MALARIA Revised 02/05/2019 Contents 1-Epidemiology ............................................................................................................................................. 2 2-Life Cycle .................................................................................................................................................. 2 3-Vector Phase .............................................................................................................................................. 3 4-Epidemiologic Classification of Cases ...................................................................................................... 4 5-Clinical Description ................................................................................................................................... 4 6-Laboratory Tests ........................................................................................................................................ 5 6.1-Blood Smears ...................................................................................................................................... 5 6.2-Timing: ............................................................................................................................................... 5 6.3-Plasmodium falciparum [Centers for Disease Control and Prevention (CDC)] ................................. 5 6.4-Plasmodium vivax ............................................................................................................................... 6 6.5-Plasmodium ovale ............................................................................................................................... 7 6.6-Plasmodium malariae ......................................................................................................................... 7 7-Treatment ................................................................................................................................................... 8 7.1.Treatment: General Approach ............................................................................................................. 8 7.2- P. falciparum Infections .................................................................................................................... 8 7.3-P. falciparum or Species Not Identified ............................................................................................. 9 7.4-P. malariae ......................................................................................................................................... 9 7.5-P. vivax and P. ovale .......................................................................................................................... 9 7.6-Antimalarials: Adverse Reactions and Contraindications ................................................................ 10 7.6.1-Chloroquine Phosphate and Hydroxychloroquine Sulfate ......................................................... 11 7.6.2-Atovaquone/proguanil ............................................................................................................... 11 7.6.3-Artemisin ................................................................................................................................... 11 7.6.4-Mefloquine ................................................................................................................................. 11 7.6.5-Primaquine ................................................................................................................................. 12 7.6.6-Quinine and Quinidine ............................................................................................................... 12 7.6.7-Doxycycline ............................................................................................................................... 14 7.6.8- Halofantrine (Marketed as Halfan) ........................................................................................... 14 7.6.9-Clindamycin ............................................................................................................................... 14 7.6.10-Artesunate ................................................................................................................................ 15 7.6.11-Tafenoquine ............................................................................................................................. 15 7.6.13-Treatment of Chloroquine-Susceptible Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium falciparum ................................................................................................ 15 7.6.14-Treatment of Chloroquine-Resistant Plasmodium falciparum ................................................ 16 7.6.15-Treatment of Chloroquine-Resistant Plasmodium vivax ......................................................... 16 8-Surveillance ............................................................................................................................................. 16 8.1-Case Definition ................................................................................................................................. 16 8.2-Investigation ..................................................................................................................................... 17 8.3-Hospital Precaution and Isolation: .................................................................................................... 17 9-Malaria Prevention for Travelers ............................................................................................................. 17 9.1-Inform the Traveler About the Degree of Risk of Malaria Infection: ............................................... 17 9.2-Recommend Precautions Against Mosquito Bites. ........................................................................... 18 9.3-Prophylactic Treatment:.................................................................................................................... 18 ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Louisiana Office of Public Health – Infectious Disease Epidemiology Section Page 1 of 24 9.4-Stand-by Treatment .......................................................................................................................... 19 9.5-Immediate Treatment ........................................................................................................................ 19 9.5.1-Advise the Traveler to Seek Immediate Treatment in Case of Fever. ....................................... 19 9.5.2-Malaria Deaths ........................................................................................................................... 19 9.5.3-Presumptive Self-Treatment of Malaria .................................................................................... 19 9.6-Antimalarial Drug Dosages, Schedules and Warnings for Prophylaxis Overseas ............................ 20 9.6.1-Drugs Used in the Prophylaxis of Malaria................................................................................. 20 9.7-Prophylaxis Recommendations According to Resistance Status ...................................................... 21 9.7.1-Travel to Areas with Chloroquine-resistant P. falciparum ........................................................ 21 9.7.2-Travel to Areas with Mefloquine-resistant P. falciparum ......................................................... 22 9.7.3-Travel to Areas with Chloroquine-sensitive P. falciparum ....................................................... 22 9.8-Chemoprophylaxis for Infants, Children and Adolescents ............................................................... 22 9.9-Chemoprophylaxis during Pregnancy and Lactation ........................................................................ 23 9.10-Lactation ......................................................................................................................................... 23 9.11-Educate Patients on the Signs and Symptoms of Malaria .............................................................. 23 9.12-Self-Treatment ................................................................................................................................ 23 Malaria is caused by an intracellular protozoa of the genus Plasmodium. The four species that cause hu- man malaria are P. malariae P. vivax P. falciparum P. ovale 1-Epidemiology Malaria is transmitted by the bite of an infected female Anopheles mosquito or through direct inoculation of infected red blood cells, i.e., congenital malaria, transfusion malaria and malaria from contaminated needles. 2-Life Cycle The life cycle of malaria is complex and certain aspects differ according to the Plasmodium species in- volved. The infective stages of plasmodia called sporozoites, are injected during feeding from the salivary glands of the infected mosquito into the blood stream through subcutaneous capillaries. Human Pre-erythrocytic Phase (before becoming red blood cells): Sporozoites enter the liver cells, where they multiply asexually. There, the nucleus undergoes repeated division, forming thousands of uninucleate merozoites. There is no inflammatory reaction in the surrounding liver tissue. After six to 16 days from the time of infection, the hepatic cell containing the tissue schizonts ruptures and the merozoites enter the circulation.