Page 135 - PJ MED OPS Handbook 8th Ed

Malaria

SPECIAL CONSIDERATIONS:
1. Malaria MUST be considered in all febrile patients currently in, or recently in, a malaria
area.
2. It is not uncommon for malaria to present like pneumonia or gastroenteritis (with vomit-
ing and diarrhea).
3. The use of chemoprophylaxis does not rule out malaria.
4. Consider bacterial meningitis in evaluating – treat for both disorders if meningitis is
suspected.

Signs and Symptoms:
1. Prodrome of malaise, fatigue, and myalgia may precede febrile paroxysm by several days.
2. Paroxysm characterized by abrupt onset of fever, chills, rigors, profuse sweats, headache, back-
ache, myalgia, abdominal pain, nausea, vomiting, and diarrhea (may be watery and profuse) in
P. falciparum.
3. Intermittent fever to >40°C (105°F) OR fever may be near continuous in P. falciparum malaria;
classic “periodicity” is usually absent. Profuse sweating between febrile paroxysms.
4. Tachycardia, orthostatic hypotension, tender hepatomegaly, and delirium (Cerebral malaria).

Management:
1. Malarone (atovaquone 250mg/proguanil 100mg) 4 tabs daily for 3 days with food PLUS
primaquine 30mg daily for 14 days (MUST rule out G6PD deficiency before giving primaquine).
2. Acetaminophen (Tylenol) 1,000mg PO q6hr PRN for fever.
DISPOSITION:
1. Urgent treatment and evacuation for complicated malaria (cerebral, pulmonary, unstable
vital signs). These indicate a medical emergency.
2. Routine evacuation for uncomplicated cases (normal vital signs, normal mental status,
tolerates PO, no cough/shortness of breath).

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 133