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When can one assert that someone has the disease "malaria"? There are several problems and the question has still not been fully resolved. The demonstration of malaria parasites in the blood is essential, but insufficient in itself. Most cases are accompanied by thrombocytopenia and normal white count. Many people will develop an acquired immunity after several years of exposure, and may harbor parasites without exhibiting symptoms. The degree of parasitemia may help, but there is no absolute criterion (the higher the parasitemia, the more chance that malaria is in fact the diagnosis). There are patients with malaria for whom the thick smear is negative (luckily this is rare in a good laboratory). There are no pathognomonic clinical signs. An accurate diagnosis is becoming more and more important, in view of the increasing resistance of P. falciparum and the higher price of modern combinations.

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