It’s World Malaria Day!!! And to commemorate, here’s another 6-questions mini-quiz for you. Give it a go.
Let’s meet Jacob, a 41-year-old solicitor.
Jacob is a 41 year old male who presented with a history of cyclic high fevers, myalgia, and night sweats. He appears confused and extremely fatigued. He admits to having returned home from visiting friends in Ghana. You suspect he has malaria. What vector is most likely responsible for the transmission of malaria?
The Anopheles mosquito is responsible for the transmission of the causative parasite in this patient. The Aedes is responsible for dengue fever and some yellow fever viruses. The Culex mosquito is known in regards to West Nile virus and Japanese encephalitis.
While taking a detailed history, Jacob tells you that his fevers are irregular in nature. You recall that different species of the Plasmodia pathogen cause irregular fever spikes. Which species is most likely responsible?
Plasmodium falciparum is the correct answer. Plasmodium ovale and vivax tend to cause 48 hour fever cycles. Plasmodium malariae tends to cause 72 hour fever spikes in patients.
You decide to perform a physical examination. During this, his spleen is palpable. He also presents with conjunctival pallor. You decide to proceed with investigations. 1) What is the best initial test, and 2) What is the confirmatory test for malaria?
A thick blood smear is the appropriate best initial test due to its high sensitivity. A thin blood smear is then used as a confirmatory test. It does have a low sensitivity, but has higher specificity.
While performing the thin blood smear, you see the following image. Is this image consistent with your earlier prediction of the species P. falciparum?
This blood smear is consistent with P. falciparum infection.
In terms of treating Jacob, what is your next step in management?
Considering Jacob presented with prostration and confusion, we should probably admit him. Artesunate therapy is given IM or IV for severe P. falciparum disease. It is then followed by artemether/lumefantrine. Mefloquine is given in uncomplicated falciparum malaria.
While going through his medical notes, you discover that he has G6PD deficiency. What side effect is he at risk of?
Patients on artesunate (or Primaquine) with G6PD are at risk of haemolytic crisis. Photosensitivity is a side effect of doxycycline. Irreversible retinopathy is a side effect of chloroquine or hydroxychloroquine.
Ola is a medical student at The Royal College of Surgeons Ireland (RCSI).