MALARIA IN ENGLISH

                                             

                                          MALARIA IN ENGLISH

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MALARIA-

           Malaria is a protozoal disease caused by infection with parasites of the genus Plasmodium and transmitted to man by infected female Anopheline (anopheles)  mosquito.

           Malaria is a world wide disease. Approximately half of the world's population is at risk of malaria. Most malaria cases and deaths occur in sub Saharan Africa. However, Asia, Latin America, Middle East and parts of Europe are also affected. Malaria continues to pose a major public health threat in India, particularly due to Plasmodium falciparum which is prone to complications.

CAUSATIVE AGENT-

           Malaria in man is caused· by four distinct species of the malaria parasite - P. vivax, P. falciparum, P. malariae and P. ovale. In India, about 50 per cent of the infections are reported to be due to P. falciparum and 4-8 per cent due to mixed infection and rest due to P. vivax. P. malariae   is said to be responsible for less than 1 per cent of the infections in India.  P.  ovale is a very rare parasite of man, mostly confined to tropical Africa.

HOW  IT SPREDS-

           (a) VECTOR TRANSMISSION:

           Malaria is transmitted by the bite of certain species of infected, female anopheles mosquitoes. A single infected mosquito, during her life time, may infect several persons. The mosquito is  infective then the sporozoites of plasmodium are present in its salivary glands.

           (b) DIRECT TRANSMISSION:

           Malaria may be transmitted accidentally by hypodermic intramuscular and intravenous injections of blood or plasma, e.g., blood transfusion. Blood transfusion poses a problem because the parasites remains infective for at least 14 days in blood bottles stored at 4 deg.

SIGN AND SYMPTOMS-

           Cyclic pattern of fever is cardinal sign of malaria. It comprises three distinct stages-

           1. the cold stage,

           2. the hot stage and the

           3. sweating stage.

           These are followed by an afebrile period in which the patient feels relaxed.

           1. the cold stage-  fever starts with headache, nausea and chills. In an hour or two it is followed by rigor. The temperature rises rapidly to 39-41°C. Headache is often severe and commonly accompanied by vomiting. In early part of this stage, skin feels cold; later it becomes hot. The pulse is rapid and may be weak. This stage lasts for 1/4-1 hour.

           2. the hot stage-  In this stage The patient feels burning hot and puts off his clothes. The skin is hot and dry to touch. Headache is intense but nausea commonly diminishes. The pulse and respiration is rapid. This stage lasts for 2 to 6 hours.

           3. the sweating stage-  In this stage Fever comes down with profuse sweating. The temperature drops rapidly to normal and skin is cool and moist. The pulse rate becomes slower, patient feels relaxed and often falls asleep. This stage lasts for 2-4 hours.

           The febrile cycles occur with definite intermittent periodicity repeating every third or fourth day depending upon the species of the parasite involved.

           Apart form fever there are

           enlargement of the spleen and

           Secondary anemia

           In patients with P. falciparum infection the fever in its first few days is usually irregular or even continuous and then the classical 48 hour periodicity becomes established. In persons with poor immunity the paroxysms are associated with marked weakness. Headache, nausea and vomiting are usually more severe, and there is greater tendency towards the development of delirium, haemolytic jaundice and anaemia. 

           The complications of P. falciparum malaria are cerebral malaria, acute renal failure, liver damage, gastro-intestinal symptoms, dehydration, collapse, anaemia, blackwater fever etc. The mortality is much greater than in other forms of malaria. The complications of P. uivax, P. ovale and P. malariae infections are anaemia, splenomegaly, enlargement of liver, renal complications etc.

DIAGNOSTIC INVESTIGATIONS-

           1. Microscopy- Two types of blood films are useful in searching for and identification of malaria parasite. The "thin film" and the "thick film". It is recommended that both types of film be prepared on a single microscope glass slide. The thick film is more reliable in searching for parasite, as large volume of blood is examined under each microscope field.

           2. Serological test- The malarial fluorescent antibody test usually becomes positive two weeks or more after primary infection. So clinically it is not important. A positive test is therefore, not necessarily an indication of current infection. The test is of the greatest value in epidemiological studies and in determining whether a person has had malaria in the past.

           3. Rapid diagnostic test (RDT)-  Rapid Diagnostic Tests are based on the detection of circulating parasite antigens with a simple dipstick format. In this test only a drop of blood is used. Several types of RDT kits are available. Some of them can only detect P. falciparum while others can detect other parasites also.

TREATMENT-

           Treatment depends upon type of parasite of malaria.

           Drug schedule for treatment of P. vivax malaria and P. ovale malaria:

           1. Chloroquine:  10 mg/kg on day 1,

           10 mg/kg on day 2 and 5 mg/kg on day 3.

           2. Primaquine:  0.25 mg/kg body weight daily for 14 days.

           Drug schedule for treatment of P. falciparum malaria and P. malariae malaria:

            day 1- Artesunate 4 mg/kg body weight plus Sulfadoxine {25 mg/kg body weight) – Pyrimethamine ( 1.25 mg/kg body weight)

            day 2- Artesunate 4 mg/kg body weight plus  primaquine 0. 75 mg/kg body weight

            day 3- Artesunate 4 mg/kg body weight  

             

PREVENTION-

Ø  Prompt and effective treatment of all cases is essential to reduce the risk further transmission.

Ø  Control of mosquitos is another very important measure to prevent malaria.

Ø  Insecticide-treated mosquito nets (ITNs) are the most universally useful measure for the prevention of malaria

Ø  Control of larval stages by elimination of mosquito breeding sites, for example by filling and draining the water collection site, increasing the speed of water in natural or artificial channels. The use of larvivorous fish especially Gambusia is well known in mosquito control

Ø  Indoor residual spraying with insecticides (IRS) is another preventive method targeting adult mosquitoes with a wide range of applicability. This method is most effective where mosquitoes rest indoors on sprayable surfaces.

Ø  Vector control also involves the application of pesticides in the form of fog or mist using special equipment. The ultra-low-volume method of pesticide dispersion by air or by ground equipment has proved to be effective and economical.  

Ø  Avoid going out between dusk and dawn when anopheline mosquitoes commonly bite. Wear long sleeved clothing and long trousers when going out   during this time and night.

Ø  Apply mosquito repellent cream to exposed skin.

Ø  Use screens/net over doors and windows; if no screens are available, close windows and doors at night.