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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.
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