Malaria and rheumatic disease 4/5 (1)

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Malaria (ICD-10 B52.8)

Definition

The tropical disease is caused by a parasite. After Tuberculosis (Tbc), the world's most common infectious disease. 90% of cases are in Africa. Benign (benign) form (1 / 3 of cases).

  • People with reduced immune defenses, for example during treatment with immunosuppressive drugs for rheumatic disease, may have a more serious course of disease
  • Rheumatic pain in the arms and legs is part of the disease

Disease Cause

  • Plasmodium quartana à Malaria quartana
    • Incubation: 21 - 42 days between infection and symptoms
    • Fever episodes: 2 days without fever
    • The disease does not heal by itself
  • Plasmodium vivax and Malaria tertiana
    • Incubation time 10 - 21 days between infection and symptoms
    • Fever episodes 1 day without fever
    • Disease Duration: Within a maximum of 5 years
  • Plasmodium Falciparum (Malaria tropica) Malignant form (2 / 3 of cases)
    • Incubation time: 7 - 10 days (90%, 10% longer) between infection and symptoms
    • Fever: Irregular
    • Disease duration: Until 2 years if not fatal disease outcome

Symptoms

  • Fever with frostbite except M.Tropica which may have subfebrile temperatures
  • Fever up to 2 years after stay in the tropics
  • 90% debuts the first month after stay in the tropics
  • Headache
  • Cough (Differential diagnoses: Flu, sepsis)
  • Pain in the right part of the upper abdominal area
  • Iterus (jaundice) (Differential diagnoses: Liver / bile disease)
  • Gastrointestinal
    • Nausea
    • Vomiting
    • Diarrhea (Differential Diagnosis: Gastroenteritis)
  • M. tropica (most common, malignant)
    • Cerebral malaria (consciousness disorder, confused, coma) (Differential diagnoses: Psychosis, meningitis).
    • Pulmonary edema, cardiac shock (differential diagnosis: heart disease, pneumonia).
    • Acute renal failure (differential diagnosis: kidney disease)

Rheumatic symptoms

  • Pain in the arms and legs

Medical investigation and findings

  • Hepatosplenomegaly (large liver and spleen)
  • Hemolytic anemia (LD is high, haptoglobin in blood is low)
  • Thrombocytopenia (low platelet count)
  • Leukocytopenia (Low White Blood Cells, Differential Diagnosis: Blood Disease)
  • Hypoglycemia (low blood glucose level)

Diagnosis

  • Microscopy
    • Blood smear with Thick drop which immediately becomes microscopic investigated at least 2 times daily on 2 consecutive days
    • Thick drop: 1 drop capillary blood on slides using the corner of another slide touched with circular movements ½ minutes to a spot on 1 cm in diameter. The thickness becomes such that you can read newspaper letters through the slide. After 30 minutes air drying: GIMSE dyeing, then again drying and microscopy (alternatively quick coloring techniques)
  • PCR Technology: Results within 24 hours
  • Plasmodia Antibodies (Result after 6-10 days)

Treatment

Suspected malaria infection (fever patient who has been in the tropics last month before symptoms starts)

  • Hospitalization: Immediate diagnosis and therapy
  • Uncomplicated M.tropica: Atovagquon + Proguanil (Malarone) or Mefloquin (Lariam), reserve: Artemether + Lumefantrin (Riamet)
  • Complicated M.tropica: Chinin + Doxycycline

Preventive

  • Absolutely complete prevention is not possible
  • Mosquito Protection
  • Chemoprophylaxis with Atovaquon / Proguanil (Malerone) or Mefloquin (Lariam): Remedy: Doxycycline
  • Pregnancy: Chloroquine, but note! resistance occurs

Literature

Tropic diseases, BINDEVEVSSYKDOMMER.no


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