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.

Answer the Questions below

1. It is true that Africans who live in Malaria endemic zones have some protection from having Malaria illness. So, in the case of Usman, explain what could be possible reason(s) why he suffered almost fatal malaria

2. For Usman’s case what will be the recommended antimalarial and how should it be administered, and for what duration to ensure total cure and parasite eradication. -4 marks

Answer 1

1. It is true that Africans who live in Malaria endemic zones have some protection from having Malaria illness. So, in the case of Usman, explain what could be possible reason(s) why he suffered almost fatal malaria.

Naturally Acquired immunity developed from the childhood exposure and infections to the people makes them develop antibodies against the Malaria causing organism and it will prevent the people living in the endemic zones areas in Contracting malaria to some extent.In the given case Mr. Usman was not living in the endemic zones for years and likely not to have antibodies developed against the malarial parasites .Therefore the absence of Natural immunity towards towards the specific parasite in the region lead him to develop a fatal malaria.Most likely he didn't contracted the malarial infections in the childhood too that might be the reason for not developing naturally developed antibodies in the body to fight against the malarial parasite.

2. For Usman’s case what will be the recommended antimalarial and how should it be administered, and for what duration to ensure total cure and parasite eradication.

Mr.usman should be treated aggressively with intravenous antimalarial therapy.

it include intravenous injection of

• Artesunate at a dose 2.4mg/kg at 0hr,12 hr,24 hr and 48hr .

if the patient can tolerate oral medications then can be switched to the following drugs:

• Doxycycline- 100mg twice daily for seven days.
• Clindamycin 20mg per kg per day in divided dose 3 times a day for seven days.
• Artemether/lumefantrine(coartem)(20mg/120mg)-3days treatment with total 6 doses.

If the patient is not fit for oral doses then:

• Continue the intravenous Artesuanate 1 dose daily for total 7 days
• IV doxycycline or clindamycin for 7 days.