| All patients of malaria should be subjected to a repeat blood
smear examination on the sixth post-treatment day. It gives valuable information on the
response to treatment and helps to identify early recrudescence in cases of P.
falciparum infection. A negative smear generally suggests clearance of parasitemia
and hence cure. A positive smear should be examined and interpreted carefully and if
needed, a second opinion can be taken before deciding on treatment, particularly as
resistant malaria. It is better to rely on a blood smear examination rather than the QBC
test for species and stage identification. In case of P. falciparum infection, repeat smear should be done
on the 28th day after treatment. In all doubtful situations, repeat smear can be done
every week, i.e. on the 6th, 14th, 21st and 28th days after treatment.
Interpretation of the 6th day Follow-up smear: A flow chart |
Original P. vivax infection |
Original P. falciparum/mixed infection |
|
 |
 |
|
|
|
Negative |
Positive |
Negative |
Positive |
|
|
|
|
|
|
|
|
Cured |
P. vivax |
P. falciparum |
Cured |
Rings |
Gameto cytes |
|
|
|
|
|
|
Indicates partial response to chloroquine therapy. In all such cases,
re-treatment with chloroquine + pyrimethamine/ sulpha. + Primaquine is necessary. |
Common to find gameto- cytes of P. falciparum on the 6th
day smear; does not require any treatment if the patient has already received the
single dose of primaquine. |
| Rings |
Gameto cytes |
Gameto cytes |
Rings |
|
1.
Patient may have received incomplete treatment due to ignorance/ poor compliance/vomiting.
2. It could be P. falciparum malaria; verify again or repeat thin smear and take
second opinion on species.
3. Rarely, it may be a case of chloroquine resistant vivax malaria. |
Could
be inactive gametocytes, leave alone and repeat the test at 28 days. |
Presence of P. falciparum gametocytes
indicates a mixed infection; if afebrile, leave alone and repeat the test after 28 days. |
Presence
of P. falciparum rings indicates a mixed infection and possible drug resistance in
P. falciparum |
|
|
