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Flashcards in Malaria Deck (6):
1

How common is malaria in the UK? Which organism predominates? What about those born in endemic areas?

- There are around 1,500-2,000 cases each year of malaria in patients returning from endemic countries.
- The majority of these cases (around 75%) are caused by the potentially fatal Plasmodium falciparum protozoa.
- The majority of patients who develop malaria did not take prophylaxis.
- It should also be remembered that UK citizens who originate from malaria endemic areas quickly lose their innate immunity.

2

What is the recommended prophylaxis regime for those travelling to malaria endemic areas?

Atovaquone + proguanil (Malarone):
- Can cause GI upset
- Take 1-2 days pre-travel
- Take 7 days after travel

Chloroquine:
- Can cause headache and contraindicated in epilepsy
- Taken weekly
- Take 1 week prior
- Take 4 weeks after

Mefloquin (larium):
- Can cause dizziness, neuropsychiatric disturbance
- Contraindicated in epilepsy
- Taken weekly
- Take 2-3 weeks prior
- Take 4 weeks after

Doxycycline:
- Can cause photosensitivity, oesophagitis
- Take 1-2 days prior
- Take 4 weeks after

Proguanil (paludrine):
- 1 week before
- 4 weeks after

Proguanil + Chloraquine:
- 1 week before
- 4 weeks after

3

What is the advice during pregnancy?

Don't travel to malaria endemic areas
If essential:
- chloroquine can be taken
- proguanil: folate supplementation (5mg od) should be given
- Malarone (atovaquone + proguanil): the BNF advises to avoid these drugs unless essential. If taken then folate supplementation should be given
- mefloquine: caution advised
- doxycycline is contraindicated

4

What are the other non-falciparum malarias?

- Most common = Plasmodium vivax often found in Central America and the Indian Subcontinent.
- Plasmodium ovale and Plasmodium malariae account for the other cases. Plasmodium ovale typically comes from Africa.

5

What are the features of non-falciparum malaria?

- General features of malaria: fever, headache, splenomegaly
- Plasmodium vivax/ovale: cyclical fever every 48 hours.
- Plasmodium malariae: cyclical fever every 72 hours
- Plasmodium malariae: is associated with nephrotic syndrome

6

How do you treat non-falciparum malarias?

- Non-falciparum malarias are almost always chloroquine sensitive
- Patients with ovale or vivax malaria should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse