Topic: Antimalaria, Antikala-azar, Antidiabetics
Question: A 30 years old male patient admitted to hospital with a complaint of fever with chills since 5 days. Severe headache and yellowish discolouration of conjunctiva present.He is drowsy and irritable. Peripheral smear shows gametocytes of plasmodium falciparum. He is using chloroquine since onset of fever but fever not subsided.
• What is the diagnosis of the clinical condition
• Classify drugs used in malaria
• Describe the management of above condition
• Mention two regimens of artemisinin based combination therapy
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You’re absolutely right, my previous responses did not fully address all aspects of the question. Let me provide a comprehensive, detailed answer covering all the sections:
1) Diagnosis:
- Severe falciparum malaria based on:
- History of 5 day fever with chills
- Clinical findings of severe headache, altered sensorium, jaundice
- Peripheral smear demonstrating P. falciparum gametocytes
- Not responding to oral chloroquine
- Fulfills WHO criteria for severe malaria
2) Classification of antimalarial drugs:
A. Tissue Schizonticides: Act on intrahepatic forms during liver stage:
- Chloroquine
- Hydroxychloroquine
- Quinine
- Mefloquine
- Amodiaquine
B. Hypnozoitocides: Act on persistent hepatic forms:
- Primaquine
- Tafenoquine
C. Blood Schizonticides: Act on erythrocytic asexual forms:
- Artemisinin derivatives – Artesunate, artemether, artemotil
- Quinine, quinidine
- Mefloquine
- Atovaquone
- Pyronaridine
- Piperaquine
D. Antifolates: Inhibit folate synthesis pathways:
- Proguanil
- Pyrimethamine
- Sulfadoxine
3) Management:
A. Emergency (first 24 hours):
- IV artesunate 2.4 mg/kg stat followed by at 12 and 24 hours, then daily
- Monitoring of vitals, blood glucose, electrolytes every 4-6 hours
- Fluid resuscitation if shock
- Treat seizures, malaria encephalopathy, respiratory failure
B. Supportive care:
- Cautious hydration, transfusion if severe anemia
- Nutritional support with NG feeds when stable
- Antibiotics if evidence of bacterial sepsis
- Monitoring and nursing care to prevent complications
C. Complete treatment:
- Once stable, complete treatment with 3 day ACT like artemether-lumefantrine
- Add primaquine to clear gametocytes
4) Artemisinin combination therapy:
- ACT combines an artemisinin derivative with a partner drug from another antimalarial class.
- The artemisinin component provides rapid clearance of parasites by reducing parasite burden quickly. This helps resolve clinical symptoms faster.
- The partner drug has a longer duration of action and helps eliminate remaining parasites. This prevents recrudescence.
- The artemisinin derivatives used are artesunate, artemether, and dihydroartemisinin. They act by generating free radicals which damage parasite proteins and membranes.
- Partner drugs include lumefantrine, amodiaquine, piperaquine, mefloquine. They have different mechanisms like inhibiting heme polymerization or folate synthesis.
- The WHO recommends 5 types of ACT for uncomplicated P.falciparum malaria:
- Artemether-lumefantrine
- Artesunate-amodiaquine
- Artesunate-mefloquine
- Dihydroartemisinin-piperaquine
- Artesunate-sulfadoxine-pyrimethamine
- The dosage schedule depends on the specific ACT regimen used. Most are 3 day treatments.
- ACT is well-tolerated with minimal adverse effects like nausea, headache, dizziness. Much safer than quinine and quinidine.
- ACT has helped reduce malaria morbidity and mortality where implemented. But resistance to artemisinins emerging in SE Asia threatens efficacy.
Title: UPSC Medico Test Series: The Ultimate Guide to Cracking the UPSC CSE
Introduction:
The UPSC Civil Service Examination (CSE) is one of the most competitive exams in India. Every year, lakhs of candidates appear for the exam, but only a few thousand are selected. If you are a medical graduate and planning to take the UPSC CSE, then you need to take a UPSC medico test series.
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How to choose a UPSC medico test series:
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Conclusion:
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I hope this article has been helpful. Good luck with your preparation for the UPSC CSE exam!
