Page 55 - Medical Parasitology_ A Textbook ( PDFDrive )

Types of Malarial Parasites and Their Morphology 47

5. Culture
This method is rarely used for diagnostic purposes. It is mainly used for
research.

Treatment

1. Treatment of uncomplicated malaria
In areas with chloroquine-susceptible infections, adults, and children are
treated with either artemisinin-based combination therapy (ACT) (except
women in first trimester of pregnancy) or chloroquine. In cases of chloroquine
resistance, ACT is given. In uncomplicated P. falciparum infection, ACT is
used for treatment (except women in first trimester of pregnancy). Infected
pregnant women in their first trimester in areas of chloroquine resistance are
treated with quinine. For prevention of relapse in vivax and ovale, primaquine
is given for 14 days under supervision. G6PD status of the patient must be
determined before starting primaquine. Primaquine is contraindicated in preg-
nant women.
2. Treatment of complicated malaria
All patients (including infants, pregnant women in all trimesters and lactating
mothers) with severe malaria should be treated with intravenous or intramuscu-
lar artesunate for at least 24 h or until they can tolerate oral medication.
Artemether or quinine is given as an alternative if parenteral artesunate is not
available.
ACT consists of an artemesinin derivative combined with a long-acting anti-
malarial drug (amodiaquine, lumefantrine, mefloquine, or sulfadoxine-pyrimeth-
amine). Artemesinin derivative must never be given as monotherapy to prevent
development of parasite resistance to these drugs (Table 6.1).

Prevention and Control

1. Chemoprophylaxis
For travellers visiting endemic areas, chemoprophylaxis provides effective
protection. The drugs recommended are proguanil, chloroquine or mefloquine
weekly or doxycycline daily. Prophylaxis should begin 1 week before travelling
and be continued while in the endemic area and for 4–6 weeks after departure
from endemic area.
2. Vector Control Strategies
(a) Insecticide residual spraying (IRS): The spraying of the indoor surfaces of
house with residual insecticides
(b) Insecticide treated bed nets (ITN)
(c) Use of repellants, protective clothing, mosquito coils and screening of
house
3. Anti-larval Measures