First of all congrats to our very first patch winners! In order of correct answer submission:
- Dennis Jarema
- Dave Schneider
When it comes to MALARiA, there are a few important points to consider (mostly based on this article):
- “An ounce of prevention is worth a pound of cure.” Don’t forget to about chemoprophylaxis, that is atovaquone/proguanil (aka Malarone®). It should be started 1 to 2 days prior to travel and continued throughout + 7 days after returning from Africa. Given it’s a mosquito-borne illness, therefore mosquito control and protection from mosquito bites are the mainstay of reducing malaria transmission. Anopheles mosquitos are active from dusk to dawn, so “patch that net hole today!“.
- The incubation period for malaria ranges from 1 to 4 weeks. Signs and symptoms of malaria at the outset of presentation can be very non-specific and include: fever, rigors (shaking chills), sweats, headache, myalgias, exhaustion, nausea, vomiting, and diarrhea.
- Patients with suspected malaria should be tested with a total of three blood smears or rapid diagnostic tests (RDT), one every 8 to 12 hours. Thick and thin blood smears should be obtained simultaneously. Many deployed providers have established relationships with local health clinics that employ a laboratory technician with extensive experience in malaria diagnosis. These relationships can be leveraged for confirmation of the rapid test results.
- Initial treatment for adult patients with uncomplicated malaria is artemether/lumefantrine (Coartem®). If atovaquone/proguanil (Malarone®) wasn’t used for prophylaxis, it can be utilized for treatment as well.
- The treatment of severe malaria for SOF forces in Africa is challenging. Only IV quinidine is (FDA)-approved, and it carries the risk of fatal dysrhythmias, so it should not be administered without adequate cardiac monitoring. IV artesunate is the drug of choice, but what’s widely available in Africa might be fake or not meeting Western quality standards. Therefore, the best plan is rapid evacuation to a USMTF where IV artesunate is available (e.g. LRMC in Germany). This scenario may require emergency treatment during evacuation, but these case-by-case decisions should be made in consultation with higher headquarters medical authorities.
- A valuable resource is the US (CDC) Malaria Hotline: during duty hours +1-770 488-7788 or after hours +1-770 488-7100.
- Lynch JH, et al. This is Africa. Bites, Stings, and Rigors: Clinical Considerations in African Operations. J Spec Oper Med. 2014;14(4):113-21.
- J Spec Oper Med. (2014). Advanced Tactical Paramedic Protocols Handbook (8th Edition, pp. 156). St. Petersburg, USA: Breakaway Media.