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Malaria - Causes and effects

User profile imageDr. Daisy Dharmaraj

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Malaria is an ancient disease which has claimed millions of lives over the centuries. Many more have suffered with the ravages of the disease.

It is a preventable and treatable disease transmitted by mosquitoes. According to the WHO, globally there were about  214 million cases of malaria and 438000 deaths in 2015 in and round 97 countries (i.e. half of the world population).In India, there have been concerted efforts to treat and prevent/ control Malaria

Malaria is caused by a small parasite called plasmodium and is transmitted through Anopheles adult female mosquitoes. Initially these mosquitoes, responded to a wonder drug called Chloroquine. Over the years however, resistance of the parasite to drugs as well as resistance by mosquitoes to insecticides developed and malaria once again became a killer and  dreaded disease.

Clinical picture

A  person who has malaria gets fever with rigors/ shivering intermittently. Typically the symptoms happen in 2  stages ; in the  cold stage, s/he has  rigor,  headache  nausea for 15 to 30 minutes. This is followed by a  hot stage  lasting for  2-6 hrs. Head ache and sweating follows. But the classical picture is uncommon. The clinical features of the disease also depend on which species of plasmodium is causing the disease. There are 4 species namely P.vivax which is responsible for about 70% of the cases. %). This species causes a  milder disease  with symptoms in a 48 hour-cycle. The fever and chills come on alternate days  P.falciparum is responsible for about 25-30%, P.ovale  and  P. malariae are less common, the latter producing  72 hr cycles of fever and chills. In children the classic symptoms may  not be seen.

If not treated properly, or if there is a repeated exposure to the parasite , this disease could relapse. There could be various complications such as enlargement of  spleen,  anemia,  herpes, renal complications and general weakness. If the causative species is P falciparum a regular picture of the disease does not manifest easily. This kind is more complicated  and affects the brain, kidney, liver etc. Therefore the patient could get  cerebral malaria, acute renal failure, liver damage, gastro intestinal  symptoms, dehydration, collapse, anemia, and bleeding - blackwater fever

Diagnosis

How does one diagnose malaria? A drop of the patient’s blood is examined under the microscope spread out as a blood smear and stained with special stains. on a slide . The parasites can be detected. Alternatively there are rapid diagnostic tests  some of which are specific to the species. Most commonly available are those for    P. Falciparum malaria, which is the most dangerous type. The results are known in 15 to 30 min.

Treatment of malaria

This is directed to eliminating the parasite from the blood in order to prevent the progression of uncomplicated malaria to severe disease / death . Care is also taken to avoid it becoming a chronic infection.

Chloroquine is still the first drug to be used in places where drug resistance to this drug has not developed. There are other drugs available such as Meflaquine, Artemisinin based combination treatment (ACT).

Those living in places where Malaria is common, need to take preventive treatment. Either Chloroquine or Primaquine is used as weekly dosage . Travellers are advised to take similar treatment which should be started a few weeks earlier and continued  a few weeks after they leave the area. There is a school of thought where no preventive tablets are taken but the patient is warned to report to the doctors if they develop fever, chills etc, and if malaria is diagnosed, they are treated for it.

Prevention

The idea is to eliminate mosquitoes and to protect oneself from mosquito bites. Mosquitoes develop in stagnated water. They hide indoor or in bushes – habits are species specific.  Thus environmental hygiene, spraying with insecticides help to reduce the mosquito density.. For personal protection people should use mosquito repellants as well as mosquito nets. Insecticide treated nets provide additional protection.

WHO has launched a special program called Roll back Malaria, which has specific guidelines to be followed by all countries.

 


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