Special Operations Forces Medical Handbook

5-44

Clinical Disease in Animals: Skin lesions, weight loss, poor appetite, lymphadenopathy, ocular lesions, renal
failure, epistaxis, lameness, anemia

ID: Malaria

LTC Glenn Wortmann, MC, USA

Introduction: Malaria is a tremendous problem in tropical, developing countries, causing 2 to 3 million deaths
per year. There are 4 species of malaria protozoa which infect humans: Plasmodium vivax (incubation period
of 12 days-10 months); P. ovale (similar to vivax); P. malariae (incubation period of 1 month); and P. falciparum
(most deadly; incubation period 5-30 days). Mosquito bite, needlestick or a blood transfusion from an infected
person transmits malaria.

Subjective: Symptoms
Headache, chills, sweats, and muscle aches are common; abdominal pain and diarrhea may occur.
Focused History: Have you had a fever? (Fever in a patient in or returning from a malarious area must be
considered to be malaria until proven otherwise) Do you have any other symptoms? (Chills, low back pain
and myalgias are often seen with malaria)

Objective: Signs
Using Basic Tools: Vital signs: Temperature over 100.4°F. Cyclic fevers (occurring every other day with P.
vivax and P. ovale and every third day with P. malariae) may occur (although this is an unreliable finding).
Inspection: Sweats and rigors may be seen
Palpation: Enlarged liver and spleen may occur
Using Advanced Tools: Lab: Thick and thin blood smears stained with Giemsa. The thick smear is reported
to be 30 times more sensitive than the thin smear, but the thin smear is required for species identification.
Smears should be done 2-3 times a day for 48 hours to exclude the diagnosis of malaria. (see Color Plates
Pictures 21, 30, 33, 36)

Assessment:

Differential Diagnosis:
Fever: See Symptom: Fever. Other causes of fever include leptospirosis, dengue, typhoid fever and bacterial
meningitis.

Plan:
Treatment: Primary:

1. P. falciparum:
   a. In Haiti, the Dominican Republic and Central America west of the Panama Canal, uncomplicated P.
   falciparum can be treated with chloroquine 1 gm (600 mg base), then 500 mg (300 mg base) 6 hours
   later, then 500 mg (300 mg base) at 24 and 48 hours.
   b. In the remainder of world, P. falciparum has become resistant to chloroquine. In that case, treatment
   of uncomplicated malaria consists of quinine sulfate 650 mg po q 8 hrs x 3-7 days plus doxycycline
   100 mg po bid x 7 days.
   c. For patients with severe malaria (parasitemia > 5 %, impaired consciousness, seizures, respiratory
   distress, substantial bleeding or shock), evacuation and therapy with intravenous quinine or quinidine is
   recommended.


2. Species other than P. falciparum:
   a. Chloroquine 1 gm (600 mg base), then 500 mg (300 mg base) 6 hours later, then 500 mg (300 mg
   base) at 24 and 48 hours.
   b. In Oceania, chloroquine resistant P. vivax has been reported, and therapy as per chloroquine resistant
   P. falciparum should be given.
   c. To prevent relapses with P. vivax and P. ovale, give primaquine phosphate 26.3 mg (15mg base) po