2. CLINICAL FEATURES First symptoms are non specific: Headache
Fatigue Myalgia and Arthralgia Incubation period: Depends on
species 8 to 25 days Affected by partial immunity Signs: Non
specific Anemia Hepatolienal syndrome
4. Acute Malaria Disease Malarial paroxysm stages: 1. Cold
stage 2. Hot stage 3. Diaphoresis stage o Cold stage: Feeling of
intense cold Vigorous shivering Lasts 15-30 minute Accompanied by
headache, nausea & myalgia
5. Paroxysm stages o Hot stage: Intense Heat Dry burning skin
Hypotension Lasts 15 minute to several hours o Sweating stage:
Profuse sweating Declining temperature Exhaustion Lasts 2-4
hours
7. Cerebral Malaria Ominous feature of P.falciparum Sudden or
gradual onset Diffuse symmetric encephalopathy Focal neurological
deficit is uncommon Divergent eye and pout reflex is common Muscle
dystonia Preserved corneal reflex except indeep coma Retinal
hemorrhage in 15 % of patients Residual neurological defecit
8. Hypoglycemia Important and common complication Associated
with poor prognosis Problematic in children and pregnant women
Clinical diagnosis maybe difficult Causes: Hepatic gluconeogenesis
failure Increase glucose consumption by host and lesser by parasite
drug induced hypoglycemia
9. Acidosis Important cause of death Results from organic acid
accumulation Hyperlactatemia coexist with hypoglycemia Acidotic
breathing is a sign of poor prognosis Bicarbonate or lactate are
best biochemical prognosticators Causes: Anaerobic glycolysis
Hypovolemia Lactate production by the parasites Failure of hepatic
and renal lactate clearance
10. Noncardiogenic Pulmonary Edema May develops even after
antimalarial therapy. More common in adults. Mortality rate is
>80% Predisposing factors: Renal failure Pregnancy Hyper
parasitemia Pathogenesis: Exact pathogenesis is unclear. Pulmonary
microvascular obstruction and increased TNF . Aggravated by
vigorous administration of IV Fluid.
11. Renal impairment More common among adults. High mortality
(upto 45%) May occur with other vital-organ dysfunction. Manifest
as Acute tubular necrosis. Renal cortical necrosis never develops
Pathogenesis: Exact pathogenesis is unclear. May related to
microcirculatory obstruction.
12. Other Complications Anemia results from: Accelerated RBC
removing by spleen RBC destruction by schizont Ineffective
erythropoiesis Liver Dysfunction Hemolytic jaundice is common.
sever with P.falciparum infection. Pathogenesis: Hemolysis
Hepatocyte injury Cholestasis
13. Malaria in Pregnancy Pregnant women prone to sever
infection. Common adverse effect on foetal: Stillbirths Fetal
distress LBW IUGR Prematurity Maternal effect: Maternal anemia
Higher mortality from cerebral malaria Premature labor
14. Malaria in Children Mortality is more in children. May
present with labored deep breathing Long term neurocognitive &
developmental deficit Conditions rare in child: Deep jaundice Acute
renal failure Acute pulmonary edema