Treating uncomplicated malaria

In this video, you will master the most common treatments for uncomplicated malaria.

John F. Fisher, MD MACP FIDSA
John F. Fisher, MD MACP FIDSA
26th Jun 2020 • 4m read

Patients diagnosed with uncomplicated malaria can be effectively treated with oral antimalarials. In this video, from our Malaria Mini: The Basics course, we look at how each treatment works, which drugs should be used for specific malaria strains, and the critical step you need to take to avoid a patient relapse.

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Video transcript

Now that we know how malaria develops and how to recognize the symptoms, how do we treat this disease. Patients diagnosed with malaria are generally categorized as having either uncomplicated, or severe malaria. patients diagnosed with uncomplicated malaria can be effectively treated with oral anti-malarials.

It is preferable that treatment for malaria not be initiated until the diagnosis has been established by laboratory testing. Presumptive treatment without the benefit of prior laboratory confirmation should be reserved for extreme circumstances, such as strong clinical suspicion, or severe disease in a setting where prompt laboratory diagnosis is not available.

The treatment of uncomplicated malaria generally caused by Plasmodium vivax, Plasmodium Valley, or plasmodium nosie usually involves the drug Chloroquine. So, how does Chloroquine work Remember earlier in the course when we discussed what the parasite is doing once it invades red blood cell, the parasite takes in hemoglobin by peinado cytosis and breaks it down into amino acids that it can use.

Remember, the parasite has heme polymerase, which detoxifies heme and he mutton to turn it into hemozoin which it can use. And heme polymerase is the target of a family of drugs known as eight amino quinolones, the most common of which is Chloroquine. These drugs work by blocking the parasite heme polymerase, which makes heme and Hamilton toxic to the parasite, which leads to its death.

With plasmodium Valley and Plasmodium vivax, a small number of parasites remain dormant inside liver cells. We refer to these as Hypno ZooLights. And they are found in virtually all patients with these two types. Therefore, in these two types, even if you treat and kill the active malaria in the red cells, you may not be able to kill this dormant form.

This means the patient could have a relapse of vive X and O Valley, if you don't also target the dormant Hypno ZooLights in the liver. So you treat uncomplicated Plasmodium vivax and Plasmodium Valley malaria with Chloroquine to target the act of malaria. And then you come back after treatment with Tremec when this agent penetrates into the liver cell and kills the Hypno ZooLights.

So you use Chloroquine plus primaquine to prevent relapse of these two types of malaria. Now, a caution about primaquine primaquine can cause massive hemolysis if given to patients who have G six PD deficiency. So if you're treating persons of African descent and a few others, you would test them for the presence of G six PD deficiency before giving them primaquine primaquine should also be avoided in pregnant women because it has been shown to cause developmental abnormalities in the babies.

In addition, if the fetus is G six P D deficient, massive hemolysis can occur, which can be fatal. So primaquine is contraindicated in pregnancy. Instead, you would generally treat with Chloroquine first, then wait until after delivery and treat the mother and baby with pemaquid. So what about falciparum malaria.

Milder cases of falciparum malaria may occur in individuals who were previously infected. And that's have antibodies to the disease for uncomplicated Plasmodium falciparum infections, acquired in areas without Chloroquine resistant strains, which includes Central America, west of the Panama Canal, Haiti and the Dominican Republic.

Patients can also be treated with oral Chloroquine, for uncomplicated Plasmodium falciparum infections acquired in areas with Chloroquine resistance for treatment options are available. Automator Luma fan train is the preferred option, if readily available. Automator is related to our test innate, which works by disrupting the mitochondrial membrane and the energy production of the mitochondria and causing the parasite to die.

Luma fan trains precise mechanism of action is unknown, but available data suggests that it inhibits nucleic acid and protein synthesis. The second option is a combination of Atovaquone which is a structural analogue of Coenzyme Q Who found in the mitochondria electron transport system and the sulfa analog Proguanil which inhibits the synthesis of folic acid in the parasite.

The third option is quinine sulfate plus doxycycline, tetracycline or cleanser Meissen. Quinine is one of the eight amino quinolones which blocks heme polymerase, doxycycline, tetracycline and Klenda Meissen all inhibit protein synthesis in the parasite. Either the tetracycline is our preferred to Klenda Meissen because there are more efficacy data available.

The fourth option is mefloquine. mefloquine acts as a blood SKIDATA side. However, it's exact mechanism of action is not known. mefloquine is generally reserved for cases where the other options cannot be used, because when used in therapeutic doses, in contrast to preventive doses, rare severe neuro psychiatric reactions can occur.

So I hope you liked this video. Absolutely. Make sure to check out the course this video was taken from and to register for a free trial account which will give you access to select the chapters of the course. If you want to learn how Medmastery can help you become a great clinician, make sure to watch the abutment mastery video. So thanks for watching and I hope to see you again soon.