For treating malaria the first and foremost thing one should do is to diagnose the malaria disease. What are the different ways of making the diagnosis?
Thick and thin blood smears should be made to rule out the presence of asexual forms of parasite. Count the number of RBCs having the parasite within them. A 100 to 200 fields should be examined before declaring the slide negative.
Another method of detection is rapid diagnostic test. This is rapid and simple method of detection that detect plasmodium falciparum specific, histidine rich protein 2 detect LDH antigen in blood sample. These tests are less reliable as these remain positive for several weeks after acute infection. Thus, one cannot use this method in high transmission areas where there is frequent infection.
Microscopy is being replaced by these rapid diagnostic tests these days.
The point which should be remembered is that mature gametocytes are not affected by antimalarial drug. Thus, to rule out resistance one should not check persistence of mature gametocytes.
What Are The Laboratory Findings?
- Leucocyte count is normal until and unless a person is suffering from severe infection.
- Normocytic normochromic anemia is usual.
- ESR and C-reactive proteins are high.
After all the lab findings and analysis one can progress towards the treatment part.
How Do You Treat Someone With Malaria?
There are differences in treatment with respect to different organism. For treating plasmodium falciparum following drugs should be used-
- Artesunate (3 days)+ sulphadoxine-pyrimethamine (1 day)+ primaquine on day 2.
- For treating Plasmodium vivax following drugs should be used-
- Chloroquine (25 mg/kg) should be given for 3 days + primaquine (0.25 mg) for 14 days.
Treatment of severe malaria includes-
Artesunate is the drug of choice for all patients with severe malaria. It should be given by IV or intramuscular route. This drug should be continued for 48 hours. Follow-up treatment includes full course of area specific ACT regimen that is in north-eastern state give ACT-AL for 3 days plus primaquine on day 2. Similarly in other states give ACT-SP for 3 days and primaquine on day 2.
Another option to treat severe malaria is by giving quinine (20 mg) IV infusion followed by maintenance dose 10 mg/kg 8 hourly. The only problem of using quinine is that it causes hypotension when given intravenously. Follow up treatment consist of quinine 10 mg/kg three times a day with doxycycline once a day. Doxycycline should not be given in children under 8 years of age and pregnant women. In such patients clindamycin should be given.
What are the Complications of Severe Malaria and How to Treat Them?
- In case of acute renal failure hemodialysis should be started as early as possible.
- Glucose level should be continuously monitored. For treating hypoglycaemia infusion of dextrose should be made as early as possible.
- Blood transfusion should be made if anemia is present or if hematocrit value is less than 20%.
- Patient developing rapid bleeding should be given fresh blood and IV vitamin K.
- Convulsions should be treated with benzodiazepam. And in further critical cases respiratory support can also be given.
- Patient having pneumonia should be treated with proper antimicrobial therapy. Pulmonary toilet should be done.
- For treating pulmonary edema patient head should be elevated to 45 degrees. For resolving edema diuretics should be given along with the oxygen therapy.
Treatment of uncomplicated malaria-
It is caused by P. vivax, P. malariae, P. knowlesi and P. ovale. Chloroquine is the drug of choice.
These are the drugs which are commonly used. The most common problem the patient faces while having quinine is problem of conchonism comprising tinnitus, nausea, vomiting, deafness and dysphoria. Thus patient should be guided properly regarding the medications and in case of discomfort due to medication one should approach doctor as soon as possible.
Pregnant women, children should be evaluated properly so as to minimize the complications associated with the disease. The person not immune to the medications should receive proper medications until slide appears negative for the parasite. Even after treatment of seven days if parasite persists then surely it is drug resistance malaria.
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