CLINICAL FEATURES OF MALARIA

febrile illness characterized by fever and related symptoms

Clinical Manifestations are related to cycle of events in relation to RBC

The first symptoms of malaria after the pre-patent period are called the primary attack. 

Usually atypical (starts getting relapse of symptoms at regular intervals of 48-72 hours)

 short term relapses (recrudescences).  long term relapses (after a gap of 20-60

days or more)due to the reactivation of the hypnozoites in

the liver in case of vivax and ovale malaria. In falciparum and malariae infections,

recrudescences can occur due to persistent infection in the blood.

Broad clinical manifestations of MalariaFever Sweating Anemia Splenomagaly (enlarged

spleen) Irratability Coma, Retinal Hemorrages  Algid Malaria ( a shocklike

syndrome) Respiratory distress

syndrome

MANIFESTATIONS OF ACUTE MALARIA

Fever and shivering. The attack begins with fever, with the temperature rising as high as 40ºC and falling again over a period of several hours.

A poor general condition, feeling unwell and having headaches like influenza.

Diarrhea, nausea and vomiting often occur as well.

MALARIAL PAROXYSM

cold stage hot stage sweating

stage

feeling of intense coldvigorous shiveringlasts 15-60 minutes

intense heatdry burning skinthrobbing headachelasts 2-6 hours

profuse sweatingdeclining temperatureexhausted and weak → sleeplasts 2-4 hours

*typical features are seen after the infection gets established for about a week

PATTERN OF FEVERThe fever

paroxysm corresponds to the period of infected erythrocyte rupture and merozoite invasion.

ATYPICAL FEATURESAtypical feverHeadacheBody ache, back

ache and joint painsDizziness, vertigoAltered behaviour,

acute psychosisAltered sensoriumConvulsions, comaCough

BreathlessnessChest painAcute abdomenWeaknessVomiting and

diarrhoeaJaundicePallorPuffiness of lids

SEVERE MALARIACEREBRAL MALARIASEVERE ANAEMIAACUTE RENAL FAILUREPULMONARY OEDEMA OR ARDSCIRCULATORY COLLAPSE OR SHOCKSPONTANEOUS BLEEDINGGENERALIZED CONVULSIONSMETABOLIC ACIDOSISHYPOGLCEMIABLACK WATER FEVER

Cerebral Malaria

• Coma• diffuse symmetric encephalopathy• Unusual focal neurological signs• Primitive reflexes absent• Retinal haemorrhage with puillary dilatations• Hemiplegia, CP• Blindness, deafness• Impaired cognition and learning

Anemia

Acute renal failure

Metabolic acidosis

Hypotension

Pulmonary edema

Hypoglycemia MULTIFACTORIALParasite utilises the glucose Associated with hyperlactatemiaDue to hepatic failure gluconeogenesis

and glcogenolyis are affected Quinine – pancreatic beta cell stimulation

Black water fever• due to intravascular hemolysis at

schizogony period• Predisposing factors

• quinine• cold exposure• fatigue• trauma• pregnancy• parturition

Effects MethaemoglobuminaemiaHyperbilirubinaemiaHaemoglobinuria

PigmentsOxyhaemoglobinMethaemoglobinBilirubinMethaemalbumin

Symptomsrapid pulsehigh fever and chillsextreme prostrationa rapidly developing anemiathe passage of urine that is black or dark red in colourFever, rigor, aching pain in loin, icterus, vomitting, circulatory collapse,

acute renal failure

MALARIA IN PREGNANCYFoetal

IUGR LBWStill birthPrematurity

increased risk of neonatal death

Fetal distressMaternal

Anaemia risk of maternal mortality

Mortality due to cerebral malaria is higher

MALARIA IN CHILDRENConvulsionsComaHypoglycemiaMetabolic acidosisSevere anemiaDeep jaundiceAcute renal failureAcute pulmonary

edema