What are the clinical features of severe falciparum malaria in adults? Briefly outline its treatment.
The clinical features include:
History of recent travel to a malaria endemic zone
Impaired conscious state
Respiratory distress and ARDS
Shock and circulatory collapse
Two classes of drugs are available: Cinchona alkaloids and the artemisinin derivatives (latter may be superior in adults). Initially commenced as parenteral and switched to oral for a total of 7 days. Doxycycline is added to non-pregnant adults. If pregnant, then clindamycin is given in addition.
Supportive therapy of organ dysfunction
Specific other treatments:
a) No proven role for exchange transfusion in severe parasitemia, although used
b) risk of hypoglycemia with quinine
Malaria in general is briefly summarised in the Required Reading section.
What the hell is "severe" malaria? The WHO in an excellent summary statement (2000) have suggested the following definition:
One can see that it closely resembles the college answer.
Furthermore, one wonders as to how a history of travel is a clinical feature.
Staying in the trend of using WHO recommendations for this answer, a 2010 guidelines statementsuggests the following management strategy for severe falciparum malaria:
As for exchange transfusion - it does not seem to improve survival, but the authors of the 2002 meta-analysis confess that there are no randomised controlled trials, and that the comparative cohort studies they reviewed had "significant problems with the comparability of treatment groups".
World Health Organization. "Severe falciparum malaria." Transactions of the Royal Society of Tropical Medicine and Hygiene 94 (2000): 1-90.
Riddle, Mark S., et al. "Exchange transfusion as an adjunct therapy in severe Plasmodium falciparum malaria: a meta-analysis." Clinical infectious diseases34.9 (2002): 1192-1198.
Reyburn, Hugh. "New WHO guidelines for the treatment of malaria." BMJ 340 (2010).
(the actual revised guidelines are available online for free)
Dondorp, Arjen M., et al. "Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial." The Lancet 376.9753 (2010): 1647-1657.
Trampuz, Andrej, et al. "Clinical review: Severe malaria." CRITICAL CARE-LONDON- 7.4 (2003): 315-323.