0071643192.pdf

INFECTIOUS DISEASE

■ Infants, elderly, or pregnant women

■ Patients with complications

■ Consider exchange transfusions (removing patient RBCs and transfusing

donor RBCs) for:

■ Parasitemia >10%

■ Pulmonary edema

■ Cerebral malaria

■ Renal complications

COMPLICATIONS

P. falciparum:

■ General

■ Lactic acidosis

■ Severe hypoglycemia

■ Noncardiogenic pulmonary edema, DIC, death

■ Cerebral malaria

■ Mortality ~20%

■ Prostration, leading to delirium, coma, and seizures

■ Blackwater fever

■ Massive intravascular hemolysis leading to acute renal failure

■ Characterized by jaundice and hemoglobinuria (black urine)

Dengue

■ Globally endemic

■ Transmitted by the Aedes aegyptimosquito

■ Four serotypes

If unsure about chloroquine

sensitivity in the region, treat

as if resistant.

TABLE 8.17. Malaria Treatment Regimens

SETTING ADULTDRUGREGIMENA PEDIATRICDRUGREGIMENa

Uncomplicated, Chloroquine phosphate Chloroquine phosphate

chloroquine-sensitive

(Central America

and Caribbean)

Uncomplicated, Quinine sulfate (PO) + Quinine sulfate (PO) +

chloroquine-resistant doxycycline primethamine sulfadoxineb

(South America, or or

South Asia, Africa) Atovaquone/proguanil Atovaquone/proguanil

or or

Mefloquine Mefloquine

Complicated (possible Quinidine gluconate Quinidine gluconate (IV)

P. falciparum, unable to (IV) +doxycycline

tolerate PO)

aFor P. vivax, P. ovale, also add primaquine phosphate to prevent relapse (test first for G6PD

deficiency).

bContraindicated in infants <2 months old.

Patients must be first tested for

G6PD deficiency before taking

primaquine due to a potentially

fatal hemolysis reaction.

Falciparum malaria can be

rapidly fatal.