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Flashcards in Malaria Deck (6):

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.


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

- 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

- 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


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


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.


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


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