Malaria

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MALARIA
I. DEFINITION
Also called Ague An acute and chronic parasitic disease which infects red blood cells. The most deadly vector-borne disease in the world A specific infectious disease produced by any one of 4 protozoan parasites, which is transmitted to man by bite of the mosquito, and the characteristic of which are chills followed by fever occurring at more or less regular interval.

II.

ETIOLOGY
Causative Organisms: y Protozoa Plasmodia(plasmodium) y Anopheles mosquito is definite host responsible for transmission of malaria y In the Philippines, the principal mosquito vector is Anopheles Minimus Flavirostris 4 SPECIES OF PROTOZOA PLASMODIA

1.

Plasmodium Vivax The most widely distributed and most benign. Causes benign tertian malaria Characterized by fever and chills for 48hours in the 3rd day. Plasmodium Falciparum most frequently encountered in the Philippines. it causes more serious type of malaria because of high parasitic densities in the blood. infected red blood cells tend to agglutinate and form micro-emboli. also known as Pernicious Anemia Plasmodium Malariae much less frequent Causes quartian malaria with fever and chills every 72hours in the 4th day.

2.

3.

4.

Plasmodium Ovale rarely seen but still reported in the Philippines.

III.

MODE OF TRANSMISSION
    bite of an infected female Anopheles mosquito Blood transfusion, contaminated syringe or needle Transplacental: Congenital Malaria Mingling of infected maternal blood with that of the infant during birth process Neonatal Malaria

IV.

I.P. and Period of Communicability
P. FALCIPARUM INCUBATION 10-12 days PERIOD after mosquitoes drilled the sporozoites into the patient. PERIOD OF 7-12 days COMMUNICABILITY max of 1 year P. VIVAX 14-17 days up to several years P. OVALE 11-26 days P. MALARIAE 12-14 days up to several years

3-5 days max of 1-3 years

3-5 days

7-14 days max of 20 years

V.

MANIFESTATIONS
             Chills followed by fever pathognomonic sign Itchiness Profused sweating Tea-colored urine Jaundiced Fatigue Anemia Malaise Headache Hepatomegaly Spleenomegaly Anorexia Bleeding

VI.

DIAGNOSIS
1. Thick Peripheral Blood Smear (Malarial Smear) Blood is extracted after the chilling episode of the patient when the patient has a fever  Confirms presence, species and density of parasites  Taken at height of the fever; if negative repeat 12 hrs after the attack 2. Clinical Diagnosis Based on triad of symptoms, 50% accurate 3. Rapid Diagnostic Test Uses immunochromatographic methods to detect Plasmodium specific antigen takes about 7-15 minutes y Sensitivity and specificity greater than 90%

VII. TREATMENTS  Determine the species of parasite infecting the patient
 Anti-malarial drugs o 4 aminoquinolones Barring resistant strains of P. Falciparum , the most potent drugs acting on the sexual erythrocyte stages. ( Chloroquine, Amodiaquine, Quinine) o Primaquine destroys gametocytes of P. Falciparum which are unaffected by the common schizonticidal drugs o Aminoquinolines o Atabrine o Fansitar Blood Transfusion Liver Protector (Essentiale Forte) Calamine Lotion/ Anti-Histamine Iron supplement

   

VIII. PREVENTIVE MEASURES and HEALTH EDUCATION
1. Eliminate breeding places of mosquitoes 2. Advise malaria chemoprophylaxis when traveling with endemic areas 3. Advise travelers to seek prompt healthcare if he develops fever after stopping prophylaxis 4. Travelers to malaria s areas should not donate blood for 3 years.

IX.

NURSING INTERVENTIONS
1. Isolate the patient 2. Care of the exposed person 3. Supportive nursing care a. Close monitor the patient b. Monitor I & O c. Determine ABG d. Consider patient with severe falciparum malaria as medical emergency 4. Provide warm bath 5. Provide a well-balanced diet

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