Malaria/Tropical

Malaria/Tropical is a topic covered in the Pocket ICU Management.

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First Things First (assess & treat for the following)

  • CDC Malaria Hotline: (770) 488-7788 M-F 8 am – 4:30 pm EST
  • Worldwide impact of malaria
    • Cases/year: ~300-500 million
    • Deaths/year: ~750,000-2 million
  • Epidemiology
    • 40% population lives in areas of malaria transmission (parts of Africa, Asia, the Middle East, Central and South America, Hispaniola, and Oceania)
    • Imported malaria
    • Non-immune population infected – travelers and migrants
    • Majority of deaths due to Plasmodium falciparum infection
      • Produces life-threatening complication in ~1% of cases
  • Severe malaria
    • No formal definition
  • World Health Organization (WHO) Criteria and Suggested Expert Guidelines
    • Cerebral malaria
      • Coma – GCS ≤11 not attributable other causes
      • Coma persists 30 minutes after generalized seizure.
      • Exclusion of other causes – bacterial meningitis, cerebral hemorrhage, etc.
    • Severe anemia
      • Hct < 15% OR Hgb < 5 gm/dL, presence of parasite count >10,000/ml
    • Renal failure
      • Adult: urine output < 400 ml/24 hr and serum creatine >2.65 mg/dl
    • Pulmonary edema and ARDS
    • Hypoglycemia (whole blood glucose < 40 mg/dl or 2.2 mmol/L)
    • Circulatory collapse/shock
      • Adults: SBP < 70 mmHg
      • Pediatrics: SBP < 50 mmHg
    • Coagulation
      • DIC
      • Spontaneous bleeding
    • Acidemia/acidosis
      • Arterial pH < 7.25
      • Plasma bicarbonate < 15 mmol/L
    • Macroscopic hemoglobinuria
      • Hemolysis after exclusion of glucose-6-phosphate dehydrogenase deficiency
    • Impaired consciousness
    • Hyperpyrexia – core temperature >40C
    • Hepatic
      • Total bilirubin >2.5 mg/dl
      • Lactate >5 mmol/L
      • Increased transaminases
    • Hyperparasitemia
      • Parasite index >5%
      • Nonimmune individuals >250,000 parasites/ul

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Last updated: May 10, 2010

Citation

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TY - ELEC T1 - Malaria/Tropical ID - 534188 Y1 - 2010/05/10/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534188/all/Malaria_Tropical PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -