TEALE FENNING

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

Regarding Congenital Malaria

In some newborns who are parasitemic at birth, the parasites spontaneously clear without the newborn ever becoming ill.
This clearance has been attributed to the

Clearance rates in endemic areas have been reported to be high, ranging from 87% to 100%.

Conversely, some newborns without detectable Plasmodium organisms at birth later develop clinical malaria.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

Pregnant women more susceptible than nonpregnant women to malaria, susceptibility greatest in first and second pregnancy.

Both P.falciparum and vivax cause adverse pregnancy outcomes, including

maternal anaemia , LBW due to PTD and FGR, but
mechanisms could differ.

Susceptibility to pregnancy-associated malaria

combination of immunological and hormonal changes of pregnancy (although the nature of the latter is the subject of debate), combined with the unique ability of a subset of infected erythrocytes to sequester in
the placenta.

Antibodies directed against the surface of infected erythrocytes in
the placenta are important in protection, and are usually absent in first pregnancy

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

chronic infection

most closely associated with decreased birthweight due to fetal growth restriction,

whereas

acute infection (especially with high parasitaemia)

more closely
associated with preterm delivery

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

Regarding donors for blood transfusion

These criteria are supported by observations that 97% and 99% of reported malaria cases in U.S. and foreign civilians occur within 1 and 3 years, respectively, of having been in a malarious area (CDC, unpublished data, 1995).

Persons who emigrate from highly malarious areas and have acquired malarial immunity may have asymptomatic parasitemia that can persist for varying periods, depending on the species. P. falciparum rarely. persists longer than 2 years, although it has persisted for up to 13 years P. malariae can persist asymptomatically in the blood at low levels for up to 40 years. Therefore, rare cases of transfusion-transmitted malaria will continue to occur despite correct application of donor exclusion criteria.

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

Pregnant women with uncomplicated malaria caused by P. malariae, P. vivax, P. ovale, or chloroquine-sensitive P. falciparum infection

Chloroquine(treatment schedule as with non-pregnant adult patients), 2nd line alternative for treatment :hydroxychloroquine

Pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. falciparum infection

quinine sulfate and clindamycin
Quinine treatment for 7 days for infections acquired in Southeast Asia and for 3 days for infections acquired in Africa or South America
Clindamycin treatment for 7 days regardless of where the infection was acquired.

Pregnant women diagnosed with uncomplicated malaria caused by chloroquine-resistant P. vivax infection

quinine for seven days is recommended regardless of where the infection was acquired. No adequate, well-controlled studies to support the addition of clindamycin to quinine when treating chloroquine-resistant P. vivax infections.

Ref: CDC

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

Doxycycline and tetracycline are generally not indicated for use in pregnant women. (Rare instances, doxycycline or tetracycline can be used in combination with quinine if other treatment options are not available or are not being tolerated, and the benefit of adding doxycycline or tetracycline is judged to outweigh the risks)

Atovaquone/proguanil

pregnancy category C medication and is generally not indicated for use in pregnant women. However, for pregnant women with uncomplicated malaria by chloroquine-resistant P. falciparum infection, atovaquone-proguanil may be used if other treatment options are not available or are not being tolerated, and if the potential benefit is judged to outweigh the potential risks. There are no data on the efficacy of atovaquone/proguanil in the treatment of chloroquine-resistant P. vivax infections.

Mefloquine

pregnancy category C medication and is generally not indicated for treatment in pregnant women. Mefloquine has not been associated with an increased risk of congenital abnormalities; however, a possible association with increase in stillbirths. CDC

mefloquine only when no other treatment options are available and if the potential benefit is judged to outweigh the potential risks.

Ref: CDC

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

For P. vivax or P. ovale infections, primaquine phosphate for radical treatment of hypnozoites should not be given during pregnancy.

Pregnant patients with P. vivax or P. ovale infections should be maintained on chloroquine prophylaxis for the duration of their pregnancy. The chemoprophylactic dose of chloroquine phosphate is 300mg base (=500 mg salt) orally once per week.

After delivery, pregnant patients with P. vivax or P. ovale infections who do not have G6PD deficiency should be treated with primaquine.

Pregnant women diagnosed with severe malaria should be treated aggressively with parenteral antimalarial therapy.

Ref:CDC

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 792

Literature on their use in pregnancy has been limited and animal studies have suggested that their use in pregnancy be restricted.

Presently, artemisinin compounds cannot be recommended for treatment of malaria in the first trimester. However, they should not be withheld if treatment is considered to be lifesaving for the mother and other antimalarials are considered to be unsuitable.

Malaria can be particularly hazardous during pregnancy. Artemisinin and its derivatives are therefore the drugs of choice for severe malaria and can be used for treatment of uncomplicated malaria during the second and third trimester of pregnancy in areas of multiple drug resistance. Owing to lack of data, their use in the first trimester is not recommended.

Published data on 607 pregnancies in which artemisinin compounds were given during the second or third trimesters no evidence of treatment-related, adverse pregnancy outcomes. Similar data show normal outcomes in 124 pregnancies exposed to artemisinin compounds in the first trimester. These numbers are too small to provide an adequate profile of the safety of these compounds when used to treat malaria in pregnancy.

In animal studies with artemisinin compounds, there is clear evidence of death of embryos and some evidence for morphological abnormalities in early pregnancy.
There is also some evidence for adverse effects on fetal body weight and survival when the drug is given later in pregnancy.

Safety data are limited, artemisinin compounds should only be used in the second and third trimesters when other treatments are considered unsuitable.

Ref: WHO