UMEM Educational Pearls

Title: Malaria

Posted: 12/25/2012 by Walid Hammad, MD, MBChB (Updated: 5/2/2024)
Click here to contact Walid Hammad, MD, MBChB

Case Presentation from our ED
- 20 y/o presents 3 weeks after emigrating from Senegal with headache and malaise. CT/LP and work up was otherwise negative. Thin smear shows 1 plasmodium falciparum parasite in 7000 RBC.
- Appropriate therapy is initiated with malarone (atovoquone and progranuil). 24 hours later the patient represents with worsening headache and fever.
- Repeat smear shows 10% parasitemia and massive numbers of parasites
Clinical Question: Can parasitemia rise after initiation of treatment?
- Answer: Yes
- Increase in blood parasite count in falciparum malaria after initiation of treatment (artemisinin derivatives or quinine) is not uncommon.
- Increased blood parasite count does not indicated treatment failure if it the parasitemia is LESS THAN 2.5 x the baseline count.
Clinical Question: Did this patient have treatment failure with malarone?
Answer: Yes
The patient’s parasitemia rose to 10% after initiation of therapy.
There are increasing case reports of treatment failure in West Africa with Malarone.

Bottom Line: A mild increase in blood parasite count after initiation of treatment is not uncommon. Marked increases should indicated treatment failure and the treatment drug should be changed to another class.

University of Maryland Section for Global Emergency Health

Author: Emilie J.B. Calvello, MD, MPH

References

Wurts, N. Et al. Early treatment failure during treatment of Plasmodium falciparum malaria with atovaquone-proquanil in the Repulic of Ivory Coast. Malar J 2012 May; 2(11): 146.

Silachomroon, U. Et al. Frequency of Early Rising Parasitemia in Falciparum Malaria Treated with Artemisinin Derivatives. Southeast Asian J Trop Med Pub Health 2001 Mar; 32(1): 50 – 56.

Attachments

1212252349_Malaria_Pearl_Visual_EJBC_copy.pdf (1,967 Kb)