Treatment of Malaria in India

1. Uncomplicated Malaria (sensitive to chloroquine)
P. vivax – chloroquine 25 mg/kg over 3 days + Primaquine 0.25 mg/kg OD for 14 days
P. falciparum - chloroquine 25 mg/kg over 3 days + Primaquine 45 mg single dose

2. Uncomplicated Malaria (chloroquine resistant)
Artemisinin Combination Therapy (ACT) i.e Artesunate 50 mg + Sulfadoxine 500 mg + Pyrimethamine 25 mg for 3 days

3. Severe Malaria
Artesunate- 2.4 mg/kg @ 0 hrs, 1.2 mg/kg @ 12 hrs, 24 hrs, then OD, IV/IM
Quinine- LD:20 mg/kg, MD:10 mg/kg, both in 5% Dextrose
Artemether- 3.2 mg/kg IM on day 1, then 1.6 mg/kg IM OD
ab Arteether- 150 mg daily i.m. for 3 days in adults only
Switch to oral anti-malarials as soon as condition improves

Hypersplenism

Condition in which spleen removes circulating RBCs, granulocytes and platelets in excess quantity.

Diagnosis:

1. Pancytopenia
2. Normal or hypercellular bone marrow
3. Splenomegaly
4. Correction of cytopenias after splenectomy

Classification

1. Primary – when no aetiology for enlarged spleen is found.
2. Secondary –
1. Portal hypertension
2. Infiltrative disease, lymphoma, myelofibrosis
3. Hemolyitc anaemias, hematological disorders
4. Rheumatoid arthritis (Felty’s syndrome)
5. Tropical splenomegaly syndrome

Pathogenesis

When splenic size increases, there is increases pooling of blood in an environment with relatively reduced availability of nutrients but full of phagocytes.

This leads to exaggerated sequestration and destruction of cells leading to

1. Pancytopenia
2. Hemolysis
3. Increased plasma volume

Treatment

Therapy needed when cytopenias become severe and symptomatic

Treatment of underlying causes

Splenectomy if underlying cause cannot be corrected or treated