227.2 📚 國考版

227.2.0.1 必背 — 5 Plasmodium Species

Species Geography Severe? Hypnozoite Cycle
P. falciparum Africa primary Most severe No Irregular
P. vivax Asia + Latin America Moderate Yes (relapse) Tertian (48h)
P. ovale W + C Africa Mild Yes (relapse) Tertian (48h)
P. malariae Worldwide patchy Mild, chronic No (but persistent) Quartan (72h)
P. knowlesi SE Asia (Borneo) Severe possible No 24-hour (fastest)

227.2.0.2 必背 — Vector + Life Cycle

  • Anopheles mosquito (female only)
  • Sporozoite → hepatocyte → merozoite → RBC cycle (fever paroxysm) → gametocyte → mosquito
  • Hypnozoites in liver for P. vivax/ovale (relapse)

227.2.0.3 必背 — Severe Malaria Criteria

  • Cerebral malaria (GCS < 11)
  • Severe anemia (Hb < 7)
  • AKI (Cr > 3)
  • ARDS / pulmonary edema
  • Severe acidosis (pH < 7.25)
  • Hypoglycemia (< 40)
  • Shock, DIC, bleeding
  • Jaundice, hemoglobinuria
  • Hyperparasitemia (> 5% non-immune)

227.2.0.4 必背 — Treatment Severe Malaria

  • IV Artesunate drug of choice
  • 2.4 mg/kg at 0, 12, 24 hr then daily
  • Switch to oral ACT when tolerating PO
  • Mortality reduction vs quinine (AQUAMAT 22% vs 39%)
  • No steroid (worsens cerebral malaria)

227.2.0.5 必背 — Uncomplicated Treatment

  • ACT (Artemisinin Combination Therapy) = first-line
  • Artemether-lumefantrine (Coartem) most common
  • 3-day course

227.2.0.6 必背 — P. vivax/ovale Radical Cure

  • Primaquine 30 mg × 14 d OR Tafenoquine 300 mg × 1
  • G6PD test required (severe hemolysis if deficient)
  • Pregnancy contraindicated

227.2.0.7 必背 — Prophylaxis (Travelers)

  • Malarone (daily, 1 d before to 7 d after)
  • Doxycycline (daily, 1 d before to 4 wk after)
  • Mefloquine (weekly, 2 wk before to 4 wk after)
  • Chloroquine (only chloroquine-sensitive regions)
  • Tafenoquine (weekly, G6PD test required)

227.2.0.8 必背 — Vaccines

  • RTS,S/AS01 (Mosquirix) — WHO 2021 recommendation, 4-dose, 36% severe reduction
  • R21/Matrix-M (Oxford) — WHO 2023, 75% efficacy, lower cost, mass rollout 2024

227.2.0.9 必背 — Diagnosis

  • Thick + thin blood smears gold standard
  • Repeat q12-24h × 3 if first negative
  • RDTs: PfHRP-2 (P. falciparum) + pLDH (pan)
  • PCR for species ID + P. knowlesi differentiation

227.2.0.10 必背 — Resistance

  • Artemisinin resistance SE Asia (kelch13) — surveillance critical
  • Chloroquine resistance widespread P. falciparum

227.2.0.11 必背 — Thrombocytopenia

  • Very common in malaria
  • Often disproportionate to anemia
  • Marker of severity in some