Malaria- Symptoms, Causes, Diagnosis, Treatment & Prevention
Medikoe Health Expert
Koramangala, bengaluru, karnataka, india, Bengaluru Feb 9, 2017
Malaria and Its Symptoms
Malaria is a mosquito-borne disease caused by a single-celled microorganism of plasmodium group and is transmitted to humans and animals by the Female Anopheles mosquito. It infects several people every year, is one of the leading causes of death, and is a complex disease to treat.
Malaria symptoms typically include fever, vomiting, tiredness and headache. It causes yellow skin, seizures, coma, or death in severe cases. Symptoms tend to start ten to fifteen days after being bitten by an infected mosquito.
If not treated properly there is a chance of recurrences of the disease months later after symptoms subside. It is caused by four different species of plasmodium.
Malarial Parasite (Causes of Malaria)
Malaria is said to be caused by four different species of single-cell protozoan of Plasmodium genus.
Plasmodium falciparum: This is the chief causative protozoan, said to cause about 50% of all malaria. It causes the most debilitating form of the disease, one of the reasons is because it destroys about 65% of the patient’s erythrocytes. The patient falls ill between acute attacks.
Plasmodium vivax: this is the second most common plasmodium causing about 40% of all malaria. This is very chronic as it reinfects the liver cells when recurs.
Plasmodium malariae: though covers only 10% of all malarial cases, relapses are pretty common.
Plasmodium ovale: this species is the least common to cause malaria.
Global climate change is likely supposed to be the reason for malaria but the degree of the severity and areas affected remain unclear.
Greater rainfall in some regions in India is said to be the leading cause of an increased number of mosquitoes.
Signs and Symptoms of Malaria
Usually, symptoms occur after 8-25 days following infection but occur late in those who have taken antimalarial medication as a precaution. Initial consideration of the disease irrespective of the malarial species are similar to influenza-like symptoms, also resembles other conditions such as sepsis, viral diseases and gastroenteritis.
Basic symptoms include-
Haemoglobin in urine
The prototypical symptom of malaria is a paroxysm- a continuum of sudden coldness followed by a shiver and then fever and sweating, occurring every two days known as tertian fever common in P. vivax and P. ovale, and every three days are known as quartan fever common for P.malariae. Plasmodium falciparum-infected person causes recurrent fever every 36-48 hours.
Most severe infection is caused by P. falciparum, symptoms start 9-30 days after infection. An individual suffering from cerebral malaria constantly exhibits neurological symptoms such as abnormal posturing, conjugate gaze palsy ( eyes don’t turn together in the same direction), nystagmus ( dancing eyes), seizures and coma.
Symptoms can also be categorised as
Uncomplicated Malaria- The most common symptoms are fever and chills, headaches, nausea and vomiting, weakness and body aches. The classic description of a malaria attack would be a 6-12 hour period of cold and shivering alternating with fever and headaches and then a stage of sweating and tiredness.
Complicated or Severe Malaria- This occurs when different body systems are affected by malaria. Its symptoms include severe anaemia, kidney failure, cerebral malaria- seizures, unconsciousness, abnormal behaviour, cardiovascular collapse, low blood sugar in pregnant sugar
How Malaria Spreads?
The parasite is the causative organism and is spread by female Anopheles mosquitoes, they usually bite between dusk and dawn hence known as “ night-biting” mosquitoes.
If a mosquito bites an infected person it becomes the carrier of the parasite and can spread the parasite on to other non infected people. Malaria cannot be spread from person to person directly.
Once the person is bitten, the parasite enters the bloodstream and approaches the liver. The parasite develops inside the liver before entering the bloodstream and invading the red blood cells.
The parasites grow and multiply abnormally in the RBCs and the infected red blood cells burst to release more parasites into the blood. Infected RBCs burst every 48-72 hours. Each time RBC’s burst you’ll have fever followed by chills and sweating.
Malaria can be spread through blood transfusions and sharing of needles, which is not so common.
Diagnosis of Malaria
Diagnosis of the disease can be difficult but can be identified through the clinical diagnostic test and microscopic diagnosis:
Clinical Diagnosis: Disease can be diagnosed based on the symptoms The first symptoms of malaria commonly include, fever, chills, sweats, headaches, muscle pains, nausea and vomiting, they are often not specific as they are also found in other diseases such as the “ influenza flu” and common viral infections. Similarly, the physical observations are often not so specific like elevated temperature, perspiration, tiredness.
Microscopic Diagnosis: Parasites can be identified through microscopic examination through performing a malaria blood test, a drop of patient’s blood is taken and is spread out as a “blood smear” on a microscopic slide. Prior to the examination, the slide is stained using Giemsa stain to give parasite a difference appearance. This is known as the gold standard test for identification of malaria in the laboratory.
Treatment of Malaria
Treatment aims to abolish the Plasmodium parasite from the patient's bloodstream. Those without symptoms may be treated for infection to reduce the risk of disease transmission in the surrounding population.
1. Artemisinin-based combination therapy (ACT): It is used to treat uncomplicated malaria. Artemisinin is derived from the plant Artemisia annua also known as sweet wormwood. It is known for its ability to rapidly reduce the concentration of Plasmodium parasites in the bloodstream.
The ACT is artemisinin combined with a drug. The role of artemisinin is to reduce the number of parasites within the first 3 days of infection, while the partner drugs eliminate the rest. The ACT has reduced the effects of malaria worldwide but now in some places, malaria is resistant to ACT.
2. Vaccines against malaria: RTS, S/AS01 (RTS, S)– Also known as Mosquirix – is an injectable vaccine that provides partial protection against malaria in young children. The vaccine is being evaluated in sub-Saharan Africa as a complementary malaria control tool that potentially could be added to the core package of WHO-recommended preventive, diagnostic and treatment measures.
3. Chloroquine Phosphate: Chloroquine is the preferred treatment for any parasite that is sensitive to the drug. But in many parts of the world, the parasites that cause malaria are resistant to chloroquine, and the drug is no longer an effective treatment.
Prevention of Malaria
Malaria is a potentially fatal illness. People planning to travel to an area with malaria should see their physician before travel, preferably at least six weeks before departure.
Travellers should use mosquito repellent and barrier techniques (long sleeves and long pants) to reduce the chance of mosquito bites and take medications to reduce the risk of disease.
Mosquito-bite precautions include wearing light-coloured protective clothing and using window screens and bed nets when available. The mosquito that spreads malaria is active between dusk and dawn.
Insect repellants should be used and should contain DEET. Room sprays and insecticides may be used to reduce the mosquito population in sleeping areas. World Malaria Day is an international observance commemorated every year on 25 April and recognizes global efforts to control malaria. Globally, 3.3 billion people in 106 countries are at risk of malaria.
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