Tuesday, 11 February 2014

Malaria

MALARIA
• Six primary Malaria vectors in India:
o Anopheles culicifacies: Rural and peri-urban areas [Species A-P, vivax & P, falciparum; Species B-
P.falciparum]
o Anopheles stephensi : Urban and industrial areas
o Anopheles fluviatilis: Hilly, forest and forest fringe areas
o Anopheles minimus: Foot-hills of NE states
o Anopheles dirus : Forests of NE states
o Anopheles epiroticus: Andaman & Nicobar islands
• Diagnosis of Malaria in India:
o Microscopy: Thick smear (High sensitivity in searching for parasite, parasite load estimation) + Thin file (for species identification, stages)
o Serological testing: Malaria Fluorescent Antibody Test (MFAT) becomes +ve after 2 weeks of
infection (not indicative of current infection)
o Rapid diagnostic test (RDT): Detect circulating parasite antigens.
MALARIA GUIDELINES 2010
• Active intervention measures for Malaria control:
o Micro-stratification of problem
o Vector control strategies
1) Anti-adult measures: Indoor residual spray (DDT/ Malathion,Fenitrothion), Space
2) Anti-larval measures: Larvicides (temephos), Source reduction, Integrated control.
• Changes in WHO recommendations for Malaria control [2010] :
Parasitological confirmation must before t/t
FIVE ACT’s recommended by WHO
1) Arthemether + Lumefanthraine
2) Artesumate + Amodiaquine
3) Artesunate + Mefloquine
4) Artesunate +Sulphadoxine Pyrimethamine
5) Dihydroarthimisinin + Piperaqunie
Integrated Community Case Management is pivot now for t/t of malaria
o Artemisin derivatives should not be used as monotherapies for uncomplicated malaria
o Single dose of Primaquine (anti- gametocyte) added to ACT treatment of P, falciparum.

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