Sun14November1246PM 26

A 19-year-old Caucasian girl returns from a gap year, having travelled to Nigeria and Kenya.

Despite taking all the recommended precautions and malaria prophylaxis, she has developed symptoms of fever and general malaise. She was diagnosed with P. falciparum malaria, and unfortunately deteriorated and required transfer to the intensive care unit.

Which of the following is a feature of severe malaria?

(Please select 1 option)

Hypoglycaemia Correct

Diarrhoea

Visual loss

Haematuria

Joint swelling

Explanation

Severe malaria is potentially life threatening. It requires early recognition, treatment and management on a high dependency or intensive care unit.

Malaria is the tropical disease most commonly imported into the UK, with 1500-2000 cases reported each year, and 10-20 deaths. Approximately three quarters of reported malaria cases in the UK are caused by Plasmodium falciparum, which is capable of invading a high proportion of red blood cells and rapidly leading to severe or life threatening multi-organ disease.

Key features of severe malaria are:

impaired consciousness and seizures

renal impairment (serum creatinine >265µmol/L or urine output <0.4 ml/kg/hr)

acidosis (pH <7.3)

pulmonary oedema or ARDS

haemoglobin <80 g/L

spontaneous bleeding or disseminated intravascular coagulation

shock, and

haemaglobinura.

Reference:

Lalloo DG, Shingadia D, Pasvol G. UK malaria treatment guidelines. J Infect. 2007;54:111-121.

Answer Statistics

1

49%

2

3%

3

16%

4

31%

5

3%

Times answered: 277