MALARIA CASE STUDY
Major Chris Carter
Defence School of Healthcare Education, Department of Healthcare Education
Birmingham City University
BACKGROUND
Malaria is a parasitic infection caused by the genus Plasmodium.
Malaria affects approximately 5% of the world’s population (Mahajan et al 2015).
In 2015, an estimated 212 million malaria cases were diagnosed (WHO 2017),
which resulted in 1-2.5 million deaths annually (Mahajan et al 2014).
Malaria is spread by the female anopheles mosquito, and is preventable. Five
species affect humans (Fletcher & Beeching 2013):
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Plasmodium Knowlesi
CASE STUDY
16 year old female.
Previously fit and well.
2 week history of headache, fatigue, muscle
aches and irregular fever.
Presented to the Emergency Department
with a reduced level of consciousness.
Emergency admission to intensive care.
DIFFERENTIAL DIAGNOSIS
Influenza
Viral hepatitis
Meningitis
Sepsis
Pneumonia
Gastroenteritis
Typhoid
Tick fever
Viral haemorrhagic fever
Acute HIV
(de Wit E et al. 2016. Bisanzo et al 2016. Cox et al 2016)
DIAGNOSIS
Generalised signs and symptoms (de Wit E et al.,
2016. Cox et al., 2016)
Microscopy
Rapid Diagnostic Tests (RDT)
UK: EDTA-anti-coagulated venous blood sample
Laboratory to receive sample within 1hour
RESPIRATORY
Intubated due to:
Respiratory failure (RR>35/min, un-recordable
saturations)
Reduced level of consciousness (airway protection)
Ventilated
Observation for potential complications:
Pulmonary Oedema
Acute Respiratory Distress Syndrome (ARDS)
Mortality from ARDS in malaria can be as high as 80%,
even with mechanical ventilation mortality can exceed
50% (Taylor et al 2012)
CIRCULATION
Invasive monitoring
Shock
Metabolic acidosis
Fever management
Anaemia
Disseminated Intravascular Coagulation
Bloods (U&E, FBC, Coag)
RENAL
Urinary catheter
<0.5ml/kg/hr
Anuric
Observation for haemoglobinuria.
Haemoglobinuria due to severe renal failure.
‘Blackwater Fever’ is an obsolete term, but can still be used by some clinicians to
describe this condition.
Renal replacement therapy.
NEUROLOGICAL
Coma
Seizures and retinal changes common; papilloedema is rare
Management of seizures
Neurological protection
Observation for hypoglycaemia
Hourly monitoring
IV fluids
NG tube
DRUG
REGIMEN
Artesunate 2.4mg/kg
0, 12 and 24 hours then
daily, until taking oral fluids
and diet.
Alternatives:
Quinine 10mg/kg alternative
FAMILY
In Zambia, families take an active role in patient
care.
This patient was admitted from a rural village, this
had an impact on:
Economic
Community
Family
Whilst emergency treatment including malaria
drugs are free, families have to pay for other
items.
PREVENTION
Malaria is preventable.
Within the hospital environment transmission
can continue between patients and staff due to
overcrowding and a lack of nets, this allows
mosquitoes to continue bite patients (Carter &
Mukonka 2017. Shepherd et al 2010).
In malaria season, precautions may include
spraying of wards, doors and windows covered
with nets and if available every bed should have
a mosquito nets.
Sufficient bed nets should be available to allow
them to be changed between patients, as this
may in turn become an infection risk.
LESSONS LEARNT
& SUMMARY
Critical care nurses experiences
limited (Bates 2008)
Early diagnosis – detailed
history (including travel history)
1400 cases and 6 reported
deaths in 2015 (Public Health
England 2016).
Notifiable disease
[email protected]
Further reading:
Carter C. Mukonka P. (2017). Malaria: diagnosis,
treatment and management of a critically ill patient.
British Journal of Nursing. 26 (13): 762-767
Acknowledgements:
Mrs Priscar Mukonka, Principle Education Officer,
Lusaka College of Nursing & Midwifery, Lusaka,
Zambia
The Main Intensive Care Unit Staff at the University
Teaching Hospital, Lusaka, Zambia
