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enseignants",{"title":54,"url":55},{"title":57,"url":58},{"title":186,"group":48,"menu":187},"Produit",[188,189,190,191,192,193,194],{"title":38,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":15,"url":77},{"title":195,"url":10},"Tarification",{"title":197,"group":48,"menu":198},"Mentions légales",[199,200,201,202,203],{"title":197,"url":84},{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":205,"group":48,"menu":206},"Service client",[207,208,209],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},{"content":211,"related":281,"meta":352,"internal":362},{"title":212,"leadIn":213,"category":214,"elements":217,"becomeAnExpert":251,"author":271,"readDuration":279,"readDurationFormatted":280},"Treating uncomplicated malaria","In this video, you will master the most common treatments for uncomplicated malaria.",{"id":215,"name":216},1,"Course previews",[218,228,233,238,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},392,{"platform":223,"name":212,"url":224,"size":225},"YouTube","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=J-1gigkCWho",{"width":226,"height":227},200,113,{"type":229,"data":230},"free_text",{"readDurationInSeconds":231,"text":232},11.466666666666667,"\u003Cp>Patients diagnosed with uncomplicated malaria can be effectively treated with oral antimalarials. In this video, from our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fmalaria-mini-basics\">Malaria Mini: The Basics\u003C\u002Fa> 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.\u003C\u002Fp>",{"type":229,"data":234},{"readDurationInSeconds":235,"title":236,"text":237},17.066666666666666,"Join our Malaria Mini: The Basics course today!","\u003Cp>Many clinicians lack the experience and relevant caseload that is necessary to master the treatment of malaria. This course will teach you how to confidently tackle this disease in your clinical practice. You’ll learn about the parasite’s life cycle and epidemiology, how to take a proper travel history, how to prevent, diagnose, and treat infections, and when to refer your patient to an expert in time to save a life!\u003C\u002Fp>",{"type":239,"data":240},"cta",{"readDurationInSeconds":241,"text":242,"buttonText":243,"buttonUrl":244,"teachIllustration":245},4,"Start the first chapter of our Malaria Mini: The Basics course for free","Start chapter 1 now","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister?target=%2Fcourses%2Fmalaria-mini-the-basics","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55f13-fb4b-40de-8f5d-7d23816122f3",{"type":229,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},188.53333333333333,"Video transcript","\u003Ch3 dir=\"ltr\">\u003Cspan>Uncomplicated malaria\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[00:00]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>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. \u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Confirming malaria before treatment\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[00:26]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>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.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Chloroquine treatment for uncomplicated malaria\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[00:50]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>The treatment of uncomplicated malaria generally caused by \u003C\u002Fspan>\u003Cem>Plasmodium vivax\u003C\u002Fem>\u003Cspan>, \u003C\u002Fspan>\u003Cem>Plasmodium ovale\u003C\u002Fem>\u003Cspan>, or \u003C\u002Fspan>\u003Cem>Plasmodium knowlesi\u003C\u002Fem>\u003Cspan> 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 a red blood cell, the parasite takes in hemoglobin by pinocytosis and breaks it down into amino acids that it can use.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>How chloroquine works in malaria\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[01:21]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>Remember, the parasite has heme polymerase, which detoxifies heme and hematin to turn it into hemozoin, which it can use. And heme polymerase is the target of a family of drugs known as 8-aminoquinolines, the most common of which is chloroquine. These drugs work by blocking the parasite heme polymerase, which makes heme and hematin toxic to the parasite, which leads to its death.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Dormant liver forms in \u003C\u002Fspan>\u003Cem>Plasmodium\u003C\u002Fem>\u003Cspan> \u003C\u002Fspan>\u003Cem>vivax\u003C\u002Fem>\u003Cspan> and \u003C\u002Fspan>\u003Cem>ovale\u003C\u002Fem>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[01:52]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>With \u003C\u002Fspan>\u003Cem>Plasmodium\u003C\u002Fem>\u003Cspan> \u003C\u002Fspan>\u003Cem>ovale\u003C\u002Fem>\u003Cspan> and \u003C\u002Fspan>\u003Cem>Plasmodium\u003C\u002Fem>\u003Cspan> \u003C\u002Fspan>\u003Cem>vivax\u003C\u002Fem>\u003Cspan>, a small number of parasites remain dormant inside liver cells. We refer to these as hypnozoites, 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 \u003C\u002Fspan>\u003Cem>vivax\u003C\u002Fem>\u003Cspan> and \u003C\u002Fspan>\u003Cem>ovale\u003C\u002Fem>\u003Cspan> if you don't also target the dormant hypnozoites in the liver.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan>Preventing\u003C\u002Fspan>\u003Cem> Plasmodium\u003C\u002Fem>\u003Cspan> \u003C\u002Fspan>\u003Cem>vivax\u003C\u002Fem>\u003Cspan> and \u003C\u002Fspan>\u003Cem>ovale \u003C\u002Fem>\u003Cspan>relapse\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[02:28]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>So you treat uncomplicated \u003C\u002Fspan>\u003Cem>Plasmodium\u003C\u002Fem>\u003Cspan> \u003C\u002Fspan>\u003Cem>vivax \u003C\u002Fem>\u003Cspan>and \u003C\u002Fspan>\u003Cem>Plasmodium\u003C\u002Fem>\u003Cspan> \u003C\u002Fspan>\u003Cem>ovale\u003C\u002Fem>\u003Cspan> malaria with chloroquine to target the active malaria. And then you come back after treatment with primaquine. This agent penetrates into the liver cell and kills the hypnozoites.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Primaquine and G6PD deficiency risk\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[02:47]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>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 G6PD deficiency. So if you're treating persons of African descent and a few others, you would test them for the presence of G6PD deficiency before giving them primaquine. \u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Treating malaria in pregnancy: avoiding primaquine\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[03:14]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>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 G6PD 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 primaquine. \u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Chloroquine for chloroquine-sensitive \u003C\u002Fspan>\u003Cem>falciparum\u003C\u002Fem>\u003Cspan> malaria\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[03:43]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>So what about \u003C\u002Fspan>\u003Cem>falciparum\u003C\u002Fem>\u003Cspan> malaria? Milder cases of \u003C\u002Fspan>\u003Cem>falciparum \u003C\u002Fem>\u003Cspan>malaria may occur in individuals who were previously infected and that have antibodies to the disease. For uncomplicated \u003C\u002Fspan>\u003Cem>Plasmodium\u003C\u002Fem>\u003Cspan> \u003C\u002Fspan>\u003Cem>falciparum\u003C\u002Fem>\u003Cspan> 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. \u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Artemether-lumefantrine for chloroquine-resistant \u003C\u002Fspan>\u003Cem>falciparum\u003C\u002Fem>\u003Cspan> malaria\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[04:14]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>For uncomplicated \u003C\u002Fspan>\u003Cem>Plasmodium\u003C\u002Fem>\u003Cspan> \u003C\u002Fspan>\u003Cem>falciparum\u003C\u002Fem>\u003Cspan> infections acquired in areas with chloroquine resistance, four treatment options are available. Artemether-lumefantrine is the preferred option, if readily available. Artemether is related to artesunate, which works by disrupting the mitochondrial membrane and the energy production of the mitochondria, causing the parasite to die. Lumefantrine’s precise mechanism of action is unknown, but available data suggests that it inhibits nucleic acid and protein synthesis. \u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Atovaquone-proguanil for \u003C\u002Fspan>\u003Cem>falciparum\u003C\u002Fem>\u003Cspan> malaria\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[04:53]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>The second option is a combination of atovaquone, which is a structural analogue of Coenzyme Q found in the mitochondria electron transport system, and the sulfa analog proguanil, which inhibits the synthesis of folic acid in the parasite.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Quinine plus doxycycline for \u003C\u002Fspan>\u003Cem>falciparum\u003C\u002Fem>\u003Cspan> malaria\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[05:13]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>The third option is quinine sulfate plus doxycycline, tetracycline, or clindamycin. Quinine is one of the eight aminoquinolines which blocks heme polymerase. Doxycycline, tetracycline, and clindamycin all inhibit protein synthesis in the parasite. Either of the tetracyclines are preferred to clindamycin because there are more efficacy data available.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 dir=\"ltr\">\u003Cspan>Mefloquine for \u003C\u002Fspan>\u003Cem>falciparum\u003C\u002Fem>\u003Cspan> malaria\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp dir=\"ltr\">\u003Cspan>[05:43]\u003C\u002Fspan>\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cspan>The fourth option is mefloquine. Mefloquine acts as a blood schizonticide. However, its 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 neuropsychiatric reactions can occur.\u003C\u002Fspan>\u003C\u002Fp>",{"courses":252,"showAwardsBelow":48},[253],{"id":254,"isFreeCmeCourse":255,"title":256,"type":257,"specialization":258,"teachers":260,"cmeCredits":215,"teacherIllustration":245,"backgroundImage":262,"relativeUrl":263,"lastChanged":264,"created":265,"description":266,"relativeURL":263,"meta":267},7005,false,"Malaria Mini: The Basics","course",[259],"Infectious diseases",[261],"John F. Fisher, MD MACP FIDSA","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55f14-c8da-4339-a93f-060fa1b44709","\u002Fcourses\u002Fmalaria-mini-the-basics","1765721125","1592814598","Many clinicians lack the experience and caseload necessary to master malaria. 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