Transcript Safari Souvenir

Safari Souvenir
A Case Study about Malaria
by Michelle LeBlanc
Patient History & Physical

49 year old man presenting to the
Emergency Center with the following
symptoms:
Fever of 39.4 o C
 Vomiting for 2 days
 Neck and back pain

Patient History & Physical continued
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
Returned from a trip to Nigeria, Africa
two weeks prior
Claims to have been taking anti-malarial
medications
Presumptive Diagnosis = Malaria
Laboratory Results
WBC (billion/L)
4.3
(4.4 – 10.1)
RBC (trillion/L)
5.02
(4.31 – 5.48)
Hemoglobin (g/dL)
13.8
(13.4 – 17.0)
Hematocrit (%)
39.8
(40.1 – 50.1)
50
(11.3 – 14.5)
Platelet (billion/L)
Malaria Smear
Plasmodium falciparum seen
Blood Culture
No growth
Questions to consider:

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How does malaria affect hematology
results?
What is the effectiveness of prophylactic
(anti-malarial) drugs?
What is the significance of the low
platelet count?
Blood Smear Findings

Plasmodium falciparum rings have delicate
cytoplasm and 1 or 2 small chromatin dots. Red
blood cells (RBCs) that are infected are not enlarged;
multiple infection of RBCs more common in P.
falciparum than in other malaria species.
Treatment

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Patient was given 500 cc of IV bolus in
EC
He received 2 does of Mefluquine
Tylenol was given as needed for pain
He was prescribed Deoxycyclin for 7
days
Types of Malaria / Symptoms
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Plasmodium vivax
Plasmodium malariae
Plasmodium falciparum
Plasmodium ovale
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
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Fever
Chills
Headache / muscle
ache
Nausea / vomiting
Kidney damage
Coma
Death
Trasmission
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Malaria is transmitted via the bite of an
infected mosquito of the Anopheles species
The parasite enters the bloodstream and
travels to the liver where it will grow and
mature
Symptoms appear in 8 days to several months
when the parasite enters the red blood cells
Transmission
Risk
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Found in 40% of the world’s population in
areas of Central and South America, Africa,
India, SE Asia and the Middle East
Currently 12,000 cases are diagnosed in the
United States each year
300-500 million clinical cases occur each
year worldwide
Hematological Complications

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Hemolysis due to increased osmotic and
mechanical fragility of the erythrocytes
Decreased platelet count
(thrombocytopenia) is associated with the
use of some anti-malarial drugs
Drug Therapy with Quinine

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Quinine is one of the most commonly
prescribed anti-malarial drugs
Quinine is the 2nd most common agent
implicated in drug induced thrombocytopenia
It’s effectiveness is questioned due to
increasing multidrug resistant malaria
phenotypes
Patient probably did take his prescribed antimalarial medication
Human Resistance to Malaria
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Hemoglobin S found in red blood cells of
Sickle Cell Anemia
Hemoglobin F found in red blood cells of
Thalassemia
The red blood cells containing these abnormal
hemoglobins are more prone to ingestion by
macrophages. Thus malaria organisms are
more readily removed from the blood stream.
Summary
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49 year old man presented to the EC with flu-like
symptoms and decreased platelet count after
returning from Africa two weeks prior
Claims to have taken “unknown” anti-malarial
medications
Blood culture found no growth but Plasmodium
falciparum was found on blood smear review
Patient released after 2 days with not follow-up
required
References

Images from DPDx – A web site developed
and maintained by CDC's Division of Parasitic
Diseases (DPD)
http://www.dpd.cdc.gov/dpdx/HTML/Image_L
ibrary.htm Last accessed on 11/05/04.
Credits
This case study was prepared
by
Michelle Leblanc, MT(ASCP)
while she was a
Medical Technology student
in the
2004 MT Class
at William Beaumont
Hospital,
Royal Oak, MI.