Malaria Plasmodium

• Facts:
  Protozoal disease transmitted by Anopheles mosquito
  Four strains of Plasmodium (P. falciparum, P.vivax, P.ovale, P.malariae)
• History / PE:
  Exposure to malaria-endemic areas
  Cyclic chills, fever (>41C), and diaphoresis
  Splenomegaly 4 or more days after symptom onset
• Diagnosis:
  Giemsa or Wright stained thick and thin blood smears
• Treatment:
  Chloroquine (increasing resistance, not effective for P.vivax, P.ovale)
  Primaquine (P.vivax, P.ovale)
  Malarone (proguanil/atovaquone) newer agent
  
  Mefloquine (chemoprophylaxis)
  
• Complications:
  Cerebral malaria
  Severe hemolytic anemia (usually P.falciparum)
  Acute tubular necrosis and renal failure (associated with blackwater fever)
  Noncardiogenic pulmonary edema
  DIC
• Notes:
  Most deaths are due to P. falciparum
  Relapses are seen in P. ovale, P. vivax
  
  Reduced risk of malaria
  Absence of Duffy factor
  Sickle cell
  G6PD deficiency
  Alpha thalassemia
• Differential Diagnosis:
  Babesiosis (maltese cross)