Malaria, the raw facts Tim Inglis

World impact common parasitic infection 1 million deaths each year mainly in children mainly in Africa

Disease patterns 1. stableunavoidable 2. unstablepreventable ? 3. travel-relatedpreventable

Clinical features Setting: history of travel to or residence in endemic area Symptoms: –COLD - initial shaking/rigor; then –HOT - fever (may be >40 o C), restlessness, vomiting & convulsions; then final –SWEATING - temperature returning to normal & possibly sleep. Timing: –Generally days to weeks after return from endemic area –Overall, 6-10hr between paroxysms

MOSQUITOHUMAN The parasite a protozoan called Plasmodium

proboscis palp antenna eye scutum scutellum halter THORAX HEAD ABDOMEN FORE-LEG WING MID-LEG HIND-LEG femur tibia claw tarsus Its vector female Anopheles mosquito

Investigations Key questions: –Does the patient have malaria? –Does the patient have P. falciparum malaria? –Does the patient have another infection? Blood films Rapid tests Other infections

Antimalarial treatment WHO guidelines: –ACT: Artemisinin-based Combination Therapy for uncomplicated malaria –Artesunate for IV treatment in low transmission areas & later pregnancy General rules: –start immediately if P.falciparum malaria –wait for results of blood film if benign malaria, –treat uncomplicated malaria as outpatient –advise return if worsens or no improvement

Expedition Medicine Personal measures –Personal protection –Chemoprophylaxis Group measures –Group prophylaxis –Area control measures –Rapid tests –Antimalarial therapy, SBET Local people Medevac arrangements

The Anopheles mosquito is a self-propagating, self-propelled syringe armed to the teeth with malaria parasites.