Question
A 6-year child visiting from Nagaland presents with high-grade fever with and 2 episodes of seizures on the way to the hospital.O/E there was pallor, mild splenomegaly, and postictal confusion. Hb was 9gm% and random blood sugar was 38mg/dl.peripheral smear and rapid antigen test suggests Plasmodium falciparum infection. What is the treatment strategy after symptomatic management has been taken care of:
| A. |
Chloroquine
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| B. |
Intravenous quinine
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| C. |
Intravenous artesunate
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| D. |
Mefloquine plus doxycycline
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Show Answer
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Correct Answer � C
Explanation
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Ans-c . Intravenous artesunate
Seizure and hypoglycemia indicate complicated falciparum malaria. Any organ system involvement like CNS causing seizures, focal deficits, delirium, hepatobiliary ( hyperbilirubinemia >3), pulmonary ( ALI/pulmonary edema), renal (AKI), hypoglycemia, shock, metabolic acidosis, hyperparasitemia are all included as complicated malaria
Parenteral ( intravenous preferably ) artesunate is the treatment of choice for complicated malaria in both high resistance and low resistance regions to chloroquine.
Uncomplicated falciparum malaria is usually treated with artemisinin combination therapy (ACT) like artemether +lumefantrine in all the regions despite chloroquine resistance.
Uncomplicated vivax malariae and knowlesi are treated with chloroquine
Radical treatment includes anti-relapse drugs like primaquine and tafenoquine, which are given as single doses in falciparum which destroys all the gametocytes in falciparum malaria. In the case of P vivax malaria, 2 weeks of primaquine is given for tissue schizonticidal activity.
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