Question

A white Latin American Professor visits Ghana with a Colleague of African descent (Usman), who was born in Ghana and has both parents living in Ghana, but he is working on a Project with his White Colleague in North of Canada. The white Professor consulted a Tropical Medicine expert and started antimalarial prophylaxis before his visit to Ghana but his African friend had some misconceptions about the efficacy and side effects of the medicines for prophylaxis so he declined its use before travel and while he was in Ghana. Usman developed serious malaria illness whilst in Ghana and almost died, but for prompt action from his Ghanaian relatives and Medical experts in an intensive care unit of the referral hospital he was rushed to.

4. List other symptoms or signs complications to Severe and Complicated malaria and indicate how it should be managed therapeutically or non-therapeutically, backed by current evidence of safety & efficacy -10 marks

5. When discharged from the hospital, List appropriate strategies that should be applied to prevent USMAN from having reinfection -5 Marks

Answer 1

1) Ans)Severe malaria is defined as presence of Plasmodium falciparum parasitemia and one or more of the manifestations in the table (table 1). Most cases of severe malaria are attributable to Plasmodium falciparum (90 percent), but Plasmodium vivax and Plasmodium knowlesi can also cause severe disease

A malaria infection is generally characterized by the following signs and symptoms:

shaking chills that can range from moderate to severe.

high fever.

profuse sweating.

headache.

nausea.

vomiting.

abdominal pain.

diarrhea.

Fever.

Chills.

Headache.

Nausea and vomiting.

Muscle pain and fatigue

Other complications of a severe case of malaria can include:

breathing problems (such as fluid in your lungs)

liver failure and jaundice (a yellow discolouration of the skin)

shock (sudden drop in blood flow)

spontaneous bleeding.

abnormally low blood sugar.

kidney failure.

swelling and rupturing of the spleen.

dehydration

In adults, cerebral malaria is part of a multi-organ disease. Patients develop fever, headache, body ache and progressively, delirium and coma. Compared to African children, seizures papilledema and retinal changes are less common and coma resolution is slower

Treatment
Treat adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women) with intravenous or intramuscular artesunate for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT.

Strong recommendation, high-quality evidence

Researchers are working to create a vaccine against malaria. Vaccination is expected to become an important tool to prevent malaria in the future.

One way to prevent malaria is to avoid mosquito bites with the following strategies:

As much as possible, stay indoors in well-screened areas, especially at night when mosquitoes are most active.  

Use mosquito nets and bed nets. It's best to treat the nets with the insect repellant permethrin.  

Wear clothing that covers most of your body.  

Use an insect repellent that contains DEET or picaridin. These repellents are applied directly to your skin, except around your mouth and eyes. If you choose a picaridin-based repellant, you will need to reapply it every several hours.  

Apply permethrin to clothing.  

It is strongly recommended that you take preventive medication when you travel to a region of the world that has malaria. Keep in mind that these medications can prevent most malaria infections, but travelers occasionally get malaria even when they are taking one of these drugs. If you develop an illness with fever within a year of your return, seek immediate medical attention and tell a health care professional about your travel.  

Efficacy:
Treatment regimen differed depending on the study but consisted essentially in IV AS (except for the use of rectal route in one study),n first or second line (mostly after IV Quinine) alone or in association with several anti-malarial drugs. In a vast majority of cases, patients were treated for severe malaria
Preventing long-term sequelae, such as improving neurocognitive outcomes in SM survivors, should be an important consideration when it comes to potential adjunctive therapy; however so far, the majority of attempts to enhance the efficacy of anti-malarial drugs with adjunctive therapy have failed. The development of adjunctive therapy would benefit from a more complete understanding of the physiopathology of SM and CM, and how it differs between adults and children. The identification of host biomarkers associated with disease severity and host response to treatment could provide a useful read out of therapeutic efficacy, and empower RCTs to evaluate adjunctive therapy with smaller and better defined cohorts.

RTS,S/AS01 prevented many cases of clinical and severe malaria over the 18 mo after vaccine dose 3, with the highest impact in areas with the greatest malaria incidence. VE was higher in children than in infants, but even at modest levels of VE, the number of malaria cases averted was substantial. RTS,S/AS01 could be an important addition to current malaria control in Africa.

2) Infection control practices to reduce reinfection include the use of protective barriers (e.g., gloves, gowns, face mask, protective eyewear, face shield) to reduce occupational transmission of organisms from the patient to the health care worker and from the health care worker to the patient

Use an insect repellant. Apply an insect repellant to your skin, clothing, and other fabrics, such as blankets. Ask your healthcare provider which insect repellant is best to use.

Cover your skin. Wear long-sleeved shirts and pants to keep your skin covered.

Sleep under a mosquito net. Spray insect repellant on your mosquito net. Check your net for holes often.

Protect your home. Put screens on your windows and doors to keep mosquitoes out. Use insecticide inside your home to kill mosquitoes that come into your house.

Remove all standing water around your home. Mosquitoes lay their eggs and mature in water.

Awareness of risk – find out whether you're at risk of getting malaria.

Bite prevention – avoid mosquito bites by using insect repellent, covering your arms and legs, and using a mosquito net.

Check whether you need to take malaria prevention tablets – if you do, make sure you take the right antimalarial tablets at the right dose, and finish the course.

Diagnosis – seek immediate medical advice if you have malaria symptoms, including up to a year after you return from travelling

Community
• Wear repellent during periods of activity
• Sleep under treated mosquito bed net
• Screen or close windows and doors from dusk to dawn
• Use mosquito coils or plug-in repellent devices
Council
• Eliminate breeding areas or areas with poor drainage
• Education of community in malaria prevention
• Monitoring of mosquito populations
- CO2 baited light traps
- Larval sampling
• Control adult mosquitoes
- Fogging at peak biting times
- Residual harbourage spraying
- Interior residual spraying

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