Treatment of Monocytosis and Lymphocytosis in Malaria

Understanding Monocytosis and Lymphocytosis in Malaria

Monocytosis in malaria is often associated with the presence of malaria pigment in monocytes, which can be a diagnostic marker even when blood films are negative 1
Examination of monocytes should be part of the diagnostic workup for any patient returning from malaria-endemic areas 1
These hematological changes are part of the immune response to the infection and typically resolve with effective antimalarial treatment 1

The American Society of Tropical Medicine and Hygiene recommends Artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated P. falciparum malaria 2, 3
The Centers for Disease Control and Prevention recommends chloroquine as first-line treatment for P. vivax or P. ovale malaria, with a dosage of 1000 mg salt initially, then 500 mg at 6, 24, and 48 hours 3
The World Health Organization recommends primaquine (30 mg base daily for 14 days) after G6PD testing for radical cure of P. vivax or P. ovale malaria 3

The Infectious Diseases Society of America recommends intravenous artesunate as first-line treatment for severe malaria, with a dosing regimen of 2.4 mg/kg IV at 0, 12, and 24 hours, then daily until oral therapy can be started 2, 3
The Centers for Disease Control and Prevention recommends intravenous quinine dihydrochloride as second-line treatment for severe malaria, with an initial dose of 20 mg/kg over 4 hours, followed by 10 mg/kg every 8 hours 4, 5

The American Society of Tropical Medicine and Hygiene recommends checking parasitemia every 12 hours until decline to <1%, then every 24 hours until negative 6
The Infectious Diseases Society of America recommends monitoring complete blood count to track resolution of monocytosis and lymphocytosis 6

The Centers for Disease Control and Prevention recommends treating pregnant women with malaria aggressively using appropriate regimens 7
The World Health Organization recommends weight-based dosing of antimalarials for children 4, 7
The American Society of Tropical Medicine and Hygiene recommends using ACTs in areas with chloroquine resistance for all Plasmodium species 3