Malaria in Children: Model Clinical Case and Viva Q&A

Clinical Case of Malaria in Children

Case: Severe Malaria in a 4-year-old Child

A 4-year-old boy is brought to the emergency department by his parents with a 3-day history of high fever, lethargy, and decreased appetite. The family had recently returned from a 2-week vacation in sub-Saharan Africa.

Clinical Presentation:

  • Temperature: 39.8°C (103.6°F)
  • Heart rate: 130 bpm
  • Respiratory rate: 32 breaths/min
  • Blood pressure: 85/50 mmHg
  • Oxygen saturation: 94% on room air

Physical examination reveals:

  • Pallor
  • Mild jaundice
  • Hepatosplenomegaly
  • Decreased level of consciousness (Glasgow Coma Scale: 12)

Laboratory Findings:

  • Complete blood count: Hemoglobin 7.2 g/dL, Platelets 45,000/µL
  • Blood smear: P. falciparum parasitemia (8% of RBCs infected)
  • Blood glucose: 54 mg/dL
  • Serum creatinine: 1.2 mg/dL
  • Total bilirubin: 3.5 mg/dL

Diagnosis:

Severe malaria caused by Plasmodium falciparum

Management:

  1. Admission to pediatric intensive care unit
  2. Intravenous artesunate: 2.4 mg/kg at 0, 12, and 24 hours, then daily
  3. Fluid resuscitation and maintenance
  4. Glucose monitoring and correction of hypoglycemia
  5. Blood transfusion (packed red blood cells)
  6. Close monitoring of vital signs, urine output, and neurological status
  7. Supportive care as needed

Outcome:

With prompt treatment, the child's condition improved over the next 72 hours. Parasitemia cleared, fever resolved, and consciousness returned to normal. The patient was discharged after 7 days with oral antimalarial medication to complete the course.



Different Presentations of Malaria in Children

Varieties of Clinical Presentations of Malaria in Children

Malaria in children can present with a wide spectrum of clinical manifestations, ranging from mild febrile illness to life-threatening complications. Early recognition and prompt treatment are crucial in preventing severe outcomes.

  1. Uncomplicated Malaria

    Common symptoms seen in children with mild malaria:

    • Fever (intermittent or continuous)
    • Chills and rigors
    • Headache
    • Myalgia (muscle pain)
    • Fatigue and malaise
    • Nausea and vomiting
    • Abdominal pain
    • Mild anemia
    • Splenomegaly (enlarged spleen)

  2. Cerebral Malaria

    A severe form of malaria characterized by neurological involvement:

    • Impaired consciousness or coma (Blantyre Coma Scale <3)
    • Seizures (focal or generalized)
    • Focal neurological deficits
    • Retinal changes (retinal whitening, vessel abnormalities, hemorrhages)
    • Abnormal posturing (decerebrate or decorticate rigidity)

  3. Severe Malarial Anemia

    A common cause of severe illness, particularly in young children:

    • Severe pallor (pale skin and mucous membranes)
    • Tachycardia (rapid heart rate)
    • Tachypnea (rapid breathing)
    • Lethargy or irritability
    • Hemoglobin <5 g/dL or hematocrit <15%
    • Possible heart failure in extreme cases

  4. Respiratory Distress Syndrome

    Severe malaria can cause lung complications:

    • Deep, labored breathing (indicative of acidosis)
    • Intercostal retractions
    • Use of accessory muscles for breathing
    • Nasal flaring
    • Pulmonary edema (fluid in the lungs)

  5. Metabolic Acidosis

    Occurs due to hypoxia and severe malaria:

    • Deep, labored breathing (Kussmaul respiration)
    • Lethargy and confusion
    • Persistent vomiting
    • Altered mental status

  6. Hypoglycemia

    Can be a life-threatening complication, particularly in young children:

    • Altered consciousness or coma
    • Sweating
    • Tachycardia
    • Seizures

  7. Acute Kidney Injury (AKI)

    Renal involvement in severe malaria:

    • Oliguria (reduced urine output) or anuria (no urine output)
    • Generalized edema
    • Elevated serum creatinine and blood urea nitrogen (BUN)

  8. Jaundice and Hepatic Dysfunction

    Malaria can cause liver dysfunction, leading to:

    • Yellow discoloration of sclera and skin (jaundice)
    • Right upper quadrant tenderness
    • Hepatomegaly (enlarged liver)
    • Elevated liver enzymes and bilirubin

  9. Disseminated Intravascular Coagulation (DIC)

    A severe complication leading to widespread clotting and bleeding:

    • Bleeding from multiple sites (nose, gums, IV sites)
    • Petechiae (small red spots due to bleeding under the skin)
    • Purpura (purple skin patches)
    • Prolonged clotting times (PT, aPTT)

  10. Algid Malaria (Shock)

    Characterized by circulatory collapse due to septic-like syndrome:

    • Hypotension (low blood pressure)
    • Cold, clammy skin
    • Weak or thready pulse
    • Decreased urine output (oliguria)

Rare Presentations

  • Blackwater Fever: Severe intravascular hemolysis causing dark urine, anemia, and renal failure.
  • Splenic Rupture: Rare but potentially fatal due to spontaneous rupture of an enlarged spleen.
  • Hyperparasitemia: High levels of parasitemia (>5%) leading to multi-organ failure.

Conclusion: Malaria in children requires a high index of suspicion, as early detection and appropriate treatment are crucial in preventing severe complications and mortality.





Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

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The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.



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