Pediatrics in Review
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 Vol. 27 No. 9, September 2006
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(Pediatrics in Review. 2006;27:346-350.)
© 2006 American Academy of Pediatrics

Consultation with the Specialist: Malaria Prophylaxis in Children


Holly D. Maples, PharmD*
Gordon E. Schutze, MD{dagger}
 * Department of Pharmacy Practice, College of Pharmacy; Department of Pediatrics, Division of Pharmacology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark
{dagger} Professor of Pediatrics, Section of Retrovirology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Tex

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Differentiate among the four species of Plasmodium.
  2. Recognize the life cycle stages of the malaria parasite.
  3. Identify the geographic areas endemic for chloroquine-sensitive and chloroquine-resistant malaria.
  4. Identify the appropriate chemoprophylactic regimen(s) for malaria in areas with and without chloroquine resistance.
  5. Recognize the site of action of the chemoprophylactic agents in the life cycle of the parasite.
  6. List nonchemoprophylactic prevention strategies for malaria.


   Case Report
 
An 8-year-old girl weighing 25 kg presented at the clinic with a 2-day history of fever, chills, malaise, fatigue, cough, and one episode of vomiting. The child had been born in Nigeria, immigrated to the United States at the age of 2 years, and just returned 5 days ago from a 3-week visit to Nigeria with her parents. Two weeks prior to travel, the entire family had been prescribed weekly chloroquine for malaria chemoprophylaxis. The girl had taken the initial 250-mg dose of chloroquine and subsequently had followed the weekly regimen; she took the last dose the day she presented to the clinic. The clinician initially diagnosed the girl with an upper respiratory tract infection along with nausea and vomiting and prescribed an oral cephalosporin antibiotic and an antiemetic agent. However, the girl’s symptoms continued, and 4 days later she collapsed, was transported to a local hospital, and died in the emergency department. Examination of a peripheral blood film on stored blood from the clinic visit and a film from blood taken in the emergency department demonstrated Plasmodium falciparum parasites. A blood sample taken postmortem revealed a chloroquine level of 1,800 ng/mL whole blood, a level consistent with recent ingestion of chloroquine and sufficient to inhibit P falciparum parasites sensitive to the drug.


   Introduction
 
Malaria is the world’s most important and devastating parasitic disease, affecting more than 300 million . . . [Full Text of this Article]






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