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Review of UK malaria treatment guidelines 2016 (Public Health England Advisory Committee on Malaria Prevention)
  1. Ceri Evans1,2,
  2. Felicity Fitzgerald3,4,
  3. Aubrey Cunnington4,5
  1. 1Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
  2. 2Blizard Institute, Queen Mary University of London, London, UK
  3. 3Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
  4. 4Department of Paediatric Infectious Diseases, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
  5. 5Section of Paediatrics, Imperial College London, London, UK
  1. Correspondence to Dr Felicity Fitzgerald, Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; felicity.fitzgerald{at}ucl.ac.uk

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Information about current guideline

This guideline covers the diagnosis and management of malaria, and was published in the Journal of Infection in June 2016.1 It was written by the Public Health England Advisory Committee on Malaria Prevention (PHE ACMP) based on review of available evidence and expert consultation (using a modified Grading of Recommendations Assessment, Development and Evaluation criteria for assessment of evidence and strength of recommendation), to be in line with WHO guidelines on management of malaria.2 It relates to malaria in both adults and children in the UK although here we focus on the diagnosis and management of children returning to the UK with suspected malaria. Malaria is the most common imported tropical pathogen in the UK, and children comprise about 10% of the 1300–1800 UK cases per annum. Plasmodium falciparum is by far the most common (around 75% of cases) and is associated with more severe disease.

Previous guideline

This guideline replaces the previous PHE ACMP UK malaria treatment guideline (2007),3 and suggested guidance/recommendations from Maitland et al4 which advocated more aggressive fluid resuscitation in severe malaria than now suggested.

Key issues that the guideline addresses

When to suspect malaria?

Malaria should be considered in any unwell or feverish child who has visited an endemic country regardless of whether prophylaxis was taken. P. falciparum usually presents within 1 month of exposure (minimum 6 days), although later presentations can occur. Other species may present over a year post-travel.

Clinical features

Malaria in children can be notoriously non-specific, even without fever. Although fever, malaise and lethargy are the most common symptoms, children can present with gastrointestinal symptoms (including diarrhoea), jaundice, breathing difficulties or sore throat. Examination may reveal hepatomegaly and/or splenomegaly and lethargy.

Diagnosis

Thick and thin blood films remain the gold standard for detection and speciation of malarial parasites, but rapid diagnostic tests (RDT) are almost as accurate for P. falciparum and P. vivax. …

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