1. Kantha Bopha Academy for
Pediatrics
Siem Reap- Angkor
K.L. Chhun, U. Vallery, Y. Chantana, BEAT RICHNER
2. Malaria is one of the most common infectious
diseases and an enormous public health problem.
The disease has been recognized for thousands
of years and it is widespread in tropical and
subtropical regions, including parts of the
Americas, Asia, and Africa.
3. Currently, malaria occurs in about 100 countries and
territories inhabited by a total of 2.4 billion people.
WHO estimates that there are 350 million to
500 million cases of malaria worldwide annually,
Of which 270 million to 400 million are Falciparum
malaria, the most severe form of the disease,
resulting approximately 1.5 million to 3 million
deaths.
4. 90% of the deaths are in children under five
years of age. Other risk groups include
pregnant women, internally displaced persons
and refugees, and international travelers.
The human suffering and economic costs are
enormous.
Malaria is still the main cause of morbidity and
mortality among children in Cambodia.
5. A delay of treatment and/or inappropriate treatment
are responsible of the high rate of lethality.
Malaria is complex but it is a curable and preventable
disease.
Lives can be saved if the disease is detected early
and adequately treated.
Mass education and appropriate organization of
health facilities with well trained staffs can reduce
the mortality.
6. How People get Malaria ?
Malaria is caused by a parasite called Plasmodium, which is
transmitted via the bites of infected mosquitoes. In the human
body, the parasites multiply in the liver, and then infect red blood
cells.
Usually, people get malaria by being bitten by an infective female
Anopheles mosquito. When a mosquito bites an infected person,
a small amount of blood is taken in which contains microscopic
malaria parasites.
About 1 week later, when the mosquito takes its next blood meal,
these parasites mix with the mosquito's saliva and are injected into
the person being bitten.
7. Because the malaria parasite is found in red blood
cells of an infected person, malaria can also be
transmitted through blood transfusion, organ
transplant, or the shared use of needles or syringes
contaminated with blood.
Malaria may also be transmitted from a mother to her
unborn infant before or during delivery
("congenital" malaria).
8.
9. Malaria Symptoms
Symptoms of malaria include fever and shaking
chills, headache, muscle aches, tiredness and
nausea, vomiting, and diarrhea may also occur.
Malaria cause anemia and jaundice because of the
destruction of red blood cells.
Symptoms usually appear between 10 and 15 days after
the mosquito bite.
10. If not treated, malaria can quickly become life-
threatening by disrupting the blood supply to vital
organs.
Infection with one type of malaria, Plasmodium
falciparum, if not promptly treated, may cause kidney
failure, seizures, mental confusion, coma, and death.
In many parts of the world, the parasites have
developed resistance to a number of malaria
medicines.
11. How soon will a person feel sick after being bitten
by an infected mosquito?
For most people, symptoms begin 10 days to 4 weeks
after infection, although a person may feel ill as early
as 7 days or as late as 1 year later.
Two kinds of malaria, P. vivax and P. ovale, can occur
again. In P. vivax and P. ovale infections, some
parasites can remain dormant in the liver for several
months up to bout 4 years after a person is bitten by an
infected mosquito.
12. When these parasites come out of hibernation and
begin invading red blood cells ("relapse"), the person
will become sick.
Infection with malaria parasites may result in a wide
variety of symptoms, ranging from absent or very mild
symptoms to severe disease and even death.
Malaria disease can be categorized as uncomplicated
or severe complicated .
13. Malaria Incubation Period
The incubation period in most cases varies from 7 to 30 days.
The shorter periods are observed most frequently with
P. falciparum and the longer ones with P. malariae.
14. Antimalarial drugs taken for prophylaxis can delay the
appearance of malaria symptoms by weeks or months.
(This can happen particularly with P. vivax and P. ovale, both
of which can produce dormant liver stage parasites; the liver
stages may reactivate and cause disease months after the
infective mosquito bite.)
Such long delays between exposure and development of
symptoms can result in misdiagnosis or delayed diagnosis
because of reduced clinical suspicion.
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15. Uncomplicated Malaria
The classical malaria attack lasts 6-10 hours. It consists of:
Cold stage (sensation of cold, shivering)
Hot stage (fever, headaches, vomiting; seizures in young
children)
Sweating stage (sweats, return to normal temperature,
tiredness)
16. More commonly, the patient presents with a combination
of the following symptoms:
Fever
Chills
Sweats
Headaches
Nausea and vomiting
General malaise.
Enlarged spleen.
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17. Enlargement of the liver
Mild jaundice
Diagnosis of malaria depends on the demonstration of
parasites on a blood smear examined under a
microscope.
In P. falciparum malaria, additional laboratory findings
may include anemia, decrease platelets, elevation of
bilirubin, and hemoglobinuria.
18. Complicated malaria
Severe malaria occurs when P. falciparum infections are
complicated by serious organ failures or abnormalities in the
patient's blood or metabolism.
The manifestations of severe malaria include:
Cerebral malaria, with abnormal behavior, impairment of
consciousness, seizures, coma, or other neurologic
abnormalities
19. Severe anemia
Hemoglobinuria
Pulmonary edema or acute respiratory distress
syndrome
Cardiovascular collapse and shock
Acute kidney failure
Metabolic acidosis
Hypoglycemia .
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20. Severe malaria occurs most often in persons who have no
immunity to malaria or whose immunity has decreased.
These include all residents of areas with low or no malaria
transmission, young children and pregnant women in
areas with high transmission.
In all areas, severe malaria is a medical emergency and
should be treated urgently and aggressively.
21. Study design:
- Epidemiologic study
- Critical signs and symptoms
- Clinical features
- Treatment
- Underlining TB primary infection
Study period:
-1st January 2008 to 31st December 2009
Patient criteria:
-All patients hospitalized with positive blood smear
22. Data collections
- Age distribution
- Sex distribution
- Geographical distribution
- Seasonal distribution
Outcome
Conclusion
23. 1364 confirmed cases out of 73667 hospitalized patient represent
1.85% over two-year period from 2008 to 2009.
24. Number of not confirmed cases
compared with all hospitalized patient
4140 suspected cases (smear negative) represent 5.61%
over73667 cases of the year 2008 -2009.
over
32. Imaging
• Lungs CT scan: In 1023 (75%) over 1364 cases,
calcifications were detected.
33. Anti-malaria drugs:
- Artesunate for falciparum malaria:
. D1: First dose 4mg/kg IV and 12hr later second dose
2mg/kg IV
. D2-D5: 2mg/kg/d IV
- Quinine for Vivax malaria:
. Dose 30mg/kg/d IVP for 7days
34. Symptomatic treatment
Severe anemia:
- Hb< 7g/l or Ht< 20%
Transfusion: 10-20ml/kg of RCC or WB
Hypoglycemia:
- D50% 1-2ml/kg 1 part + sterile water 4 part or D10%:
5ml/kg
Convulsion:
- Valium: 0.5mg/kg IR or 0.2-0.5mg/kg IVP
- Phenobarbital: 10-20mg/kg IV
ARF:
- Furosemide: 0.5-2mg/kg/dose (maximum 6mg/kg/dose)
35. Treatment of TB primary infection
Rifater (Isoniazid 80mg+rifampicin120mg+ pyrazinamide 250mg):
1 tablet/ 10kg for 6 months.
36. Deaths : 05 (0.36%)
1359 cases : good outcome without sequelae.
37. Complicated malaria is presented with one or more
of the ten main clinical manifestations:
1-severe anemia,2-hypoglycemia,3- acute renal
failure,4-metabolic acidosis,5-cerebral malaria,6-
hemoglobinuria,7-respiratory distress,8-lung
edema,9-shock, and 10- digestive hemorrhage with
shock.
Complicated malaria is a medical emergency and so
it requires early diagnosis and prompt treatment.
38. • The absence of fever or a negative blood
smear should not exclude complicated Malaria.
• Severe anemia is the predominant clinical
symptom of complicated malaria (43%)
=>blood transfusion necessary.
• Children in the age range from 1 to 5 are
predominantly affected.
• 75% of the present cases have underlining TB
primary infection.
