Categories: disorders

Malaria: Causes, Symptoms, Management and Prevention

Malaria

Hippocrates and Malaria

Hippocrates, a physician born in ancient Greece, today regarded as the “Father of Medicine”, was the first to describe the manifestations of malaria, and relate them to the time of year and to where the patients lived.

Nobel Prizes in Malaria

The discovery of this parasite in mosquitoes earned the British scientist Ronald Ross the Nobel Prize in Physiology or Medicine in 1902. In 1907, Alphonse Lavern received the Nobel prize for his findings of the malaria parasite that was present in human blood.

Introduction

  • It is also called Parasitic disease.
  • This is a Vector-borne infectious disease.
  • Oldest disease.
  • Hundreds of millions of illnesses occur due to this disease.
  • A million deaths each year happen due to malaria.
  • This is endemic in most of the tropic areas of the world.
  • Transmission, morbidity, and mortality are greatest in AFRICA.
  • Female ANOPHELINE mosquitoes are responsible for causing this disease.
  • This is very common in travelers.

Alternative names of malaria

  • Falciparum malaria
  • Biduoterian fever
  • Blackwater fever
  • Tertian malaria
  • Quartan malaria

Prevalence

  • The incidence of this disease is reduced b/w 1950 to 1960.
  • The incidence is increased from 1970.
  • Mostly the travelers are susceptible to this disease.
  • Due to increased travel, almost 2000 cases are imported annually into the UK and most cases of this disease are due to the plasmodium falciparum usually from Africa.

Etiology

There are 4 species of plasmodium causes this disease

  • Plasmodium vivax
  • Plasmodium malariae
  • Plasmodium ovale
  • Plasmodium falciparum

Plasmodium falciparum is dangerous and life-threatening.

How people get malaria

Most people get through

  • Blood
  • Needles
  • Biting of female anopheles’ mosquito

Pathogenesis

The life cycle of Malaria

This involves two hosts and this is a complex and multi-stage process.

  • In humans
  • In mosquito

Pathology of malaria

Anemia

  1. Vivax & P. ovale attacks on Retiform RBC.
  2. Malariae attacks on Mature RBC.
  3. Falciparum attacks on Every RBC.

The plasmodium falciparum attacks every red blood cell that is why malaria caused by the plasmodium falciparum is severe and life-threatening.

Signs and symptoms

General symptoms include

  • Paroxysm

           Cold stage

The patient feels intense cold and shivers from head to toe.

 Hot stage

In this hot stage, the patients feel an intense head and uncovered himself from the blanket.

     Sweating stage     

In the sweating stage, the temperature of the patient declines.

In case of vivax and ovale

  • Paroxysm appears à 48 hours later.
  • Spleen and liver enlarge and may become tender.
  • Anemia develops.

In the case of Plasmodium malaria infection

  • Mild symptoms
  • Paroxysm appearà every third day

In the case of falciparum infection

  • Pernicious
  • Onset: headache, malaise, vomiting, cough, mild diarrhea
  • The fever pattern is not specific.

Who is at risk?

  • Young children
  • Pregnant women
  • People with HIV/Aids
  • International travelers from non-endemic areas Immigrants from endemic areas and their children

Clinical forms of falciparum malaria

  • Cerebral malaria
  • Algid malaria
  • Septicemic malaria
  • Blackwater fever

Cerebral malaria

The most severe form of malaria.

It’s a neurological complication of infection with plasmodium falciparum.

It is characterized by the comatose and seizures.

It causes swelling of the brain leading to the damage of the brain.

Algid malaria

It is a rare complication.

It causes vascular collapse leading to peripheral circulatory failure.

Septicemic malaria

It is characterized by continuous high fever leading to multi-organ failure.

Blackwater fever

There is rapid and massive hemolysis of red blood cells.

It is characterized by diarrhea, vomiting, pulmonary edema, dark red to brown-black urine.

Dengue is different from Malaria

  • Dengue (pronounced DEN gee)
  • Fever is a painful
  • Mosquito-borne disease
  • It is caused by any one of four closely related dengue viruses. These viruses are related to the virus that causes yellow fever.
  • Aedes mosquitoes.

Yellow fever is different from Malaria

Yellow fever is an acute viral disease.

  • It is caused by the yellow fever virus.
  • The origin of yellow fever is in Africa.
  • Aedes aegypti.
  • Vaccination is available for yellow fever.
  • No NSAIDs are used for yellow fever.
  • Symptomatic treatment for yellow fever is used.
  • Paracetamol is used in yellow fever.

Treatment of Malaria

Aim of treatment

There are two aims of the treatment.

  • Prevention of disease.
  • Eradication of the disease.

Major anti-malarial drugs

The following are the major anti-malarial drugs widely used.

  • 4-aminoquinoline
  • 4-aminoquinoline
  • Quinoline methanol
  • 8-aminoquinoline
  • Folate antagonist
  • Tetracycline
  • Phenanthrene methanol
  • Amyl alcohol
  • Sesquiterpene lactone E.P
  • Chloroquine
  • Amodiaquine
  • Quinine
  • Quinidine
  • Mefloquine
  • Primaquine
  • Fansidar
  • Doxycycline
  • Halofantrine
  • Lumefantrine
  • artemisinins

General treatment

Analgesics

Antipyretics

I/V fluids for dehydration

Treatment of acute attack

Chloroquine sensitive malaria

All three except P. falciparum are sensitive.

Chloroquine:

(tab. Rasochin containing 250 mg chloroquine phosphate while chloroquine base =150mg)

  • Total 10 tablet course.
  • Treatment for 2-3 week course of primaquine(15mg/day), hepatic hypnozoites and prevent relapse.
  • Chloroquine + Primaquine
  • Amodiaquine + primaquine

Chloroquine-resistant malaria

  • P. Falciparum
  • Artemether ( Artem cap. 40 milligrams, injection 80 mg)
  • Quinine sulfate
  • Mefloquine (fancimef)
  • Pyrimethamine+sulfadoxine (fansidar)
  • Halofantrine ( Halfan)

Dosing schedule for mefloquine

Other combination therapy

  • Should be treated with

Quinine sulfate plus a single dose of Combination Drug Pyrimethamine and Sulphodoxine (Fansidar)

  • Other Alternatives
  1. Quinine plus Doxycycline or Tetracycline
  2. Quinine plus Clindamycin
  • Newer alternatives

Mefloquine and Halofantril.

Preventions

  • The complete elimination of mosquito breeding places.
  • National improvements should be organized by the government on health and Hygiene.
  • Use of Mosquito nets, treated with Pyrethrin.
  • Clothing with sleeves and long trousers must be used.
  • The use of Mosquito repellents is necessary.
  • Different campaigns should be organized by the government for awareness among the general population.

Vaccines for malaria

This degree of protection would be extremely difficult to achieve and might not be technically feasible because many vaccine developers have therefore focused their efforts on creating a vaccine that limits the ability of the parasite to successfully infect large numbers of red blood cells. This would not prevent infection but would limit the severity of the disease and help prevent deaths.

Monitoring & follow-up

  • Blood smear should be repeated daily (twice daily in severe infection). Within 48-72 hours after the start of treatment, patients usually become afebrile and improve clinically except in complicated cases.
  • All patients should be investigated with repeated blood film of malarial parasite one month upon recovery of malarial infection, to ensure no recrudescence.

Counseling of the patient by the pharmacist

  • A person can have malaria parasites and show no signs of the illness. This is why it is important to take measures to protect oneself from the disease.
  • Fever is not a normal sign. Hence, Fever should be treated or investigated.
  • Signs of malaria include fever, headache, body aches, chills, rigors, and signs of severe Malaria as discussed earlier because these are important.
  • Uncomplicated/simple malaria can quickly progress to severe/complicated fever, which is life-threatening and can be fatal if not treated in time.
  • Seek medical advice whenever you are sick because it is important for the patient.
  • Explain to the patients’ use of and application of malaria prevention methods such as sleep under Insecticide Treated Nets (ITNs) or LLINs. These nets not only kill mosquitoes that come into contact with it but also repel and reduce mosquitoes in the room. They are safe to the user and should be used daily all year round.

Whenever you have a fever visit a health facility immediately for treatment.

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