Malaria

 

Malaria is a serious illness characterized by high fever with chills. It is transmitted by a mosquito. Many people all over the world are infected with malaria every year. About a million cases of malaria occur in India annually.

 

 

Malaria is caused by the protozoan parasite Plasmodium. Five types (species) of Plasmodium can cause malaria. These include:

1. P. vivax

2. P. falciparum

3. P. malariae

4. P. ovale

5. P. knowlesi

In India, malaria is mainly caused by P. vivax and P. falciparum. Malaria due to P. vivax is more prevalent in plain areas, while P. falciparum is responsible for most of the malaria cases in hilly areas and those covered with forests.

Malaria is transmitted by the female anopheles mosquito. The bite transfers the parasite (sporozoites) into the blood which travels to the liver. In the liver, the parasites mature and multiply to form merozoites. This is followed by an invasion of the red blood cells that causes malaria. 

 

 

High fever with chills is the cardinal symptom of malaria. Fever is usually intermittent but can be continuous also. The attacks (malarial paroxysm) occur in three stages:

1. Cold stage -- sudden feeling of cold and shivering

2. Hot stage -- high fever

3. Sweating stage

Other symptoms include:

1. Headache

2. Nausea and vomiting

3. Body pain especially in the muscles and joints

4. Loss of appetite

Severe cases may cause:

1. Anemia

2. Bleeding

3. Jaundice

4. Convulsions

 

 

Diagnosis involves finding the type of parasite causing malaria. The doctor will take medical history along with symptoms. Tests include:

1. Microscopy of thick blood smear to detect and identify the malarial parasite

2. Rapid diagnostic test (RDT) that detects circulating parasite antigens

 

 

Treatment for malaria includes administration of the medicine chloroquine. For the severe form of disease IV quinine or quinidine may be given. Other drugs that may be prescribed include:

1. Doxycycline

2. Tetracycline

3. Clindamycin

Primaquine is used to kill dormant liver forms of P. vivax and P. ovale. Recently, chloroquine resistance has been seen in P. falciparum from some areas. Mefloquine, halofantrine, and lumefantrine may be used for the treatment of malaria caused by the chloroquine-resistant form of P. falciparum.

 

 

Complications may occur if treatment does not begin in time. These include:

1. Severe anemia

2. Difficulty in breathing

3. Drop in blood sugar

4. Organ failure (lung, liver, or kidney failure)

5. Blood coagulation [Disseminated intravascular coagulation (DIC)]

6. Rupture of spleen leading to massive bleeding

7. If malaria infects the brain, meningitis may occur. Malaria can be fatal in severe cases.

See a doctor if you have a high fever with chills, especially if you have mosquitoes breeding around your home.

 

With timely treatment, malaria can be cured and its transmission to other people can be prevented. However, delay in treatment could threaten life. This may happen due to a failure to diagnose malaria in time.

Prevention of malaria can be achieved by public health and community-based programs that aim at controlling the breeding of mosquitoes and destroying their breeding sites.

1. Wear clothes that cover arms, legs, and feet.

2. Avoid sleeping or staying long in open areas.

3. Use mosquito repellants in your home and clothes.

4. Use mosquito screens on doors windows to prevent entry of mosquitoes in the homes.

Use the following tips to prevent breeding of mosquitoes:

1. Do not let water collect and stand in areas around your house.

2. Do not keep broken pots, tires, or any waste material clogged up in or outside the home.

3. Practice regular fogging with mosquito repellents or larvicides.

 

 

National Institute of Malaria Research, New Delhi. National Vector Borne Disease Control Programme. Guidelines for diagnosis and treatment of malaria in India 2014.

Rosenthal PJ, Kamya MR. Malaria. In: Goldman L, Schafer AI eds. Goldman’s Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 345.