PRACTICAL GUIDELINE FOR PRIMARY

CARE PHYSICIAN
To day is The WORLD MALARIA DAY
Theme : Counting Malaria Out
Identified Cases
Diagnosis
Treatment
Fever/ history fever
Living in endemic area/ history
travel to malaria area
Manifestation complication :
jaundice, convulsion, comateus
RDT
Microscopic
PCR
Test for exclusion :
Hematology
Biochemical
Serology for dengue, typhoid,
leptospirosis
Confirmed diagnosis : ACT
Suspected/ clinical : Non-ACT/
conventional
Severe Malaria : Artesunate
A woman 50 years old, main complaint of yellow eyes.
She felt weak and tired since 2 weeks ago. She had
vomiting, giddiness, poor appetite, dark urine, and
defecation normal in color.
Physical examination: concious, BP: 100/70mmHg
Pulse: 90x/m, Temp. : 37
0
C, Resp. : normal
Sclera and skin ; jaundice (+)
Heart & Lung : normal, Abdomen: soft, no masses
Liver : hepatomegaly 2 m bcm
L: not palpable
DIAGNOSIS : Acute Viral Hepatitis
Comment : Agree/ NOT Agree / Do not know
A. Give liver supportive agent
B. Hematology & biochemical test
C. USG
D. Viral Hepatitis Marker
E. Urine microscopic
F. CT scan
Day 2 -3 : still weak, less eating, BP
90/60, volume good, no fever. USG :
sludge, suggested CHOLECYSTITIS.
What we should do ?
A. Put on Antibiotic
B. Request for ERCP
C. Put on Ursodeoxy-cholic acid
D4, chill, fever,38C. Lab. Hb. 9 gr%, Leuco
7800/mm3 (62% neutrophile), thrombocyte
63.000. Total bil 8.4 mg/dl (Direct 7.8 mg/dl),
gamma-GT 60; Alk.PO4 159. Urea 147, creat
1.69. TTl protein 6.2 mg/dl (alb 2.54); Se iron
22, TIBC 271. Malaria smear negative
Question :
A. Antibiotik change to Parenteral
B. Do another hematology profile
C. Blood culture
D. Do another test for malaria
D5 : Falcip malaria ++++ ring; count > 3000
par/ 200L
Treament :
A. ACT
B. Non- ACT
C. Quinine Parenteral
D. Artesunate iv
E. Arthemeter im
Follow-Up : D 14 : bil 2.06 ( indirect 1.4), Hb. 6.5
g%. Fever subsided, getting beter.
G- 6 PD enzym : 314
Patient with fever/ history of fever :
Where they lived
History travelling
Blood transfussion
Liver/ spleen enlargement
May not related to liver diseases
Watched for systemic infection
Jaundice :
Parenchymal/ Obstruction/ Hemolysis
Systemic Infection
Thrombocytopenia :
NOT always dengue
Common in Malaria, Typhoid fever
Rarely occur in autoimmune/ idiopathic
Anemia :
Not in Acute Infection/ Illnesses
Common in haemorhagic, malignancy,
chronic infection
Rarely hemolysis associated with malaria
A woman, 39 years old, comes with vaginal
bleeding and abdominal pain. She is
pregnant 7 months ( G1PoAo ). She had
history of fever 6 days, headache. Lived in
Papua.
BP 160/100, temp 37.8C, pulse 80x/ minute
Lab : Hb. 13 gr%, Mal vivax ring +, 4 par/
200 leuco
Treatment :
Suldox 3 tb/ once
Paracetamol 1 tb, tds
A woman, 26 ears old, admiteed
hospital with abdominal pain, she is
pregnant 24 weeks (G1PoAo).
Hb 6.8 gr%, Thrombocyte 73.000,
developed fever 39 C
Malaria falcip ring +, 8 par/200l
51 years women, admitted with history 4
days fever with breathless, temp 37.5, BP
150/100, pulse 108 : resp. : 36x/menit
No history of DM, Hpt -, previous admission
Penanganan ? :
A. Furosemide i.v
B. Oksigen
C. Foto thorax
D. Nebulizer
E. Aminophyllin IV
F. Morphine iv
12 hrs after hospitalization BP
70/50, pulse 120x/min, temp 35.6,
Kussmaul breathing
What you should do ?
A. EKG
B. Blood Gas
C. Infuse rapidly with R/L
D. Dopamine/ dobutamine
E. Blood sugar
F. Profile hematology
Slides current until 2008
Hb: 16,3 , WBC: 17900/uL, Diff Leuco : -
/-/82/19/-, Trombo : 109.000. Malaria
falciparum: +++, 1100/ 200 WBC, bl.
Sugar: HI -,1015mg%, 900mg%, Bil.
Total:2.47, bil direct:1.15 mg%,ureum:
86.4 mg%, creatinine :2.87mg%, sodium:
124 meq/L, potassium: 6.3 meq/L
PRIORITY TREATMENT :
1) ( F.
2) ( A ..
3) ( I
4) .. ( A.