Safari Souvenir A Case Study about Malaria by Michelle LeBlanc.

Safari SouvenirSafari Souvenir

A Case Study about Malaria A Case Study about Malaria by Michelle LeBlancby Michelle LeBlanc

Patient History & PhysicalPatient History & Physical

49 year old man presenting to the 49 year old man presenting to the Emergency Center with the following Emergency Center with the following symptoms:symptoms: Fever of 39.4Fever of 39.4 oo CC Vomiting for 2 daysVomiting for 2 days Neck and back painNeck and back pain

Patient History & Physical - Patient History & Physical - continuedcontinued

Returned from a trip to Nigeria, Africa Returned from a trip to Nigeria, Africa two weeks prior two weeks prior

Claims to have been taking anti-malarial Claims to have been taking anti-malarial medicationsmedications

Presumptive Diagnosis = MalariaPresumptive Diagnosis = Malaria

Laboratory ResultsLaboratory Results

WBC (billion/L)WBC (billion/L) 4.34.3 (4.4 – 10.1)(4.4 – 10.1)

RBC (trillion/L)RBC (trillion/L) 5.025.02 (4.31 – 5.48)(4.31 – 5.48)

Hemoglobin (g/dL)Hemoglobin (g/dL) 13.813.8 (13.4 – 17.0)(13.4 – 17.0)

Hematocrit (%)Hematocrit (%) 39.839.8 (40.1 – 50.1)(40.1 – 50.1)

Platelet (billion/L)Platelet (billion/L) 5050 (11.3 – 14.5)(11.3 – 14.5)

Malaria SmearMalaria Smear Plasmodium falciparum seenPlasmodium falciparum seen

Blood CultureBlood Culture No growthNo growth

Questions to consider:Questions to consider:

How does malaria affect hematology How does malaria affect hematology results?results?

What is the effectiveness of prophylactic What is the effectiveness of prophylactic (anti-malarial) drugs?(anti-malarial) drugs?

What is the significance of the low What is the significance of the low platelet count?platelet count?

Blood Smear FindingsBlood Smear Findings

Plasmodium falciparumPlasmodium falciparum rings have delicate rings have delicate cytoplasm and 1 or 2 small chromatin dots.  Red cytoplasm and 1 or 2 small chromatin dots.  Red blood cells (RBCs) that are infected are not enlarged; blood cells (RBCs) that are infected are not enlarged; multiple infection of RBCs more common in multiple infection of RBCs more common in P. P.

falciparumfalciparum than in other malaria species.  than in other malaria species. 

TreatmentTreatment

Patient was given 500 cc of IV bolus in Patient was given 500 cc of IV bolus in ECEC

He received 2 does of MefluquineHe received 2 does of Mefluquine Tylenol was given as needed for painTylenol was given as needed for pain He was prescribed Deoxycyclin for 7 He was prescribed Deoxycyclin for 7

daysdays

Types of Malaria / Symptoms Types of Malaria / Symptoms

Plasmodium vivaxPlasmodium vivax Plasmodium malariaePlasmodium malariae Plasmodium falciparumPlasmodium falciparum Plasmodium ovalePlasmodium ovale

FeverFever ChillsChills Headache / muscle Headache / muscle

acheache Nausea / vomitingNausea / vomiting Kidney damageKidney damage ComaComa DeathDeath

TrasmissionTrasmission

Malaria is transmitted via the bite of an Malaria is transmitted via the bite of an infected mosquito of the infected mosquito of the AnophelesAnopheles speciesspecies

The parasite enters the bloodstream and The parasite enters the bloodstream and travels to the liver where it will grow and travels to the liver where it will grow and maturemature

Symptoms appear in 8 days to several months Symptoms appear in 8 days to several months when the parasite enters the red blood cellswhen the parasite enters the red blood cells

TransmissionTransmission

RiskRisk

Found in 40% of the world’s population in Found in 40% of the world’s population in areas of Central and South America, Africa, areas of Central and South America, Africa, India, SE Asia and the Middle EastIndia, SE Asia and the Middle East

Currently 12,000 cases are diagnosed in the Currently 12,000 cases are diagnosed in the United States each yearUnited States each year

300-500 million clinical cases occur each 300-500 million clinical cases occur each year worldwideyear worldwide

Hematological ComplicationsHematological Complications

Hemolysis due to increased osmotic and Hemolysis due to increased osmotic and mechanical fragility of the erythrocytesmechanical fragility of the erythrocytes

Decreased platelet count Decreased platelet count (thrombocytopenia) is associated with the (thrombocytopenia) is associated with the use of some anti-malarial drugsuse of some anti-malarial drugs

Drug Therapy with QuinineDrug Therapy with Quinine

Quinine is one of the most commonly Quinine is one of the most commonly prescribed anti-malarial drugsprescribed anti-malarial drugs

Quinine is the 2Quinine is the 2ndnd most common agent most common agent implicated in drug induced thrombocytopeniaimplicated in drug induced thrombocytopenia

It’s effectiveness is questioned due to It’s effectiveness is questioned due to increasing multidrug resistant malaria increasing multidrug resistant malaria phenotypesphenotypes

Patient probably did take his prescribed anti-Patient probably did take his prescribed anti-malarial medicationmalarial medication

Human Resistance to MalariaHuman Resistance to Malaria

Hemoglobin S found in red blood cells of Hemoglobin S found in red blood cells of Sickle Cell AnemiaSickle Cell Anemia

Hemoglobin F found in red blood cells of Hemoglobin F found in red blood cells of ThalassemiaThalassemia

The red blood cells containing these abnormal The red blood cells containing these abnormal hemoglobins are more prone to ingestion by hemoglobins are more prone to ingestion by macrophages. Thus malaria organisms are macrophages. Thus malaria organisms are more readily removed from the blood stream. more readily removed from the blood stream.

SummarySummary

49 year old man presented to the EC with flu-like 49 year old man presented to the EC with flu-like symptoms and decreased platelet count after symptoms and decreased platelet count after returning from Africa two weeks priorreturning from Africa two weeks prior

Claims to have taken “unknown” anti-malarial Claims to have taken “unknown” anti-malarial medicationsmedications

Blood culture found no growth but Blood culture found no growth but Plasmodium Plasmodium falciparumfalciparum was found on blood smear review was found on blood smear review

Patient released after 2 days with not follow-up Patient released after 2 days with not follow-up requiredrequired

ReferencesReferences

Images from DPDx – A web site developed Images from DPDx – A web site developed and maintained by CDC's Division of Parasitic and maintained by CDC's Division of Parasitic Diseases (DPD) Diseases (DPD) http://www.dpd.cdc.gov/dpdx/HTML/Image_http://www.dpd.cdc.gov/dpdx/HTML/Image_Library.htmLibrary.htm Last accessed on 11/05/04. Last accessed on 11/05/04.

CreditsCredits

This case study was prepared This case study was prepared by by

Michelle Leblanc, MT(ASCP) Michelle Leblanc, MT(ASCP)

while she was a while she was a

Medical Technology student Medical Technology student

in the in the

2004 MT Class 2004 MT Class

at William Beaumontat William Beaumont

Hospital, Hospital,

Royal Oak, MI.Royal Oak, MI.