General

Weekend Case Discussion - 2 -31/7/16

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31 Jul 2016 - General
 

Young female patient, with no medical background, was recently arrived from Malawi 2 weeks ago, admitted to hospital due to 2 days history of fever and abdominal pain. Patient was apyrexia on admission, and abdominal examintaion showed no tenderness / no pain. Further history revealed that he was admitted to hospital in Malawi 3 weeks prior to his travel, and was treated for malaria for 3 days. Investigation showed that his platelet level is slightly low at around 125, normal Hb, and white cell count, blood film show malaria, parasiteamia 0.75, was confirmed to be plasmodium falciparum after. ;Patient has no sign of severe malaria innfection. What will be your treamtent strategy for this patient???


She was not entirely sure what kind of treatment she received in Malawi. But, she did improve clinically after treatment in Malawi, around 2 weeks with symptoms free prior to flying over. Her current symptoms only started recently 2 days ago. Given the fact that patient is clinically well, and with no signs of severe malaria (like altered consciousness, respiratory distress, circulatory collapse, metabolic acidosis, renal failure, hemoglobinuria, hepatic failure, coagulopathy, severe anemia...
 (Total 119 words)
She should be treated in hospital until parasitaemia has cleared. What was she given in Malawi? Artemisinin-based combination therapies preferred. Alternative choice is oral quinine 600 mg tds for 7 days, together with doxycycline 100 mg bd for 7 days. Example of ACT will ve Artemether-lumefantrine. One tablet contains 20 mg artemether and 120 mg lumefantrine.A 3-day treatment schedule with a total of 6 oral doses is recommended. The patient should receive the initial dose, followed by the secon...
 (Total 126 words)