Neobook — clinical reference

Description

Diagnosis

General Measures

Medicine Treatment

Note: notifiable medical condition.

Refer to the most recent Malaria Treatment Guidelines from the Department of Health for the most suitable management in the various endemic areas.

Global malaria endemic areas:

https://www.iamat.org/risks/malaria?gclid=CjwKEAiAjIbBBRCitNvJ1o257WESJADpoUt072u5_X4Wb0fVtkQLiEFrWye263Ef_on8eykkOwLK_hoCFtDw_wcB

Local endemic areas:

https://www.santhnet.co.za/index.php/travel-health-advice/travel-advice/malaria-advice-for-travellers/item/330-malaria-risk-map-for-south-africa-2017.html

DESCRIPTION

Malaria is an infection of red blood cells by a parasite micro-organism called Plasmodium. Five species of Plasmodium are known to cause malaria in humans in Africa. The five species are:
- Plasmodium falciparum (P. falciparum)
- Plasmodium vivax (P. vivax)
- Plasmodium ovale (P. ovale)
- Plasmodium malariae (P. malariae)
- Plasmodium knowlesi (P. knowlesi)
The parasites are usually transmitted to humans by the bite of a vector mosquito. In South Africa, P. falciparum is the most common and the most dangerous of the malaria species. Malaria caused by P. falciparum is an acute febrile illness that may progress rapidly to severe disease if not diagnosed early and treated adequately.
Symptoms and signs of malaria are non-specific.
The most important element in the diagnosis of malaria is a high index of suspicion in both endemic and non-endemic areas. Any person resident in or returning from a malaria area and who presents with fever (usually within 3 months of possible exposure to vector mosquito bites) should be tested for malaria. The progression of P. falciparum malaria to severe disease is rapid and early diagnosis and effective treatment is crucial. Pregnant women, young children ≤ 5 years of age and people living with HIV/AIDS are at particularly high risk of developing severe malaria.

Symptoms and signs of malaria may include:

severe headache
fever >38°C
muscle and joint pains
diarrhoea
shivering episodes
nausea and vomiting
flu-like symptoms
dry cough

Severe disease may present with one or more of the following additional clinical features:

prostration (severe general body weakness)
sleepiness, unconsciousness or coma, convulsions
respiratory distress and/or cyanosis
jaundice
renal failure
shock
repeated vomiting
hypoglycaemia
severe anaemia (Hb <7 g/dL)
haemoglobinuria/black urine
abnormal bleeding

DIAGNOSIS

Microscopic examination of thick and thin blood smears. Thick films are more sensitive than thin films in the detection of malaria parasites.
Where rapid diagnostic tests, e.g. HRP2 antigen dipsticks are available, these can be used to diagnose malaria within 10–15 minutes.

Note:
Rapid tests may remain positive up to 1 month after successful treatment.
One negative malaria test does not exclude the diagnosis of malaria. Request a 2nd test.

GENERAL MEASURES

Provide supportive and symptomatic relief.
Monitor for complications.
Ensure adequate hydration.
Carefully observe all patients with P. falciparum malaria for the first 24 hours for features of severe malaria.

MEDICINE TREATMENT

All first doses of antimalarial medicines must be given under supervision and patients must be observed for at least an hour as vomiting is common in patients with malaria.
Treatment must be repeated if the patient vomits within the first hour. Vomiting oral treatment is one of the commonest reasons for treatment failure.

In areas with high incidence of malaria (whether locally transmitted or imported) it should be definitively diagnosed and treated at PHC level. In other areas, patients should be referred for treatment.

See: Malaria, non-severe/uncomplicated / Malaria, Severe/Complicated / Malaria, prophylaxis

Click here to access the pdf.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.1_20 January 2025

Chapter 10: Infections and Related Conditions_10.7 Malaria