness
Plantar reflex 7
Laboratory diagnosis
Microscopy
Immunological tests
Antigen capture tests
Antibody detection tests
QBC test
DNA probe
PCR 8
Microscopy
gold standard for diagnosis
thick smear: rapid
diagnosis
thin : species identification
other advantage
- platelets, anaemia, toxic picture
If negative : repeat blood
test 6 hourly for 6 times
Why parasites are not detected
at times in peripheral smear ?
a. sequestration in deep
vascular bed
b. partially treated patients
c. prophylactic antimalarial
treatment
d. inexperienced microscopist
e. poor quality staining
10
Antigen capture tests
* Pf-ICT test
* Parasight-F test/ Malacheck
etc
Principle: dipstick antigen
capture assay employs a
monoclonal antibody detecting
the Pf.HRP-2 antigen in the
blood
Rapid, simple, sensitive test
Species specificity 11
Antibody detection test
- RIA
- ELISA
antibody persists for a long
time so not helpful in
acute infection
12
QBC test
Spinning blood in a specialised
capillary tubes in which
parasite DNA is stained with
acridine orange.
Detected by ultraviolet
microscope
Sensitive and specific (?) in
Experienced hands
13
PCR test
Sensitive
Can identify different species
Takes 48- 72 hours
Expensive
Available in selected places
only
DNA Probes
14
Cerebral malaria
Coma scoring
Exclude other causes of coma