A Family Doctor's Tale - MALARIA

DOC I HAVE MALARIA

Malaria has been present for so many decades and despite all the medical advances has still cannot be eliminated from the world and is still causing deaths .

The problem as usual is the vector the Anopheles mosquito which cannot be eliminated.

It is also very important to diagnose the condition correctly by clinical evaluation and a thick blood film test for the malaria parasite.


Malaria is a parasitic disease transmitted to humans through the bite of infected Anopheles mosquitoes characterized by high fever at certain times of the day, chills and rigors.

The cause of Malaria is a parasite called Plasmodium of which there are 4 species:

P.vivax,

P.falciparium,

P.malariae and

P.ovale.

When the parasites (Plasmodium) enter the blood in the human body through the mosquito bite, they travel to the liver.


In the liver after 6 -14 days depending on the species, they mature and then re-enter the bloodstream and infect the red blood cells. There they multiply inside them.

Within 48 hours of becoming infected in the case of P.vivax, falciparium,and ovale, the red blood cells rupture, releasing more parasites (merozoites) which in turn infect more red blood cells.

In the case of P.malariae, the cycle is 72 hours.

Malaria causes anaemia by the rupturing of the red blood cells.
The large amounts of free haemoglobin released into the circulation after red blood cells rupture accumulate in the liver and spleen causing enlargement.

The symptoms of Malaria occur in cycles of 48 to 72 hours, due to the massive release of parasites into the bloodstream.

1.Fever, chills and sweating -

fever is high coinciding with the release of merozoites in the blood stream. It drops to a lower fever, then goes up again when the parasites are released into the blood stream again.


2.muscle pain & rigors - due to the high fever and sweating


3.headache, nausea and vomiting - due to high fever and liver infection


4.jaundice with enlarged and tender liver due to infection of the liver


5.anaemia and bloody stools due to the rupture of the red blood cells


6.convulsion and coma if the brain is affected.

Diagnosis of malaria is by:


1.Blood smear tests for the malaria parasite- a thick blood smear done at the height of the fever is able to show up the parasite more accurately than a thin blood film.

2.Blood tests for anemia, liver and kidney functions.

Malaria is treatable and curable.


Antimalarial drugs are readily available.
Drugs used include chloroquine, quinine and primaquine.


The drug  used for treatment depends on factors such as
1. age,
2. where the malaria was acquired (as the malarial parasite from certain areas may be resistant to common ant-malarial drugs),
3.drug allergies and
4.G6PD deficiency patients who can have severe reactions to quinine based drugs.

For patients who have G6PD deficiency or are allergic to quinine drugs, the use of Lariam(mefloquine), Malarone(Atovaquone) and Doxycycline have been used effectively against the Malaria parasite.

In severe cases, the person suffering from malaria may require treatment in the intensive care unit of a hospital, especially if there are complications involving the brain or kidneys.

The outcome is expected to be good in most cases of malaria with treatment, but poor in Falciparum infections with complications such as:


liver failure and kidney failure
destruction of blood cells (haemolytic anaemia)
meningitis
rupture of the spleen and subsequent massive haemorrhage

There is no effective vaccine against malaria.


Antimalarial drugs may be given prophylactically to persons traveling to areas where the disease is widespread, or to pregnant women in areas in which the disease is endemic.


Antimalarial drugs should be prescribed for visitors to areas where malaria is prevalent.


Treatment should begin at least one week before entering the area, and continue for 2 weeks after leaving the area.


The types of antimalarial medicine prescribed will depend on the drug-resistance patterns in the areas to be visited.


It is very important to know the countries and areas you will be visiting to obtain appropriate preventive support for malaria.

Most cases of Malaria can be completely cured.

In rare cases, reinfection may occur if the patient remains in the endemic area without proper prophylaxis.

Preventive measures are concentrated on getting rid of the anopheles mosquito by removing all possible breeding grounds such as places containing stagnant water.


Use of insecticides and natural biologic predators of mosquitoes will help to reduce the population of the anopheles mosquito.