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 <4 yrs old

≥15 mm

No risk
factors b

Certain medical comorbidities
(e.g., diabetes mellitus,
silicosis, renal disease)
Member of a local high-risk
group based on local
epidemiology
Close contact with high-risk
adults a
Residence in a long-term care
facility or correctional
facility

adults: foreign-born persons from high-prevalence nations; residents or employees of high-risk
congregate settings (e.g., correctional facilities, homeless shelters, drug treatment centers).
b Ideally, persons without TB risk factors would not be tested according to American Thoracic Society
guidelines.


e-TABLE 94.17
MOST COMMON CLINICAL AND RADIOGRAPHIC FINDINGS IN
THE MOST COMMON SITES OF CHILDHOOD TUBERCULOSIS
DISEASE a