OviattsOnTheGo: PALU !!!!

"Palu" is the shortened form of the French term for malaria, "paludisme". While the word "malaria" actually means "bad air", it is caused by a parasite transmitted by mosquitos. According to my trusty Oxford Handbook of Tropical Medicine, about 3 billion people live in at risk areas of the world including sub-Saharan Africa, parts of Southeast Asia, and parts of South America. There are 250 million cases each year and about 1 million deaths, many of those being in African infants and young children.

This time of the year is "malaria season" in sub-Saharan Africa - standing water left from the brief, recent rainy season has provided an incubation place for the Anopheles mosquitos. Every day here, many many children and infants come in extremely sick with malaria. They all have high fever, lethargy and anemia - commonly they come in with hematocrits of 8 to 20% (normal would be at least 35%). Most are not eating or drinking well and many are vomiting so at risk for dehydration. Some have cerebral ("brain") malaria and are nearly comatose and having seizures. Some have unmeasurably low blood sugars.

Children who come in like this have a GE test ("goutte epaisse" or "thick drop" blood smear to look for malaria parasites) and a hematocrit to see if they need a transfusion - we use a "cut-off" of 15% to order a transfusion. The blood here is matched for ABO and Rh type but the lab does not have the ability to do a formal crossmatch as is routine back home.

The good news is that most of these kids recover and go home, often in as little as 24 to 48 hours!!!! In addition to transfusion of blood, if needed, they receive daily intramuscular injections of a potent anti-malarial drug artemether. If there is any concern for a bacterial infection, the antibiotic ceftriaxone is added. Valium is given for seizures and concentrated dextrose if the blood sugar is too low. Fever is controlled with paracetamol (tylenol) and children hydrated by drinking ORS ("oral rehydration solution") which comes in packets that are mixed with water; if they can not drink, a nasogastric tube is placed to give the ORS; intravenous fluids are only given in the minority of cases.

Typically, after the initial doses of treatment +/- a transfusion, children are MUCH better - last week I admitted a young boy who was limp and critically ill but the next day, he looked bored and was playing with his mother's cellphone!! At discharge, children are given 3 days of an oral anti-malarial prescription to complete their treatment, amoxicillin if felt necessary, a few days of acetaminophen, and some vitamin/iron tablets. .......all of the children below presented with severe malaria and went home much improved - praise God!!

The Oxford Handbook of Tropical Medicine has been on
every trip we have made to mission hospitals. It is concise and easily fits into the "carpenter's apron" that we carry with our "tools" on our daily rounds and in the clinic. Like the old commercial for the American Express card, "don't leave home without it!" We also carry the reference UpToDate on our kindle/tablets.