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Overview :
Stauffer and Fischer developed a flow diagram for evaluating a
patient suspected of having malaria. This can help guide initial diagnostic
testing and management. The authors are from the University of Minnesota and
Mayo Clinic.
Patient selection: malaria suspected based on history of
exposure together with signs and symptoms of malaria
Parameters:
(1) Does the patient appear toxic?
(2) Is Plasmodium falciparum the dominant species in the
exposure area?
(3) Is the patient likely to be partially immune to falciparum
malaria?
Criteria for partial immunity to falciparum malaria - all of the
following:
(1) > 6 years of age
(2) history of malaria infection
(3) resided in an area where malaria is highly endemic within
past 2 years
If toxic:
(1) admit to hospital ICU
(2) perform multiple thick and thin smears
(3) consider PCR if available
(4) start parenteral therapy
If non-falciparum species suspected:
(1) perform
thick and thin smears
(2) if initial
smears are negative repeat as outpatient every 8-12 hours for minimum of 3
sets
If Plasmodium falciparum suspected and the patient likely has
partial immunity:
(1) perform
thick and thin smears
(2) if initial
smears are negative repeat as outpatient every 8-12 hours for minimum of 3
sets
If Plasmodium falciparum suspected and the patient is likely
nonummune:
(1) admit to
the hospital
(1) perform
thick and thin smears
(2) if initial
smears are negative repeat every 8-12 hours and with fevers
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