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What is new in Malaria Management ?

What is new in Malaria Management ?. Dr. PC Bhattacharyya Sr. Consultant Physician down town hospital Guwahati ,Assam. Current Scenario.

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What is new in Malaria Management ?

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  1. What is new in Malaria Management ? Dr. PC Bhattacharyya Sr. Consultant Physician down town hospital Guwahati ,Assam

  2. Current Scenario • No significant development in management since the advent of artemisinin. • Many new drugs are in experimental stage • Various combination of different drugs are tried with variable success • Newer investigations contributed much towards the successful management

  3. Newer Investigations Serological Tests : Molecular biological techniques DNA Probes RNA probes Transcript amplification system and target amplification by PCR Probe amplification ring Q beta replicase Compound or ‘Christmas tree’ Probes Fluorescence microscopy

  4. Serological tests

  5. Management (i) Immediate general management Immediate admission in ICU Resuscitation Airway/Circulation by ALS technique ABG/Serum electrolyte estimation Coagulation profile Detection of pulmonary oedema and ARDS & ventilatory support

  6. Management (ii) 8. Hypoglycaemia 9. Circulatory collapse 10.Renal shutdown- Dialysis 11. Anaemia – blood transfusion 12. Haemoglobinuria 13. Hyperpyrexia 14. Jaundice & exchange transfusion

  7. Newer Drugs - I • TETRACYCLENE : Doxycycline, Cotrimoxazol Clindamycin • NAPHTHOQUINONE : (Atovaquone or BW 566 C80), • VINYL SULPHONES : Inhibit cystesine proteinase ) . • WR 238 ,605 : New 8 aminoquinolone, • SULPHONES/ BIGUANIDES

  8. NEWER DRUGS - II AZITHROMYCIN DESFERRIXAMINE DRUGS WHICH REVERSE CHLOROQUINE RESISTANCE Calcium channel blocker. MISCELLANEOUS Pyronaridine, Benflumentol, Hydroxy Piperaquine, Trioxane. Teraoxanes, Hydroxynaphthoquinones & Pyridianomenthanols. Dapsone, Ketoconazole, Miconazole, Ampho-B

  9. Exchange Transfusion Rationale • Rapid reduction of parasite load • Improving rheology • Reduction of microcirculatory sludge • Correction of anaemia • Buying time for optimum action of drugs

  10. Exchange Transfusion Indications • Parasitaemia >30% without organ dysfunction • Parasitaemia > 10% with organ dysfunction • Pregnancy • Patient >60 yrs. of age

  11. Exchange transfusion Technique • Through Femoral/brachial vein • Patients blood exchanged in small quantity • Volume exchanged- 2000ml- parasitaemia >10% 3000ml – parasitaemia >11-20% 4000ml – parasitaemia >20%

  12. Exchange transfusion Our experience in DTH Number of cases 9 • Exchange transfusion 3 cases 2 had ARDS, All survived • Without exchange transfusion 6 cases 5 cases died (4 cases had ARDS)

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