Bronchial Malaria: Clarification of Terminology
There is no medical entity called "bronchial malaria" or "bronchi malaria." The question appears to conflate two separate conditions: malaria (a parasitic infection) and bronchial/respiratory diseases. I will address malaria diagnosis and management, as this is likely what was intended.
Diagnostic Approach to Malaria
Thick and thin blood smears with Giemsa stain are the gold standard for malaria diagnosis, allowing species identification and quantification of parasitemia. 1, 2
Key Diagnostic Steps:
- Obtain three blood smears at 12-hour intervals if initial testing is negative, as a single negative smear does not exclude malaria 3
- Rapid diagnostic tests (RDTs) provide results within 15 minutes with sensitivity for P. falciparum ranging from 67.9% to 100% 4
- When laboratory facilities are unavailable, clinical symptoms (paroxysmal fever, chills, sweats, headache) and measured fever are the best predictors of infection 1, 4
Critical Diagnostic Pitfall:
The presence of Plasmodium on blood smears does not definitively prove malaria is the cause of febrile illness—other causes including pneumonia, acute lower respiratory infection, or meningitis must be ruled out 1, 4
Clinical Symptoms of Malaria
Initial Presentation:
- Fever (cardinal feature) with chills, sweats, and rigors 1, 3, 5
- Headache, body aches, and malaise 1, 3
- Gastrointestinal symptoms: nausea, vomiting, diarrhea 3, 5
- Cough may be present 4, 3
Physical Examination Findings:
- Splenomegaly (likelihood ratio 6.6 for diagnosis) 3
- Visible jaundice may be present 3
- Hepatomegaly in some cases 6
Laboratory Abnormalities:
- Thrombocytopenia (<150,000/mL) occurs in 70-79% of patients and is the most frequent biological anomaly 3, 6
- Hyperbilirubinemia 6
- Anemia in severe cases 7
Management of Uncomplicated Malaria
For P. falciparum Malaria:
Oral artemisinin-based combination therapy (ACT) is first-line treatment for uncomplicated P. falciparum malaria in chloroquine-resistant areas. 1, 2, 7, 8
- In chloroquine-sensitive regions (e.g., Haiti): chloroquine 1,500 mg total dose over 3 days (600 mg at 0 hours, 600 mg at 24 hours, 300 mg at 48 hours) 1, 4, 7
- Monitor clinical improvement and parasite clearance throughout treatment 1, 2
For P. vivax and P. ovale Malaria:
Either chloroquine or oral ACT can be used, PLUS an 8-aminoquinoline drug (primaquine or tafenoquine) must be added to eliminate liver hypnozoites. 1, 2, 4
- Primaquine dosing: 15 mg daily for 14 days (adults) or 0.3 mg/kg/day (children) 1, 4
- G6PD testing is mandatory before primaquine administration to prevent potentially life-threatening hemolysis 2, 4
Management of Severe Malaria
Criteria for Severe Malaria:
Severe malaria requires immediate ICU admission and IV artesunate when ANY of the following are present: 1, 2, 7
- Impaired consciousness or coma
- High parasitemia (>2% in non-immune patients, >5% in semi-immune)
- Metabolic acidosis (lactate >7 mmol/L, bicarbonate <14 mmol/L)
- Hypoglycemia (<49 mg/dL)
- Renal impairment (creatinine >1.48 mg/dL)
- Severe anemia (hemoglobin <10.9 g/dL)
- Respiratory distress or pulmonary edema
- Shock or hypotension
Treatment Protocol:
Intravenous artesunate is the first-line therapy for severe malaria, administered at 2.4 mg/kg at 0,12,24, and 48 hours. 1, 2, 7, 8
- Switch to oral ACT after three doses of IV artesunate when parasite levels are <1% 1, 2
- Monitor parasitemia every 12 hours until decline to <1%, then every 24 hours until negative 1, 2
- Daily monitoring of complete blood count, hepatic function, renal function, glucose, and blood gas analysis 1, 2
- Screen for delayed hemolysis on days 7,14,21, and 28 after artesunate treatment 1, 2
Special Populations and Critical Considerations
Pregnant Women:
Pregnant women with malaria require aggressive treatment using standard adult regimens—both chloroquine and quinine are safe during pregnancy. 1, 4
Timing of Treatment:
When malaria is suspected, administer the first dose of antimalarial medication when the blood smear is taken—do not delay treatment while awaiting species identification. 2, 4
Common Pitfalls to Avoid:
- Do NOT use corticosteroids—they have adverse effects on outcomes in cerebral malaria 2, 4
- Administer fluids carefully to prevent pulmonary edema and worsening cerebral edema 2
- Use 5% dextrose with half-normal saline as preferred IV fluid to prevent hypoglycemia while minimizing salt leakage 2
- Do NOT transfuse platelets for thrombocytopenia—it resolves spontaneously with effective antimalarial treatment 2
Respiratory Complications:
Patients with P. falciparum malaria can develop acute respiratory distress syndrome (ARDS) even as parasitemia resolves, requiring close monitoring and potential ICU transfer. 9