Out of all the plasmodium species though plasmodium falciparum is known for causing the worst infections, most plasmodium infected red blood cells get screened and destroyed by the spleen, plasmodium falciparum though avoid this fate by generating a sticky protein that coats the surface of the infected red blood cells and these look like knobs or little bumps, this protein causes the red blood cells to clump together and jam up tiny blood vessels, a process known as saito adherence, this literally blocks the flow of blood so that infected cells aren’t able to flow into the spleen and it also blocks blood flow from reaching other vital organs which can wreak havoc on them between hemolytic anemia and ischemic damage, from blocked blood flow organ failure can set in pretty quickly, when the brains affected it’s termed cerebral malaria and it results in altered mental status seizures and coma, when the livers affected its term bilious malaria and it results in diarrhea, vomiting, jaundice and liver failure. Other commonly affected organs include the lungs, the kidneys, and the spleen which taken together create a sepsis like clinical picture that can eventually lead to death. Together all these scenarios are called complicated malaria.

Malaria is usually diagnosed with a thick blood smear that locates parasites sitting within the red blood cells and a thin blood smear which directly identifies the plasmodium species, it’s also important to know the percentage of red blood cells infected by a parasite because patients with greater than 5% parasite amia can have worse outcomes, some common lab findings include thrombocytopenia which is a low platelete count elevated lactate dehydrogenase levels due to hemolysis and a normal chromic, normal acidic type of anemia meaning that the red blood cells are few in number but those that remain are of normal size in color, treatment for malaria is generally divided into the different stages of infection suppressive treatment or chemo prophylaxis is aimed at killing sporozoites before they infect hepatocytes, so it’s usually given to travelers that are headed to a country with endemic malaria. There are treatments aimed at eliminating the parasites which resides in the urethra siddik phase so it’s usually given during an active infection, the exact medication or a group of medications that are used to treat an active infection depends largely on the severity of the infection, the age and pregnancy status of the patient, the local malarial resistance pattern which depends on the geography and the Plasmodium species causing the infection.

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