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Complicated Malaria, Severe complicated malaria includes cerebral malaria…
Complicated Malaria
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Risk Factors
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Hyperendemic area
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Poor, tropical and subtropical areas
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Lifecycle of Malaria
Infected Anopheles Mosquito, bites for blood
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Prevention drug
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Atovaquone + proguanil
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cycloguanil (active metabolite of proguanil)
inhibits plasmodial dihydrofolate
reductase, thereby preventing DNA synthesis
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Severe complicated malaria includes cerebral malaria where it is manifested by confusion, seizures or even coma. Cerebral malaria is the most severe neurological complication caused by Plasmodium falciparum infection.
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Clinical definition: state of unarousable coma, presence of parasitized red blood cells and lack of other causes of coma
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:<3: Hemodynamic instability occurs when there’s abnormal or unstable blood supply, which can cause inadequate blood flow
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severe malaria has four main components:
:warning: retinal whitening
:warning: vessel discolouration
:warning: haemorrhages
:warning: papilloedema.
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is a feeling of weakness, overall discomfort, illness, or simply not feeling well
When an RBC is infested with plasmodium falciparum, its oxygen delivery capacity decreases, due to change in shape, rigidity, and decrease in the total number of RBC in the body
to reducing oxygen delivery to tissues, causing muscle damage which lead to decrease in contractile force, fatigued significantly more, and recovered significantly slower from fatigue
Base on an article individual with muscle damage, protein degradation or enhanced catabolism, will present with a creatine kinase (CK) abnormalities (increase), and decrease in RNA and protein content found in the skeletal muscle
A sign of cerebral malaria, cause by blockage
Infested RBC will become more rigid and increase adhesiveness. Therefore, higher chance of coagulation and blockage of the blood vessels.
The blockage to the brain blood vessel will lead to hypoxia to the brain, swelling of the brain, and even damaging the brain and the damage may be permanent
Brain cells are extremely sensitive to oxygen deprivation and can begin to die within five minutes after oxygen supply has been cut off, causing altered mental state, seizures, coma and even brain death
One of the main functions of spleen is the removal or filtering out of destroyed, dead and old RBCs
Enlarge spleen can be the complication of the increased hemolysis or RBC cell rapture due to malaria
increase of RBC filtration, the spleen organ will undergo hypertrophy process to compensate the increased workload led to the organ enlargement
the drastic decrease in RBC number it will trigger the spleen to undergo extramedullary haematopoiesis, as mention above increase workload leads to hypertrophy
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:<3: Hemodynamically unstable patients don't have enough pressure in the circulatory system to keep blood flowing reliably to all the various parts of the body where it needs to be at the same time.
:warning: not generating enough pressure is not the same thing as being able to measure low blood pressure
:warning: body will have reactions to fluctuations of blood pressure long before that particular vital sign can be clearly identified
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:pencil2: As P. falciparum parasites mature to trophozoites within the red blood cell, they induce the formation of sticky knobs on the surface of erythrocytes. Hence, they adhere to the endothelium of capillaries and venules.
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:pencil2: Further adherent of the newly malaria infected erythrocytes (rosetting) causing further clogging of the microcirculation
:pencil2: Obstruction to the cerebral microcirculation results in brain hypoxia and increase lactate production due to anaerobic glycolysis leading to brain damage.
Kidney failure lead to metabolic acidosis and burst of RBC causes low O2 supply, patient need to increase gases exchanges rate
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:pencil2: At rest, a normal respiratory rate can vary depending on age and activity but is usually between 12 and 20 breaths per minute for a resting adult. Tachypnea is indicated by a rate greater than 20 breaths per minute.
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:check: falciparum malaria is associated with impaired circulatory control and the tendency to postural hypotension is worsened significantly by antimalarial treatment.
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Doxycycline blocks or inhibits some of the body's responses to infection and inflammation. Inflammation makes the eye and eyelids red and irritated. By reducing excessive inflammation, delicate tissues such as the cornea may be spared from scarring or destruction.
Chloroquine deposits in the retinal pigment epithelium leading to its degeneration and that of the neurosensory retina leading to irreversible visual loss.
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