Malaria - Causes, symptoms and treatment. MF.

Malaria is a group of diseases that occurs with an increase in temperature, a decrease in hemoglobin of the blood, an increase in the liver and spleen. The cause of the disease is microorganisms - different types of malarial plasmodium that enter the human body when bitten by a female of the Anopheles mosquito. Every year, up to 500 million people with malaria are registered in the world, and approximately 90% of people in Africa are affected.

World map. Red color shows areas where cases of malaria are most often reported.

Children most often infected with malaria are up to 5 years old. The death rate from malaria in this age group is the highest.

A bit of history. Malaria is one of the most ancient diseases of mankind. Approximately in 2700 BC.in China, a fever epidemic is described, which in many ways resembles malaria. In 1696 the Geneva physician Morton singled out this disease in a separate form, and also pointed out the medicinal properties of the cinchona bark. Lanzizi justified the connection of the disease with the swampy terrain( mala aria in translation from Italian means bad air).In 1880, a physician Charles Louis Alphonse Loveran suggested that this disease can be caused by a microorganism. And in 1897 R. Ross stated that the only carriers of the disease are mosquitoes of the genus Anopheles. In the future, powerful antimalarial drugs were synthesized, insecticides aimed at fighting mosquitoes, and by 1960 malaria in the USSR was completely eliminated. But in Africa, where climate conditions are the most favorable for the reproduction of malarial plasmodium, malaria is progressing. More and more cases are now being registered in our country, especially in individuals after visiting dangerous areas. Therefore, the problem of early diagnosis and proper treatment of malaria remains relevant at the present time.

Causes of malaria

The causative agent of the disease is malarial plasmodium. It parasitizes in the body the female mosquito of the genus Anopheles.

Appearance of a mosquito genus Anopheles

At the moment of a bite, the female mosquito injects with the saliva of the pathogen, the person is infected. With the blood flow, the malarious plasmodium settles in the liver cells, where it begins to actively multiply. After a while, the microorganisms in large quantities again enter the blood, but this time they enter the red blood cells, destroying them. With the destruction of red blood cells, all the main symptoms of malaria are associated.

In rare cases, it is possible to get malaria from a patient or from a carrier of microorganisms in case of blood transfusion, and also when using insufficiently processed tools when performing various medical and diagnostic manipulations.

Symptoms of malaria

Depending on the type of pathogen, the time from infection to external symptoms of the disease is 10 to 40 days( for variants with a long incubation up to 16 months).
The onset of the disease is acute. But sometimes, a few days before the appearance of specific symptoms, there may be weakness, drowsiness, dry mouth, and cognition. For the classical version of malaria, a paroxysmal course is characteristic. Each attack includes: "chills"( 3 hours), "fever"( 6-8 hours), "sweat".

Graphic representation of body temperature fluctuation with malaria. Attention is drawn to the periods of a sharp temperature rise followed by a sharp drop to normal figures.

The duration of the attack ranges from 1-2 hours to 12-14 hours, depending on the type of pathogen. During the "heat" period, the body temperature sharply rises to 40-41 ° C, which is accompanied by intense pain in the muscles, headache, dizziness, nausea, and often vomiting. With a decrease in body temperature develops a marked sweating, weakened patients fall asleep. After one or two weeks after the onset of fever, the patients get yellow skin and sclera of the eyes, there are pulling pains in the left and right subcostal area, and with a palpation there is clearly an increase in the liver and spleen.

External manifestations of jaundice in malaria

In the absence of treatment, patients, especially children and pregnant women, usually die because of complicated complications.

Diagnosis of malaria

Diagnosis of malaria is based on the identification of classic symptoms of the disease: paroxysmal fever, enlargement of the liver, spleen. The blood of patients is always determined by anemia. Of great importance is the fact of being in a dangerous area for 3 years before the onset of the disease, or blood transfusion or medical manipulations associated with a breach of the integrity of the skin or mucous membrane for 3 months before the onset of fever. The most accurate method of diagnosis is the detection of malarial plasmodium in the blood. At the present time, special diagnostic kits are widely available, which allow for a short time to determine the presence of an agent in the blood.

Treatment of malaria

When suspected of malaria, patients are urgently hospitalized in the infectious disease department. All patients are recommended strict bed rest and plenty of drinking. Warm saline solutions are preferred. To prevent fever, quinine is prescribed. An effective agent that destroys pathogens is the primaquine or quinocide. In addition to antimicrobials, intravenous fluids are used to reduce the toxic effects of plasmodium on the human body, as well as hemosorption and hemodialysis.

Possible complications of malaria

• Coma .The most severe complication of malaria. In the initial period there is an intense headache, dizziness, vomiting. The patient is nervous, restless. Then, complete apathy develops, the patient is motionless, reluctant to answer questions, perform commands. This sleepy state is replaced by a coma. The patient does not react to any external stimuli, respiratory and cardiovascular disorders develop. Without treatment, all patients die.
• Acute renal failure .Occurs when fragments of damaged erythrocytes accumulate in the kidneys, as well as with direct toxic effects on the kidneys of the products of vital activity of the malarial plasmodium. It is characterized by a decrease in the amount of urine, the development of symptoms of intoxication. With timely treatment, complete recovery is possible.
• Infectious-toxic shock .Characterized by a sharp drop in blood pressure, the development of respiratory failure, hemorrhages in the brain, adrenal glands, other internal organs. This condition, even with intensive treatment, is characterized by very high mortality.
• When the disease develops during pregnancy, serious complications are fetal death of the fetus , as well as infection of the child during passage through the birth canal and the development of a severe and often deadly form of the disease.
• If the spleen is significantly enlarged during motion or at rest, it may break. The rupture of the spleen can be suspected with the sudden appearance of intense pain in the left subcostal area, a drop in blood pressure, the development of syncope. The only method of treatment in this situation is an emergency operation.

Forecast of malaria development

With adequate treatment, the prognosis for life with malaria is favorable. But the immunity after the disease is formed extremely slowly, so it is possible to re-infection. With the development of complications, the prognosis is determined by damage to vital organs.

Malaria prevention

Preventive measures are aimed at the destruction of mosquitoes of the genus Anopheles in hazardous areas, as well as to reduce the risk of human infection. The risk of infection is reduced if the following measures are taken:

• timely treatment of infected patients.
• careful selection of donors and high-quality sterilization of medical instruments.
• use of personal protective equipment when in hazardous areas: protective clothing, nets or curtains at night, use of repellents( DETA).
• individual drug prevention. 3-5 days before the proposed trip to the danger zone, it is recommended to start taking medications( quinine, hingamine) in preventive doses. The medication is continued for the duration of the stay, and for 4-8 weeks after leaving the danger zone. With the proper use of medicines, the risk of infection is significantly reduced.

A well-established malaria vaccine does not exist in , since hundreds of different strains of malaria can exist simultaneously in the same locality.

Doctor therapist Sirotkina EV