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A Case Study about Malaria A Case Study about Malaria by Michelle LeBlancby Michelle LeBlanc
Patient History & PhysicalPatient History & Physical
49 year old man presenting to the 49 year old man presenting to the Emergency Center with the following Emergency Center with the following symptoms:symptoms: Fever of 39.4Fever of 39.4 oo CC Vomiting for 2 daysVomiting for 2 days Neck and back painNeck and back pain
Patient History & Physical - Patient History & Physical - continuedcontinued
Returned from a trip to Nigeria, Africa Returned from a trip to Nigeria, Africa two weeks prior two weeks prior
Claims to have been taking anti-malarial Claims to have been taking anti-malarial medicationsmedications
Presumptive Diagnosis = MalariaPresumptive Diagnosis = Malaria
Laboratory ResultsLaboratory Results
WBC (billion/L)WBC (billion/L) 4.34.3 (4.4 – 10.1)(4.4 – 10.1)
RBC (trillion/L)RBC (trillion/L) 5.025.02 (4.31 – 5.48)(4.31 – 5.48)
Hemoglobin (g/dL)Hemoglobin (g/dL) 13.813.8 (13.4 – 17.0)(13.4 – 17.0)
Hematocrit (%)Hematocrit (%) 39.839.8 (40.1 – 50.1)(40.1 – 50.1)
Platelet (billion/L)Platelet (billion/L) 5050 (11.3 – 14.5)(11.3 – 14.5)
Malaria SmearMalaria Smear Plasmodium falciparum seenPlasmodium falciparum seen
Blood CultureBlood Culture No growthNo growth
Questions to consider:Questions to consider:
How does malaria affect hematology How does malaria affect hematology results?results?
What is the effectiveness of prophylactic What is the effectiveness of prophylactic (anti-malarial) drugs?(anti-malarial) drugs?
What is the significance of the low What is the significance of the low platelet count?platelet count?
Blood Smear FindingsBlood Smear Findings
Plasmodium falciparumPlasmodium falciparum rings have delicate rings have delicate cytoplasm and 1 or 2 small chromatin dots. Red cytoplasm and 1 or 2 small chromatin dots. Red blood cells (RBCs) that are infected are not enlarged; blood cells (RBCs) that are infected are not enlarged; multiple infection of RBCs more common in multiple infection of RBCs more common in P. P.
falciparumfalciparum than in other malaria species. than in other malaria species.
TreatmentTreatment
Patient was given 500 cc of IV bolus in Patient was given 500 cc of IV bolus in ECEC
He received 2 does of MefluquineHe received 2 does of Mefluquine Tylenol was given as needed for painTylenol was given as needed for pain He was prescribed Deoxycyclin for 7 He was prescribed Deoxycyclin for 7
daysdays
Types of Malaria / Symptoms Types of Malaria / Symptoms
Plasmodium vivaxPlasmodium vivax Plasmodium malariaePlasmodium malariae Plasmodium falciparumPlasmodium falciparum Plasmodium ovalePlasmodium ovale
FeverFever ChillsChills Headache / muscle Headache / muscle
acheache Nausea / vomitingNausea / vomiting Kidney damageKidney damage ComaComa DeathDeath
TrasmissionTrasmission
Malaria is transmitted via the bite of an Malaria is transmitted via the bite of an infected mosquito of the infected mosquito of the AnophelesAnopheles speciesspecies
The parasite enters the bloodstream and The parasite enters the bloodstream and travels to the liver where it will grow and travels to the liver where it will grow and maturemature
Symptoms appear in 8 days to several months Symptoms appear in 8 days to several months when the parasite enters the red blood cellswhen the parasite enters the red blood cells
TransmissionTransmission
RiskRisk
Found in 40% of the world’s population in Found in 40% of the world’s population in areas of Central and South America, Africa, areas of Central and South America, Africa, India, SE Asia and the Middle EastIndia, SE Asia and the Middle East
Currently 12,000 cases are diagnosed in the Currently 12,000 cases are diagnosed in the United States each yearUnited States each year
300-500 million clinical cases occur each 300-500 million clinical cases occur each year worldwideyear worldwide
Hematological ComplicationsHematological Complications
Hemolysis due to increased osmotic and Hemolysis due to increased osmotic and mechanical fragility of the erythrocytesmechanical fragility of the erythrocytes
Decreased platelet count Decreased platelet count (thrombocytopenia) is associated with the (thrombocytopenia) is associated with the use of some anti-malarial drugsuse of some anti-malarial drugs
Drug Therapy with QuinineDrug Therapy with Quinine
Quinine is one of the most commonly Quinine is one of the most commonly prescribed anti-malarial drugsprescribed anti-malarial drugs
Quinine is the 2Quinine is the 2ndnd most common agent most common agent implicated in drug induced thrombocytopeniaimplicated in drug induced thrombocytopenia
It’s effectiveness is questioned due to It’s effectiveness is questioned due to increasing multidrug resistant malaria increasing multidrug resistant malaria phenotypesphenotypes
Patient probably did take his prescribed anti-Patient probably did take his prescribed anti-malarial medicationmalarial medication
Human Resistance to MalariaHuman Resistance to Malaria
Hemoglobin S found in red blood cells of Hemoglobin S found in red blood cells of Sickle Cell AnemiaSickle Cell Anemia
Hemoglobin F found in red blood cells of Hemoglobin F found in red blood cells of ThalassemiaThalassemia
The red blood cells containing these abnormal The red blood cells containing these abnormal hemoglobins are more prone to ingestion by hemoglobins are more prone to ingestion by macrophages. Thus malaria organisms are macrophages. Thus malaria organisms are more readily removed from the blood stream. more readily removed from the blood stream.
SummarySummary
49 year old man presented to the EC with flu-like 49 year old man presented to the EC with flu-like symptoms and decreased platelet count after symptoms and decreased platelet count after returning from Africa two weeks priorreturning from Africa two weeks prior
Claims to have taken “unknown” anti-malarial Claims to have taken “unknown” anti-malarial medicationsmedications
Blood culture found no growth but Blood culture found no growth but Plasmodium Plasmodium falciparumfalciparum was found on blood smear review was found on blood smear review
Patient released after 2 days with not follow-up Patient released after 2 days with not follow-up requiredrequired
ReferencesReferences
Images from DPDx – A web site developed Images from DPDx – A web site developed and maintained by CDC's Division of Parasitic and maintained by CDC's Division of Parasitic Diseases (DPD) Diseases (DPD) http://www.dpd.cdc.gov/dpdx/HTML/Image_http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htmLibrary.htm Last accessed on 11/05/04. Last accessed on 11/05/04.
CreditsCredits
This case study was prepared This case study was prepared by by
Michelle Leblanc, MT(ASCP) Michelle Leblanc, MT(ASCP)
while she was a while she was a
Medical Technology student Medical Technology student
in the in the
2004 MT Class 2004 MT Class
at William Beaumontat William Beaumont
Hospital, Hospital,
Royal Oak, MI.Royal Oak, MI.