Follow up DFASM3 3 – Malaria

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Malaria

 

Where?

Johns Hopkins

Doctor’s name and Position

DANA POTTER- Chief resident
GREGORY SNEIDER- Intern

Patient’s name:

Mrs Williams

Age:

41

Matiral status:

single

Presenting complaint:

-          High fever
-          Malaise
-          Chills
-          Abdominal cramping 5 days prior to presentation
-          Nausea and vomiting previous 3 days

Past medical history:

-    Frequent long stays in Uganda
-    No prophylaxis in previous stays
-    Reactions to Lariam: dizziness and violent headaches

Further examinations:

-    Blood work
-    Blood smear for malaria
-    Chest X-ray

Results:

-    WBC at 3.4
-    Hgb at 13.9
-    Platelets at 17
-    AST at 90
-    ALT at 118
-    Bilirubin at 4.7
-    Bicarbonate 26
-    Creatinine at 0.6
-    INR 1.1
-    PTT 30
-    Fibrinogen levels at 478
-    D-Dimer > 5250
-    Positive blood smear for malaria – high parasitemia 15%
-    CXR: no abnormality

Clinical features of complicated malaria as defined by the W.H.O:

-    impaired consciousness
-    prostration
-    clinical jaundice plus evidence of other vital organ dysfunction
-    multiple convulsions – more than two episodes in 24 hours
-    circulatory collapse or shock
-    abnormal spontaneous bleeding
-    failure to feed
-    respiratory distress

Diagnosis:

Severe cerebral malaria due to Plasmodium falciparum

Treatment:

IV quinidine locally and then artesunate

Prognosis:

The patient recovered without severe neurologic sequelae

 

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