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Malaria

Malaria has been eradicated from North America, Europe and Russia but, despite efforts, continues to flourish in parts of the tropics. Falciparum malaria is the most severe form of the disease. When treated, malaria sedom is fatal; untreated, it's fatal in 10% of victims, usually as a result of complications.

Untreated primary attacks last from a week to a month or longer. Relapses are common and can recur sporadically for several years. Susceptibility to the disease is universal.

Causes

Malaria is caused by protozoan of the genus Plasmodium.

  • Infection begins with a bite from an infected mosquito.
  • The parasite travels from the mosquito to your liver, where the parasite begins to reproduce.
  • The parasite leaves the liver and travels to the bloodstream, where it infects red blood cells. The parasite reproduces in the red blood cells, which destroys the cells and releases more parasites into the bloodstream.
  • If another mosquito bites an infected person, that mosquito can then carry the infection to someone else.

Symptoms and Signs

High fever accompanied by chills, headache, shivering.There are three main types of malaria, depending upon the parasites which cause it. They are tertian fever, quartan fever and malignant tertian malaria. The most common symptom of all types of malaria is:

  • High fever, which may occur every day, on alternate days, or every fourth day.
  • The fever is accompanied by chills, headache, shivering, and pain in the limbs.
  • The temperature comes down after some time with profuse sweating.

The main complications of malaria are anaemia, kidney failure, and dysentery.

Diagnostic tests

Unequivocal diagnosis depends on laboratory identification of the parasites in red blood cells of peripheral blood smears. Romanovsky's staining demonstrates the asexual forms of the parasite. Other staining is also useful.

Supplementary laboratory test values that support this diagnosis include decreased hemoglobin (normocytes, normochromic anemia), a normal or decreased white blood cell (WBC) count (as low as 3,000/mm³), and protein and WBCs in urine sediment. In falciparum malaria, serum values reflect DIC: a reduced platelet count (20,000 to 50,000/mm³), prolonged prothrombin time (18 to 20 seconds), prolonged partial thromboplastin time (60 to 100 seconds), and decreased plasma fibrinogen levels.

Treatment

Malaria is treated with oral chloroquine in all but chloroquine-resistant P.falciparum infection.

Malaria caused by P.falciparum. which is resistant to chloroquine, requires treatment with oral quinine, given concurrently with pyrimethamine with sulfadoxine and a sulfonamide, such as sulfadiazine. Relapses require the same treatment, or quinine alone, followed by tetracycline. Mefloquine also may be used for chloroquine-resistant malaria.

The only drug effective against the hepatic stage of the disease that is available in the United States is primaquine phosphate, given daily for 14 days. This drug can induce DlC from increased hemolysis of red blood cells (RBCs); consequently, it's contraindicated during an acute attack.

For travelers spending less than 3 weeks in areas where malaria exists, weekly prophylaxis includes oral chloroquine, beginning 2 weeks before and ending 6 weeks after the trip. Chloroquine and pyrimethamine with sulfadoxine may be ordered for those staying longer than 3 weeks, although combination treatment can cause severe adverse reactions. If the traveler isn't sensitive to either component of pyrimethamine with sulfadoxine, he may be given a single dose to take if he has a febrile episode.

Any traveler who develops an acute febrile illness should seek prompt medical attention, regardless of prophylaxis measures taken.

Prevention

Malaria can be prevented by protection against mosquito bites, cleanliness of surrounding areas, and ensuring that there is no pool of SL.1.gnant water lying around, and ensuring that there is no pool of stagnant water lying around.

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