Pediatric emergency medicine trisk 596

Species Predominant region P falciparum Africa Indian subcontinent Papua New Guinea Southeast Asia Southern Central America Northern South America Haiti P malariae Sub-Saharan Africa Southeast Asia Complications Hypoglycemia: the most common complication of severe malaria; symptoms of hypoglycemia can be difficult to differentiate from malaria symptoms (altered mentation, diaphoresis, tachycardia) Cerebral malaria: altered mentation, seizures, encephalopathy, retinal hemorrhages; focal neurologic signs are rare; CSF demonstrates mild pleocytosis, slightly elevated CSF protein, and very low CSF glucose Respiratory distress can be caused by noncardiogenic pulmonary edema/ARDS (due to malaria itself or fluid overload after resuscitation) or to compensatory respiratory alkalosis to compensate for metabolic acidosis Renal failure (acute tubular necrosis, interstitial nephritis, glomerulonephritis; “blackwater fever” with urinary discoloration from hemoglobinuria) Shock: hypovolemic and/or due to severe anemia Hepatic dysfunction: icterus with or without hepatorenal syndrome; coagulopathy, transaminitis, cholestasis, and both conjugated and unconjugated hyperbilirubinemia may be seen Congenital malaria: risk is increased in mothers with HIV infection Anemia Chronic asymptomatic parasitemia Nephrotic syndrome P ovale P vivax Western Pacific islands Amazon basin West Africa Anemia Philippines Hypersplenism may be seen in healthy individuals in endemic areas as a Papua New consequence of serial infections; over Guinea time, the spleen may autoinfarct Eastern Indonesia Hypersplenism is more common in nonimmune persons with malaria Relapse (persistent hepatic stage) requires primaquine for cure Western Mexico, Anemia Central and Hypersplenism South America Congenital malaria North and East Relapse (persistent hepatic stage) requires Africa primaquine for cure Middle East Indian subcontinent Papua New Guinea Southeast Asia (rare in SubSaharan Africa) CSF, cerebrospinal fluid; ARDS, adult respiratory distress syndrome e-TABLE 94.16 TUBERCULIN SKIN TEST INDURATION CONSIDERED POSITIVE BASED UPON EPIDEMIOLOGIC OR OTHER RISK FACTORS ≥5 mm Contact with persons with infectious TB Child with an abnormal radiograph or in whom tuberculosis disease is suspected HIV infected or other immunocompromised patient a High-risk ≥10 mm Birth or residence in a highprevalence nation Age