• For returning traveler, must think about:
  • Geography - where they went and what is endemic there
  • Incubation period
  • What vaccinations they have had
  • Exposures while there - including water, mosquitos, etc.
  
  

  Posted 08/31/16 10:18:24 AM by Anna Krigel

• Vaccinations required for travel to Ghana:
  • All routine vaccinations
  • Yellow fever
  • Hepatitis A
  • Typhoid
  • Malaria prophylaxis
  • Meningitis - Ghana is part of the "meningitis belt" and requires vaccination in dry season (December - June)
  
  

  Posted 08/31/16 10:22:19 AM by Anna Krigel

• Diagnosis of malaria:
  • Detection of parasites by light microscopy on Giemsa-stained blood smears (prepared thick and thin)
    • Parasite density is determined and monitored on smear, can correlate with disease severity
    • Parasite species is identified on smear (P. falciparum, P. vivax, O. ovale, P. malariae)
  • Rapid diagnostic tests - detect one or more malaria parasite antigens (histidine-rich protein 2, Plasmodium LDH, or aldolase)
  
  

  Posted 08/31/16 10:32:36 AM by Anna Krigel

• Malaria prophylaxis in P. falciparum-resistant areas:
  • atovaquone-proguanil - daily, more expensive than mefloquine, more desirable side effect profile
  • mefloquine - weekly, less expensive but can cause vivid dreams
  • doxycycline - daily, can cause sun sensitization, least expensive
  
  

  Posted 08/31/16 11:02:01 AM by Anna Krigel

• For further reading...

  Guidelines for treatment of malaria in the United States (CDC)
  
  

  Posted 08/31/16 11:04:36 AM by Anna Krigel

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