eMedicine Specialties > Infectious Diseases > Parasitic Infections

Malaria: Follow-up

Author: Emilio V Perez-Jorge, MD, FACP, Fellow, Infectious Disease, Wright State University Boonshoft School of Medicine, Veterans Affairs Medical Center
Coauthor(s): Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Contributor Information and Disclosures

Updated: Apr 29, 2009

Follow-up

Further Inpatient Care

  • Patients with hyperparasitemia (>5% of RBCs infected), CNS infection, or otherwise severe symptoms and those with P falciparum infection should be considered for inpatient treatment to ensure that medicines are tolerated.
  • Obtain blood smears every day to demonstrate a response to treatment. The sexual stage of the protozoan, the gametocyte, does not respond to most standard medications (eg, chloroquine, quinine), but gametocytes eventually die and do not pose a threat to the individual's health or cause any symptoms.

Further Outpatient Care

  • Patients with non– P falciparum malaria who are well can be treated on an outpatient basis. Obtain blood smears every day to demonstrate response to treatment. The sexual stage of the protozoan, the gametocyte, does not respond to most standard medications (eg, chloroquine, quinine), but gametocytes eventually die and do not pose a threat to the individual's health.
  • Occasionally, morphologic features do not permit distinction between P falciparum and other Plasmodium species. In such cases, patients from a P falciparum –endemic area should be presumed to have P falciparum infection and should be treated accordingly.
  • In patients from Southeast Asia, consider the possibility of P knowlesi infection. This species frequently causes hyperparasitemia and tends to be more severe than infections with other non– P falciparum plasmodia. It should be treated as P falciparum infection.

Deterrence/Prevention

  • Avoid mosquitoes by limiting exposure during times of typical blood meals (ie, dawn, dusk). Wearing long-sleeved clothing and using insect repellants may also prevent infection.
  • Adult-dose 95% DEET lasts up to 10-12 hours, and 35% DEET lasts 4-6 hours. In children, use concentrations of less than 35% DEET. Use sparingly and only on exposed skin. Remove DEET when no longer exposed.
  • Consider using bed nets that are treated with permethrin.
  • Consider chemoprophylaxis with antimalarials in patients traveling to endemic areas.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider a diagnosis of malaria
    • Malaria is often overlooked because infected patients typically present with nonspecific symptoms.
    • Patients with malaria may present with localized findings, including gastrointestinal or pulmonary symptoms, among others. All patients who have been exposed to malaria and present with fever should have blood smears sent to a laboratory.
    • In addition, malaria can still develop in patients who are compliant with malaria prophylaxis.
    • Obtaining blood smears is a simple and inexpensive method to determine if patients are infected.
  • Failure to treat hypnozoite stage of P vivax and P ovale infections with primaquine to prevent relapse
  • Failure to prescribe appropriate malaria prophylaxis in travelers

Special Concerns

  • Pregnant patients with malaria are at increased risk of morbidity and mortality.4 In addition, nonimmune mothers and immune primigravidas may be at an increased risk of low birth weight, fetal loss, and prematurity. Consult an expert in malaria to determine the safest and most effective prophylaxis or treatment in a pregnant woman.
 


More on Malaria

Overview: Malaria
Differential Diagnoses & Workup: Malaria
Treatment & Medication: Malaria
Follow-up: Malaria
References
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References

  1. Cox-Singh J, Davis TM, Lee KS, Shamsul SS, Matusop A, Ratnam S, et al. Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening. Clin Infect Dis. Jan 15 2008;46(2):165-71. [Medline].

  2. CDC information website for malaria. Available at http://www.cdc.gov/malaria/.

  3. Mens P, Spieker N, Omar S, et al. Is molecular biology the best alternative for diagnosis of malaria to microscopy? A comparison between microscopy, antigen dectection and molecular tests in rural Kenya and urban Tanzania. Trop Med Int Health. Feb/2007;2:238-44. [Medline]. [Full Text].

  4. Poespoprodjo JR, Fobia W, Kenangalem E, Lampah DA, Warikar N, Seal A, et al. Adverse pregnancy outcomes in an area where multidrug-resistant plasmodium vivax and Plasmodium falciparum infections are endemic. Clin Infect Dis. May 1 2008;46(9):1374-81. [Medline].

  5. Ashley EA, White NJ. Artemisinin-based combinations. Curr Opin Infect Dis. Dec 2005;18(6):531-6. [Medline].

  6. Baird JK, Hoffman SL. Prevention of malaria in travelers. Med Clin North Am. Jul 1999;83(4):923-44, vi. [Medline].

  7. Croft A. Extracts from "Clinical Evidence." Malaria: prevention in travelers. BMJ. Jul 15 2000;321(7254):154-60. [Medline].

  8. Cunha BA. Malaria or typhoid fever: a diagnostic dilemma?. Am J Med. Dec 2005;118(12):1442-3; author reply 1443-4. [Medline].

  9. Cunha BA. The diagnosis of imported malaria. Arch Intern Med. Aug 13-27 2001;161(15):1926-8. [Medline].

  10. Cunha BA. The Importance of non-specific laboratory tests in suspecting malaria in returning US travelers. Ann Intern Med. 2004;14:e141/7/547.

  11. Cunha BA. Triad of non-specific laboratory tests in malaria. Scand J Infect Dis. 2008;40(4):350-1. [Medline].

  12. Dorsey G, Gandhi M, Oyugi JH, Rosenthal PJ. Difficulties in the prevention, diagnosis, and treatment of imported malaria. Arch Intern Med. Sep 11 2000;160(16):2505-10. [Medline].

  13. Eliades MJ, Shah S, Nguyen-Dinh P, et al. Malaria surveillance--United States, 2003. MMWR Surveill Summ. Jun 3 2005;54(2):25-40. [Medline].

  14. Froude JR, Weiss LM, Tanowitz HB, Wittner M. Imported malaria in the Bronx: review of 51 cases recorded from 1986 to 1991. Clin Infect Dis. Nov 1992;15(5):774-80. [Medline].

  15. Idro R, Jenkins NE, Newton CR. Pathogenesis, clinical features, and neurological outcome of cerebral malaria. Lancet Neurol. Dec 2005;4(12):827-40. [Medline].

  16. Kain KC, Harrington MA, Tennyson S. Imported malaria: prospective analysis of problems in diagnosis and management. Clin Infect Dis. Jul 1998;27(1):142-9. [Medline].

  17. Kain KC, Harrington MA, Tennyson S, Keystone JS. Imported malaria: prospective analysis of problems in diagnosis and management. Clin Infect Dis. Jul 1998;27(1):142-9. [Medline].

  18. Kain KC, Keystone JS. Malaria in travelers. Epidemiology, disease, and prevention. Infect Dis Clin North Am. Jun 1998;12(2):267-84. [Medline].

  19. Mandell G, Bennet J, Dolin R. Plasmodium species (malaria). In: Principles and Practice of Infectious Diseases. Vol 2. 6th ed. Elsevier; 2005:Chapter 272.

  20. Marsh K, Forster D, Waruiru C, et al. Indicators of life-threatening malaria in African children. N Engl J Med. May 25 1995;332(21):1399-404. [Medline].

  21. Plowe CV. Antimalarial drug resistance in Africa: strategies for monitoring and deterrence. Curr Top Microbiol Immunol. 2005;295:55-79. [Medline].

  22. Schlagenhauf-Lawlor P. Use of rapid malaria test for and by travelers. In: Traveler's Malaria. B.C. Decker Inc.; 2001:Chapter 13.

  23. Schlossberg D. Malaria--treatment and prophylaxis. In: Current Therapy of Infectious Diseases. Mosby; 2001.

  24. White NJ. Antimalarial drug resistance. J Clin Invest. Apr 2004;113(8):1084-92. [Medline].

  25. Wiest PM, Opal SM, Romulo RL, Olds GR. Malaria in travelers in Rhode Island: a review of 26 cases. Am J Med. Jul 1991;91(1):30-6. [Medline].

  26. Winters RA, Murray HW. Malaria--the mime revisited: fifteen more years of experience at a New York City teaching hospital. Am J Med. Sep 1992;93(3):243-6. [Medline].

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Further Reading

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Keywords

malaria, blackwater fever, tertian fever, quartan fever, jungle fever, airport malaria, Anopheles mosquito, Plasmodium falciparum, P falciparum, Plasmodium vivax, P vivax, Plasmodium ovale, P ovale, Plasmodium malariae, P malariae, Plasmodium knowlesi, P knowlesi, paludismo

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Contributor Information and Disclosures

Author

Emilio V Perez-Jorge, MD, FACP, Fellow, Infectious Disease, Wright State University Boonshoft School of Medicine, Veterans Affairs Medical Center
Emilio V Perez-Jorge, MD, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, Infectious Diseases Society of Ohio, Ohio State Medical Association, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Thomas Herchline, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Joseph Richard Masci, MD, Chief of Infectious Diseases, Associate Director, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Elmhurst Hospital Center, Mount Sinai School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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