Let's recognize the first signs of swamp fever. Herpes: treatment of colds on the lips of a child
Depending on the type of malaria, the presence or absence of complications of the disease, the stage of the development cycle of malarial plasmodium, the presence of resistance (resistance) to antimalarial drugs, individual etiotropic therapy regimens are developed from the presented antimalarial drugs.
| Drug group | Drug names | Mechanism of action | Efficacy against malaria species | Receive mode |
| Quinolylmethanols | Quinine
(quinine sulfate, quinine hydrochloride and dihydrochloride, quinimax, hexaquin) | Hematoschizotropic antimalarial drugs
effective against plasmodia during the period of erythrocyte schizogony. Prevents the penetration of plasmodia into red blood cells. Gametocidal drug acts on gametocytes (sexual forms), prevents further entry of plasmodium into the body of a mosquito. | All types of plasmodium, including those resistant to chloroquine. | Adults
- 2 g / day. for 3 doses orally, 20-30 mg/kg/day. in 2-3 doses intravenously, 3-7 days. Children – 25 mg/kg in 3 doses, 3-7 days. |
| Chloroquine (delagil, hingamin) | Hematoschisotropic and moderate gametocidal action. | All types of plasmodia. | Adults
– 0.5 g/day. orally, 20-25 mg/kg in 3 injections every 30-32 hours intravenously. Children – 5 mg/kg/day 2-3 days. |
|
| Hydroxychloroquine (plaquenil) | Hematoschisotropic and moderate gametocidal action. | All types of plasmodia. | Adults
– 0.4 g/day. inside 2-3 days. Children – 6.5 mg/kg/ days 2-3 days. |
|
| Mefloquine (lariam) | Hematoschisotropic action | | Adults:
first dose – 0.75, after 12 hours – 0.5 g. Children – first dose – 15 mg/kg, after 12 hours – 10 mg/kg. |
|
| Primaquin | Histoschizotropic drug acts on tissue schizonts of plasmodia, incl. and on hypnozoites (dormant forms). Effective for preventing relapses. Gametocidal action. | Three-day and oval malaria. | Adults:
2.5 mg/kg every 48 hours – 3 doses. Children: 0.5 mg/kg every 48 hours – 3 doses. |
|
| Biguanides | Proguanil (bigumal, paludrin) | Histoschisotropic action . Slow hematoschizotropic action. | Tropical malaria, including those resistant to quinine and chloroquine. | Adults:
0.4 g/day 3 days. Children: 0.1 - 0.3 g / day. 3 days |
| Diaminopyrimidines | Pyrimethamine (chloridine, Daraprim) | Histoschisotropic action . Slow hematoschizotropic action in combination with sulfadoxine. | Tropical malaria. | Adults:
0.075 g once. Children: 0.0125 – 0.05 g once. |
| Terpene lactones | Artemisinin (artemeter, artesunate) | Hematoschisotropic
action. Reserve drug | All types of malaria. | Adults and children:
first dose – 3.2 mg/kg, then 1.6 mg/kg 1-2 times a day for 5-7 days. |
| Hydroxynaphthoquinones | Atovahon (mepron) | Hematoschisotropic
action. Reserve drug, used in the presence of resistance to other drugs. | All types of malaria. | Adults:
0.5 g 2 times a day for 3 days. Children: 0.125-0.375g 2 times a day for 3 days. |
| Sulfonamides | Sulfadoxine | Hematoschisotropic | Tropical malaria. | Adults:
1.5 g once. Children: 0.25 – 1.0 g once. |
| Sulfones | Dapsone | Hematoschisotropic action in combination with pyrimethamine. | Adults:
0.1 g/day Children: 1-2 mg / kg / day. |
|
| Tetracyclines | Tetracycline | Hematoschisotropic histoschisotropic action. | Tropical malaria, resistant to the above drugs. | Adults:
0.3 – 0.5 g 4 times a day. Children over 8 years old: 25-50mg/kg/day |
| Linkosamides | Clindamycin | Hematoschisotropic
action, low activity, moderate histoschisotropic action. | Tropical malaria, resistant to the above drugs, low activity. | Adults:
0.3 – 0.45 g 4 times a day. Children over 8 years old: 10-25 mg / kg / day. |
Caring for a person with malaria
A person with malaria needs constant and careful care, which will reduce suffering during attacks of fever. During the period of chills, it is necessary to cover the patient; you can put heating pads at the feet. During the heat, it is necessary to open the patient, remove the heating pads, but prevent hypothermia and drafts. For headaches, you can put a cold pack on your head. After profuse sweating, change the underwear and give the patient rest.
In the room where the patient is located, it is necessary to prevent mosquitoes from entering (using nets, insecticides) in order to prevent the spread of malaria.
When complications of malaria appear, the patient is transferred to a ward or intensive care unit.
Diet for malaria
- Interictal period– no diet is prescribed, common table No. 15 with plenty of drink.
- During an attack of fever – table No. 13 with plenty of drink. Table number 13 provides for an increase in the body's defenses, nutrition should be frequent and fractional.
- low-fat varieties of fish and meat, low-fat broths,
- boiled eggs,
- dairy products,
- mashed rice, buckwheat and semolina porridge,
- boiled vegetables,
- stale wheat bread, crackers,
- ground soft fruits and berries,
- juices, fruit drinks, decoctions,
- honey, sugar.
Prevention of malaria
Prevention of malaria is necessary when living and temporarily staying in countries endemic for malaria. So when traveling to a malaria-prone country, you need to prepare in advance. Pregnant women, children under the age of 4 and people living with HIV should not travel to malaria-affected countries. Protection against mosquito bites
- Mosquito nets on windows and doorways, you can sleep under a mesh curtain, tucking it under the mattress.
- Repellents– chemical compounds that repel mosquitoes, but do not kill them, which are applied to human skin or clothing. There are various forms: creams, sprays, aerosols, gels, etc. Use according to the instructions.
- Insecticides– means for killing mosquitoes. It is recommended to treat rooms, nets, and thresholds with an insecticide aerosol. Half an hour after treatment, it is necessary to ventilate the room.
Drug prevention of malaria
Antimalarial drugs are used. It is necessary to clarify the regional resistance of malaria to drugs. Drug prevention does not provide 100% protection, but significantly reduces the risk of disease.Drugs used to prevent malaria(must start 1 week before travel and continue for 4 – 6 weeks after arriving home) :
- Chloroquine (delagil) 0.5 g for adults and 5 mg/kg/day. children once a week.
- Hydroxychloroquine (Plaquenil) 0.4 g for adults and 6.5 mg/kg for children once a week.
- Mefloquine (Lariam) 0.25 g for adults and 0.05 - 0.25 mg for children once a week.
- Primaquin 30 mg for adults and 0.3 mg/kg for children once every 48 hours.
- Proguanil (bigumal) 0.2 g/day. adults and 0.05-0.2 g for children.
- Primethamine (chloridine) 0.0125 g for adults and 0.0025 – 0.0125 g for children in combination with the drug dapsone 0.1 g for adults once a week.
Identifying and effectively treating patients with malaria
It is necessary to promptly examine patients with suspected malaria, and also be sure to examine patients with each hyperthermic syndrome who arrived from places where malaria is endemic for 3 years. Effective treatment helps stop further transmission of the pathogen through mosquitoes.Malaria vaccine
There is currently no official malaria vaccine. However, clinical studies of an experimental vaccine against tropical malaria are underway. Perhaps, in 2015 - 2017, this vaccine will help cope with the malaria epidemic in the world.
What is lip malaria and how does it manifest?
Malaria on the lips manifests itself in the form of small blisters, located close to each other and filled with clear liquid. The cause of such lesions on the skin is the herpes simplex virus type 1. Therefore, the use of the term “malaria” to refer to this phenomenon is not correct. Also among the common names for the herpes virus on the lips there are such terms as “cold” or “fever on the lips”. This disease manifests itself with local symptoms that develop in accordance with a certain pattern. In addition to local symptoms, patients may also be concerned about some general manifestations of this disease. The stages of manifestation of herpes on the lips are:
- tingling;
- bubble formation;
- formation of ulcers;
- scab formation;
- healing.
The initial stage of herpes on the lips is manifested by mild itching. The patient begins to experience a slight tingling sensation in the corners of the mouth, on the inner and outer surfaces of the lips. Along with tingling, the patient may be bothered by the desire to scratch the areas around the wings of the nose or other parts of the face. Sometimes language can be involved in this process. The duration of this stage most often does not exceed 24 hours. These symptoms may occur due to overheating or hypothermia of the body. Often, herpes on the lips is a harbinger of a cold. In women, this phenomenon can develop during menstruation.
Bubble Formation
At this stage, the inflammatory process begins to develop. The areas in which tingling was felt swell and small transparent bubbles form on their surface. Vesicles are located close to each other, forming small clusters. These formations are filled with a clear liquid, which, as they increase, becomes more cloudy. The pressure in the blisters increases and they become very painful. The place of localization of the bubbles is the upper or lower lip, as well as the area under the nose.
Formation of ulcers
After 2 - 3 days, the bubbles with liquid begin to burst. During this period, the patient is most contagious, since the liquid contains a large number of viruses. An ulcer forms at the site of the burst vesicle.
Formation of scabs
At this stage, the ulcers begin to become covered with a brown crust. All affected areas are involved in the process, and within one day, dried scabs form at the site of the blisters. Bleeding wounds, itching or burning sensations may occur when the crust is removed.
Healing
Within 4 - 5 days, wounds heal and the skin is restored. In the process of falling off the scab of the patient, slight peeling and itching may disturb, which often provokes patients to peel off the crust of ulcers on their own. This leads to the healing process being delayed. Such interference can lead to the addition of a bacterial infection.
Common manifestations of herpes on the lips
Along with rashes in the area of the lips, herpes simplex type 1 can be manifested by a deterioration in the general condition, weakness, and headache. Often, patients have enlarged lymph nodes located in the lower jaw. Body temperature may also rise, muscle pain develops, and salivation increases.
What types of malaria are there?
There are four main types of malaria. Each type is caused by a specific type of malarial plasmodium, which determines the specificity of the disease. The types of malaria are:
- tropical malaria;
- three-day malaria;
- malaria ovale;
- quartan.
Tropical or, as it is also called, comatose malaria has the most severe course. It accounts for about 95–97 percent of all deaths. The clinic is dominated by severe toxic syndrome. The changes in the phases of “chills,” “heat,” and “sweat,” characteristic of other forms of malaria, are not expressed.
The disease begins with the appearance of fever, diffuse headache and myalgia ( severe muscle pain). After a couple of days, symptoms of toxic syndrome appear - nausea, vomiting, low blood pressure. Tropical malaria is characterized by the appearance of a rash on the body ( allergic exanthema), cough, feeling of suffocation. During the first week, hemolytic anemia develops, which is accompanied by the development of jaundice. Anemia develops due to increased destruction ( hemolysis – hence the name anemia) red blood cells. Enlargement of the liver and spleen is observed only in the second week, which significantly complicates the early diagnosis of malaria.
Many people with weakened immune systems may develop toxic shock, malarial coma, or acute renal failure already in the first or second week of the disease. Patients who develop a malarial coma become lethargic, sleepy, and apathetic. After a few hours, consciousness becomes confused, inhibited, and convulsions may also appear. This condition is characterized by an unfavorable outcome.
Due to massive destruction of red blood cells, acute renal failure most often develops. So, from destroyed red blood cells, hemoglobin enters first into the blood and then into the urine. As a result, the processes of urine formation in the kidneys are disrupted and diuresis decreases ( daily urine). Due to oliguria, metabolic products that are normally excreted in the urine remain in the body. A condition called uremia develops.
Three-day malaria
Three-day malaria refers to benign types of malarial invasion. As a rule, it is not accompanied by severe complications and does not lead to death.
Its beginning is preceded by a short prodromal period, which is absent in the tropical species. It manifests itself as weakness and pain in the muscles, after which a fever appears sharply. The difference between three-day malaria is that temperature rises occur every 48 hours, that is, every third day. This is where the name of this type of malaria comes from. During the period of rising temperature, patients are excited, breathing heavily, their skin is hot and dry. Heart rate is sharply increased ( up to 100 – 120 beats per minute), blood pressure drops, and urinary retention develops. The phases of “chills,” “heat,” and “sweat” become more distinct. The average duration of an attack varies from 6 to 12 hours. After two to three attacks ( respectively on days 7 – 10) an enlarged liver and spleen appear, and jaundice develops.
However, it can also happen that attacks of fever occur every day. This phenomenon is due to the entry into the blood of several generations of malarial plasmodium at once. Several months after the illness, the patient may continue to have periodic rises in temperature.
Malaria oval
This type of malaria is in many ways similar to tertian malaria, but has a milder course. The difference between malaria ovale is that attacks of fever occur every other day. The temperature rises mainly in the evening hours, which is not typical for previous types of malaria.
Quartan
This type of malaria, like the previous one, belongs to the benign forms of malarial invasion. It develops acutely, without any prodromal phenomena. Fever attacks occur every 72 hours. The temperature rises to 39 - 40 degrees. During attacks, the patient is also in serious condition - consciousness is confused, the skin is dry, the tongue is coated, blood pressure drops sharply.
In addition to the classic types of malaria, there is also a schizont type. It develops as a result of ready-made schizonts entering the human blood ( plasmodia that have undergone an asexual development cycle). Schizont malaria mainly develops as a result of blood transfusions or through the transplacental route. Therefore, this type is also called syringe or graft. Its difference is the absence of the development phase of plasmodium in the liver, and the clinical picture depends entirely on the volume of blood administered.
Mixed malaria also occurs, which develops as a result of simultaneous infection with several types of malarial plasmodia.
What are the features of tropical malaria?
The main features of tropical malaria are the severity of the developing symptoms, the nature of which is similar for all forms of the disease. Also, complications, duration and outcome of tropical malaria from other types of the disease have some differences. Onset of the disease
Malaria is characterized by a prodromal period ( mild course of the disease), which is characterized by general malaise and mild headaches. Feverish states typical of this disease, followed by periods of calm ( paroxysms), occur after 2–3 days. In tropical malaria, the onset of the disease is more acute. From the first days, patients begin to experience nausea, vomiting, and indigestion in the form of diarrhea. Headaches vary in intensity. These symptoms are accompanied by a persistent fever that can last for several days. Subsequently, the fever acquires an intermittent course with other phases of paroxysms.
Features of tropical malaria from other forms
| All forms of malaria except tropical | Criteria | Tropical malaria |
| The attacks are characterized by a clear change in phases of chills, heat and sweat. The duration of the second stage rarely exceeds 12 hours. After the end of the heat, body temperature drops sharply and increased sweating begins. Seizures occur according to a certain pattern. So, with three-day malaria, paroxysm bothers the patient once every 3 days, with four-day malaria - once every four days. | Paroxysms | The difference between paroxysms in this form is the short duration and weak severity of the first phase ( chills). In some cases, attacks begin to develop from the fever stage, bypassing the chills. In this case, the temperature suddenly reaches high values ( above 40 degrees) and can last all day. There is no specific systematic pattern in the occurrence of attacks. They can occur every other day, daily or twice a day. A decrease in temperature can occur without heavy sweating. |
| The patient may not feel anemia and this symptom is in most cases detected during laboratory testing. Sometimes blood changes are manifested by pale skin and weakness. | Anemia | With tropical malaria, anemia is more pronounced. Blood tests can detect pathologies from the first days of the disease. Patients experience lethargy and apathy due to a reduced amount of hemoglobin. There is a bluish tint to the extremities. |
| The spleen increases in size after several attacks. In this case, the abdomen becomes large and palpation can reveal a twofold increase in this organ. | Enlarged spleen | This form of malaria is characterized by a rapid enlargement of the spleen, which can be detected by ultrasound as early as 2–3 days. In this case, patients complain of pain in the area of the right hypochondrium, which becomes stronger with a deep sigh. |
| With malaria, there is an enlargement of the liver, which entails nausea and pain, which is localized in the right hypochondrium. Liver functions are not significantly impaired, but yellowness of the skin and mucous membranes is present. A change in the size of this organ occurs after the first attacks and leads to a 10–15 percent increase in the total mass of the organ. | Liver enlargement | In tropical malaria, liver enlargement is more progressive. Also, this form is characterized by liver damage, which entails damage to the hepatic lobules ( functional units of the liver). |
| With malaria infection, there is a decrease in blood pressure during the fever phase and a slight increase during the chills stage. Patients also complain of rapid heartbeat and pain in the heart area, which are stabbing in nature. | Pathologies of the cardiovascular system | Tropical malaria is manifested by severe hypotension ( lowering blood pressure). In addition, there are severe heart pains, murmurs, tachycardia. |
| During attacks, patients experience headaches, motor agitation. There may be feverish delirium. In most cases, with the normalization of temperature, these symptoms disappear. | Nervous system disorders | Tropical malaria is characterized by more pronounced damage to the nervous system. Severe headaches, feelings of anxiety and restlessness, convulsions, and confusion are often observed. |
| Malaria may be accompanied by a disorder such as albuminuria ( increased excretion of protein in the urine). Often, kidney dysfunction provokes edema. Such violations are quite rare - in 2 percent of cases. | Kidney dysfunction | With this form, kidney dysfunction is diagnosed in 22 percent of patients. |
Complications
Severe complications, which often result in the death of the patient, most often develop with tropical malaria.
Complications of tropical malaria are:
- malarial coma– the patient’s unconscious state with a complete lack of reaction to any stimuli;
- algid– toxic-infectious shock, in which the patient retains consciousness, but remains in prostration ( severely depressed and indifferent state);
- hemoglobinuric fever– development of acute renal and liver failure.
The duration of this form of malaria differs from other types of the disease. Thus, the total duration of three-day malaria varies from 2 to 3 years, four-day malaria - from 4 to 5 years, oval malaria - approximately 3 - 4 years. The duration of tropical malaria does not exceed, in most cases, one year.
What are the signs of malaria in adults?
The main symptom of malaria in adults is attacks of fever ( paroxysms) giving way to a state of rest. They are characteristic of all forms of the disease, except tropical malaria. Before the first attack, the patient may experience a headache, pain in the muscles and joints, and general malaise. Body temperature may also rise to subfebrile levels ( no higher than 38 degrees). This condition continues for 2–3 days, after which febrile paroxysms begin. Malarial attacks are characterized by the presence of phases that develop and replace each other in a certain sequence. At first, the attacks may be irregular in nature, but after a few days a clear pattern of development of this symptom is established. The duration of pauses between attacks depends on the form of the disease. With three-day malaria, the attack repeats once every 3 days, with four-day malaria - once every 4 days. Attacks develop at the same time, most often between 11 and 15 hours. The phases of a malarial attack are:
- chills;
This stage can be manifested by both mild trembling and severe chills, from which the patient’s whole body shakes. At the same time, the patient’s hands, feet and face become cold and acquire a bluish tint. The pulse quickens and breathing becomes shallow. The skin turns pale, becomes rough and acquires a bluish color. Chills can last from half an hour to 2 - 3 hours.
Heat
This phase is accompanied by a sharp increase in temperature, which can reach above 40 degrees. The patient's condition noticeably worsens. The face becomes red, the skin becomes dry and hot to the touch. The patient begins to experience severe headaches, muscle heaviness, and rapid, painful heartbeat. The tongue is covered with a grayish coating and is not sufficiently moist. Often the fever stage is accompanied by vomiting and diarrhea. The patient is in a state of excitement, convulsions and loss of consciousness may occur. The heat provokes an unquenchable thirst. This condition can last from 5 – 6 to 12 hours.
Sweat
The heat stage is replaced by the final phase, which is manifested by profuse sweating. The temperature drops sharply to normal values, sometimes reaching 35 degrees. The patient feels relief, calms down and falls asleep.
Other signs of malaria
Along with attacks, the most characteristic signs of malaria include anemia ( anemia), splenomegaly ( enlarged spleen) and hepatomegaly ( liver enlargement). This disease also has a number of symptoms that manifest themselves both on the physical and mental levels.
Signs of malaria include:
- anemia;
- splenomegaly;
- hepatomegaly;
- urinary disorders;
- dysfunction of the cardiovascular system;
- icteric staining of the skin and mucous membranes;
- skin hemorrhages;
- herpetic rashes ( manifestations of herpes);
- nervous disorders.
In patients with malaria, anemia sharply develops, which is characterized by a deficiency of hemoglobin and red blood cells. It develops due to massive destruction of red blood cells, due to the presence of malarial plasmodium in them ( so-called hemolytic anemia). Signs of anemia are most obvious between attacks. However, anemia may persist for a long time after recovery. The patient's skin becomes yellowish or sallow in color, weakness and increased fatigue are noted. With anemia, body tissues experience severe oxygen deficiency, because hemoglobin is an oxygen carrier.
Splenomegaly
An enlarged spleen is observed after 3–4 attacks of fever and persists for a long time. In tropical malaria, the spleen may enlarge immediately after the first paroxysm. Along with the increase, pain in this organ is observed. The spleen becomes denser, which is determined by palpation. In the absence of adequate treatment, the spleen enlarges so much that it begins to occupy the entire left side of the abdomen.
Hepatomegaly
The enlargement of the liver occurs faster than the change in the spleen. In this case, the edge of the liver drops below the costal arch and becomes denser and more painful. The patient complains of painful discomfort in the area of the right hypochondrium.
Urinary disorders
Against the background of ongoing processes in the body, during attacks during chills, patients experience frequent urination. In this case, the urine has an almost transparent color. With the onset of fever, the volume of urine becomes more scanty, and the color becomes darker.
Dysfunction of the cardiovascular system
The most severe disturbances of the cardiovascular system are expressed during malarial paroxysms. Characteristic signs of this disease are an increase in blood pressure during chills and a drop during fever.
Jaundice staining of the skin and mucous membranes
It is an early sign of malaria in adults. When red blood cells are destroyed, not only hemoglobin is released from them, but also bilirubin ( bile pigment). It gives the yellow color to the skin and mucous membranes. In people with dark skin color, it is sometimes difficult to detect icteric discoloration. Their jaundice is determined by the color of the visible mucous membranes, namely the sclera ( outer shell of the eye). The yellowish color of the sclera or their icterus may appear long before the icteric discoloration of the skin, and therefore is an important diagnostic sign.
Skin hemorrhages
Due to vascular spasms, a hemorrhagic rash forms on the patient’s body ( subcutaneous hemorrhages). The rash has no specific localization and spreads unevenly throughout the body. Externally, this sign looks like star-shaped spots of blue, red or purple.
Herpetic rashes
If a patient with malaria is a carrier of the herpes virus, it worsens during a febrile state. Bubbles with clear liquid characteristic of the virus appear on the lips, wings of the nose, and less often on other areas of the face.
Nervous disorders
The most obvious disorders of the nervous system are manifested in three-day and tropical malaria. Patients experience constant headaches, insomnia, and lethargy in the morning and throughout the day. The psyche of patients undergoes negative changes during attacks. They are depressed, have poor orientation, and answer questions asked in a confused manner. Often during a fever, patients become delirious and experience hallucinations. Tropical malaria is characterized by a violent state of the patient, which can continue even after an attack.
What are the signs of malaria in children?
In children, the signs of malaria vary widely, depending on the child’s age and immune system. Signs of malaria in children include:
- fever;
- anemia;
- rash;
- disorders of the gastrointestinal tract;
- disorders of the nervous system;
- convulsions;
- enlargement of the spleen and liver.
It is the main symptom of childhood malaria. It can be either constant or in the form of attacks. Classic attacks, which are typical for adults, are rare. Such attacks occur in several stages. The first stage is chills; the second is heat ( heat); the third is pouring sweat. Children are characterized by high temperature rises of up to 40 degrees or more. The younger the child, the stronger the fever. During the second stage, children are excited, they experience rapid breathing, dry and red skin. A drop in temperature is accompanied by heavy sweating and severe, debilitating weakness. Such classic seizures are rare in children. More often, the temperature is variable, and in 10–15 percent of children, malaria occurs without fever at all. Infants often experience constant fever, drowsiness, and lethargy. The equivalent of an attack in infants is a sharp pallor of the skin, turning into cyanosis ( bluish discoloration of the skin). In this case, the skin becomes sharply cold, and tremors of the limbs are observed.
Anemia
As a rule, malaria in children occurs with severe anemia. It appears from the first days of the disease and is often an early diagnostic sign. It develops due to massive destruction of red blood cells. The number of red blood cells sometimes drops to 30–40 percent of normal.
A distinctive sign of malarial invasion in children is changes in the blood not only in red blood cells and hemoglobin, but also in other blood elements. Thus, very often there is a general decrease in leukocytes ( leukopenia), platelets. At the same time, the erythrocyte sedimentation rate increases. Despite severe anemia, jaundice in children with malaria is observed only in 15 to 20 percent of cases.
Rash
The rash is especially common in young children. It first appears on the abdomen, then spreads to the chest and other parts of the body. The nature of the rash can be very diverse - petechial, macular, hemorrhagic. The development of the rash is caused by a decrease in the number of platelets and increased permeability of the vascular wall.
Gastrointestinal disorders
Disorders of the digestive system are almost always observed. The younger the child, the more varied these disorders are. They manifest themselves in the form of diarrhea, repeated vomiting, and nausea. Loose stools mixed with mucus are often observed, which is accompanied by bloating and pain. In infants, this may be the first sign of malarial infestation. Repeated vomiting also occurs, which does not bring relief.
Nervous system disorders
They can appear both at the height of febrile attacks and during the temperature-free period. These disorders manifest themselves in the form of meningeal symptoms, which are characteristic of all types of malaria. Photophobia, stiff neck, and vomiting appear. Such symptoms disappear simultaneously with a drop in temperature. Motor agitation, delirium, and confusion may also occur. This variety of nervous system disorders is explained by the effect of malaria toxin on nerve cells.
Convulsions
Seizures or convulsions are also very common in children with malaria. Basically, cramps appear at the height of fever. They can be clonic or tonic. Their appearance is explained by high temperature, and not by the presence of any disease. These seizures belong to the category of febrile seizures, which are characteristic of childhood. The younger the child, the more likely he is to have seizures.
Enlarged spleen and liver
It is a common but inconsistent symptom. The spleen and liver enlarge only after several repeated attacks of fever.
A separate type of malarial infection in children is congenital malaria. In this case, malarial plasmodium enters the child's body in utero through the placenta. This malaria is extremely severe and often ends in death. Children with congenital malaria are born prematurely, with low weight and abnormalities of internal organs. The skin of such children is pale, with a waxy or jaundiced tint, and a hemorrhagic rash is often observed. The spleen and liver are sharply enlarged. When born, children do not make their first cry, they are usually lethargic, with reduced muscle tone.
Why is malaria dangerous during pregnancy?
The danger of malaria during pregnancy is the increased risk of developing malignant forms of the disease. Physiological changes that accompany the process of bearing a child make a woman more susceptible to infection. The nature of the consequences is determined by the stage of pregnancy at which malaria infection occurred. The outcome of the disease is also influenced by the condition of the woman’s body and the timing at which treatment was started. Infectious agents can have a negative impact both on the pregnant woman and directly on the fetus itself. Consequences of malaria for women
The infection poses the greatest danger if it is contracted in the early stages of pregnancy. The most common consequence is spontaneous abortion. Termination of pregnancy occurs due to irreversible changes that have occurred in a woman’s body under the influence of malarial plasmodia. If pregnancy continues, children are often born prematurely, of which 15 percent die during childbirth and 42 percent die in the first days after birth. Among full-term children born to women infected with malaria, the percentage of stillbirths is an order of magnitude higher than among other mothers. Often, children of patients with malaria are born with low birth weight and are often ill during the first years of life.
Complications of malaria during pregnancy are:
- anemia (there is anemia among the people);
- nephropathy (a form of late toxicosis caused by kidney dysfunction);
- eclampsia (critical complications due to brain damage);
- hypoglycemia (decreased blood sugar).
Lack of hemoglobin in the blood provokes multiple pathological processes in a woman’s body. The liver stops producing the necessary amount of protein to form new cells, which can result in intrauterine developmental delay of the embryo. Toxins are no longer excreted in full, which can lead to insufficient oxygen supply to the fetus.
Other consequences of malaria due to anemia are:
- premature placental abruption;
- stillbirth;
- weakness of labor.
Nephropathy develops after the 20th week of pregnancy and is manifested by increased blood pressure, swelling of the hands and face, insomnia and headaches. Laboratory tests for this disorder detect increased levels of protein and uric acid in the urine. The consequences of nephropathy can be intrauterine growth retardation, pregnancy loss, and fetal death.
Eclampsia
This disorder develops due to damage to brain cells caused by malaria infection. Eclampsia manifests itself as convulsive seizures, after which the patient falls into a coma. After some time, the patient returns to consciousness. In some cases, a prolonged coma may develop, from which the woman cannot emerge. Vascular spasms that occur during seizures can lead to asphyxia ( suffocation) or hypoxia ( oxygen starvation) embryo. Eclampsia often causes intrauterine fetal death. In a pregnant woman, this complication of malaria can cause stroke, heart or lung failure, liver or kidney dysfunction. Often, against the background of this disorder, premature placental abruption occurs. All these pathologies can lead to the death of both the fetus and the woman herself.
Hypoglycemia
This syndrome can develop in pregnant women infected with tropical malaria. Hypoglycemia manifests itself in attacks, the repeated repetition of which can harm both the fetus and the expectant mother. The lack of the required amount of glucose can cause heartbeat disturbances or retardation in physical and mental development in the embryo. For women, this condition is fraught with depression of cognitive functions, depression, and attention disorders.
Also, the consequences of congenital malaria include:
- jaundice;
- epileptic seizures;
- anemia ( often in severe form);
- enlarged liver and/or spleen;
- increased susceptibility to infections.
What drugs are there against malaria?
Against malaria, there is a wide range of different drugs that act on different stages of the development of Plasmodium falciparum. First of all, etiotropic drugs are used, the action of which is aimed at destroying the malarial plasmodium from the body. Drugs whose action is aimed at eliminating symptoms ( symptomatic treatment).There are the following main groups of drugs against malaria:
- drugs that act on malarial plasmodia in the liver and that prevent their further penetration into red blood cells - proguanil, primaquine;
- drugs that act on erythrocyte forms of plasmodium, that is, those that are already in erythrocytes - quinine, mefloquine, atovaquone;
- drugs that act on the sexual forms of Plasmodium falciparum - chloroquine;
- drugs to prevent relapses of malaria - primaquine;
- drugs used to prevent malaria - plasmocide, bigumal.
- drugs that are used to both treat and prevent malaria are antifolates.
Main drugs used in the treatment and prevention of malaria
| A drug | Characteristic |
| Chloroquine | Mainly used for the prevention of all types of malaria. The drug should be taken a week before entering an endemic zone ( country or region with a high incidence of malaria). |
| Mefloquine | Used to prevent malaria in cases where chloroquine is ineffective. |
| Quinine | It is used in the treatment of malignant forms of malaria, for example, in the tropical form. The drug may be contraindicated due to individual intolerance. |
| Proguanil | They are used in the treatment of malaria in combination with other drugs, such as atovaquone. Also used for prevention. |
| Pyrimethamine | It has a wide spectrum of action and is effective against malarial plasmodium and toxoplasma. Rarely used in monotherapy, as it quickly causes resistance. |
| Atovaquone | Used in the treatment of malaria, but not registered in most CIS countries. Highly effective against all types of malaria, used in the treatment of malaria in AIDS patients. |
| Galfan | It is a reserve drug and is used in extreme cases for forms of malaria resistant to other drugs. It also has great cardiotoxicity. |
There are other drugs used in the treatment of malaria:
- antihistamines – clemastine, loratadine;
- diuretics – furosemide, diacarb, mannitol;
- colloidal and crystalloid solutions - refortan, 20 and 40% glucose solution;
- cardiotonic drugs – dopamine, dobutamine;
- glucocorticoids – Avamis, beclazone;
What anti-malaria pills are there?
There are different anti-malaria tablets depending on the main active ingredient. | The name of the tablets | Characteristic | ||||||
| Quinine sulfate | Take 1 - 2 grams per day, lasting 4 - 7 days. They can be found in the form of 0.25 gram and 0.5 gram tablets. The daily dose is divided into 2 – 3 doses. The tablets should be taken with acidified water. It is best to use water with lemon juice. The dose and duration of taking the tablets depends on the type of malaria. Children's doses depend on age. |
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| Chloroquine | Adults are prescribed 0.5 grams per day. On the first day, the daily dose was increased to 1.5 grams in two doses - 1.0 and 0.5 grams. Children's doses are 5 – 7.5 milligrams per kilogram. Treatment with chloroquine lasts 3 days. |
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| Hydroxychloroquine | Adults are prescribed 0.4 grams per day. On the first day, the daily dose was increased to 1.2 grams in two doses - 0.8 and 0.4 grams. Children's doses are 6.5 milligrams per kilogram. Treatment with hydroxychloroquine tablets lasts 3 days. |
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| Primaquin | Available in 3 and 9 milligrams. They are taken at 27 milligrams per day for two weeks. The daily dose is divided into 2 – 3 doses. Proguanil is prescribed not only for therapy, but also for the prevention of malaria. The dosage depends on the type of malaria. On average, the daily therapeutic dose is 0.4 grams, and the prophylactic dose is 0.2 grams. Treatment lasts 3 days, and prophylaxis lasts the entire period of stay in an area with a high risk of infection, plus another 4 weeks. Children's doses do not exceed 0.3 grams per day. Diaminopyrimidine group of drugs Sulfanilamide group of drugs Sulfones Tetracycline group of drugs and lincosamides
What tests for malaria need to be taken? For malaria, it is necessary to take a general urine test, as well as general and specific blood tests that will help diagnose this disease. General urine analysis Hemoleukogram All blood tests begin with a hemoleukogram. In malaria, red blood cells are destroyed in large numbers, which leads to shifts in the overall ratio of cellular elements in the blood. The main deviations in the hemoleukogram in malaria are:
For malaria, it is also necessary to take a biochemical blood test, which confirms the active destruction of red blood cells in the vascular bed. Immunological blood test Polymerase chain reaction based on a drop of blood What are the stages of malaria? The clinical picture of malaria is divided into several stages. The stages of malaria are:
The incubation period is the period of time from the moment the malarial plasmodium enters the body until the first symptoms appear. The duration of this period depends on the type of malarial plasmodium. The duration of the incubation period depending on the type of malaria The length of the incubation period may vary if inadequate prevention has previously been taken. Stage of primary manifestations During periods of no fever, symptoms such as muscle pain, headaches, weakness, and nausea persist. If malaria develops in children, then during this period symptoms of gastrointestinal disorders predominate. These symptoms are vomiting, diarrhea, and bloating. As the liver enlarges, a dull pain in the right hypochondrium increases and jaundice develops, as a result of which the patients’ skin acquires a jaundiced tint. One of the most formidable symptoms of this period is rapidly developing anemia ( decrease in the number of red blood cells and hemoglobin in the blood). Its development is caused by the destruction of red blood cells by the malarial plasmodium. Red blood cells are destroyed, and hemoglobin comes out of them ( which subsequently appears in the urine) and bilirubin, which gives the skin its yellow color. Anemia, in turn, leads to other complications. This is, firstly, oxygen deficiency that the body experiences. Secondly, hemoglobin released from red blood cells enters the kidneys, disrupting their functionality. Therefore, acute renal failure is a common complication of this period. It is also the main cause of death from malaria. This stage characterizes the main clinical picture of malaria. In case of untimely diagnosis and treatment, conditions such as malarial coma, toxic shock, and hemorrhagic syndrome develop. Toxic syndrome at this stage is moderate, complications are rare. As in the stage of early manifestations, anemia develops, the liver and spleen are moderately enlarged. Recovery stage Sometimes a latent stage may occur between the periods of early and late relapses ( complete absence of symptoms). It can last from two to ten months and is mainly characteristic of three-day malaria and malaria ovale. What are the consequences of malaria? There are multiple consequences of malaria. They can occur both in the acute period of the disease ( that is, in the stage of early manifestations), and after. The consequences of malaria are:
As a rule, it is a complication of tropical malaria, but can also be a consequence of other forms of malarial invasion. This complication is characterized by a staged, but at the same time, rapid course. Initially, patients complain of severe headache, repeated vomiting, and dizziness. They experience lethargy, apathy and severe drowsiness. Over the course of several hours, drowsiness worsens and a soporous state develops. During this period, convulsions and meningeal symptoms are sometimes observed ( photophobia and muscle stiffness), consciousness becomes confused. If there is no treatment, a deep coma develops, during which blood pressure drops, reflexes disappear, and breathing becomes arrhythmic. During a coma, there is no reaction to external stimuli, vascular tone changes and temperature regulation is disrupted. This condition is critical and requires resuscitation measures. Toxic shock Also, with toxic shock, damage to the nervous system occurs, which is manifested by confusion, psychomotor agitation, and fever ( due to temperature regulation). Acute renal failure Symptoms of acute renal failure are rapid deterioration of the condition, decreased diuresis, and dark colored urine. In the blood there is a disturbance in the water-electrolyte balance, a shift in the alkaline balance, and an increase in the number of leukocytes. Acute massive hemolysis Hemorrhagic syndrome These blood clots are formed due to enhanced thrombocytopoiesis, which, in turn, is activated due to the destruction of red blood cells. Thus, a vicious circle is formed. As a result of hemolysis of red blood cells, numerous breakdown products are formed, which enhance the formation of blood clots. The more intense the hemolysis, the stronger the hemorrhagic and DIC syndrome. Is there a vaccine against malaria? A vaccine against malaria exists, but it is not currently universal. Its routine use is not approved in European countries. The first malaria vaccine was created in 2014 in the UK by the pharmaceutical company GlaxoSmithKline. British scientists have created the drug mosquirix ( moskirix), which is intended to vaccinate populations most at risk of contracting malaria. Since 2015, this vaccine has been used to vaccinate children in many countries in Africa, where malaria is most common. Moskirix vaccination is given to children from one and a half months to two years. It is at this age that African children are most susceptible to malaria. According to scientists, as a result of vaccination, not all children developed immunity against malaria. In children aged 5 to 17 months, the disease was prevented in 56 percent of cases, but in children under 3 months it was prevented in only 31 percent of cases. Thus, the currently created malaria vaccine has a number of negative qualities, which suspends its large-scale use. New developments are currently underway to create a more universal malaria vaccine. According to scientists, the first mass vaccinations should appear by 2017. |
Malaria is an acute infectious disease caused by malarial plasmodia, characterized by certain patterns: a cyclic course with alternating periods of acute febrile attacks and interictal conditions, splenomegaly, anemia.
From this article you will learn the main causes and symptoms of malaria in children, how malaria in children is treated and what preventive measures you can take to protect your child from this disease.
Treatment of malaria in children
How to cure malaria?
Treatment of children with malaria is carried out in a hospital. Patients with severe, complicated forms of tropical malaria are treated in the intensive care unit. Bed rest for the period of febrile attacks. Diet according to age.
Etiotropic therapy. Antimalarial drugs for treatment are divided into two groups: schizotropic, acting on asexual forms, and gametotropic, acting on sexual forms of plasmodium.
Treatments for malaria in children
Among the schizotropic drugs for the treatment of malaria in children are:
Gametotropic drugs for the treatment of malaria cause the death of gametocytes (primaquine, quinocide); prevent the formation of sporozoites (bigumal, chloridine).
Specific treatment for malaria should be started immediately after diagnosis based on the epidemiological history and clinical picture. After taking blood (a “thick” drop and smear), the patient is prescribed a hemato-schizotropic drug (Delagil), without waiting for the results of a blood test.
To cure uncomplicated malaria, relief therapy with dela-gil (chloridine) is carried out. Subsequent administration of primaquine depends on the type of malaria:
- for tropical malaria it is used for treatment as a gametocidal agent during the transmission season - for 3 days;
- for three-day and oval malaria - as a histoschizotropic drug to prevent late relapses - for 10-14 days;
- for four days - not shown.
Fansidar (metakel-fin) is used to treat malaria caused by chloroquine-resistant strains of P. falciparum.
In the treatment of delagil-resistant, as well as severe forms of malaria in children, quinine is used as an etiotropic agent at the rate of 10 mg/kg twice a day after 8-12 hours intravenously drip very slowly (over 2-4 hours) in 100-200 ml of physiological solution. For malarial coma, quinine is administered intravenously in a slow stream (over 20-30 minutes) in 20 ml of glucose. Quinine is prescribed for up to 10 days (more often - 4 - 5 days), then treatment of malaria with Fansidar is continued (up to 10 days).
Infusion therapy for the purpose of detoxification and dehydration, corticosteroids (5-10 mg/kg body weight for prednisolone), diuretics, iron supplements, and drugs for the treatment of disseminated intravascular coagulation are used as pathogenetic agents.
Prevention. Measures to prevent malaria are carried out in the following areas: neutralization of the source of infection, destruction of vectors, protecting people from mosquito attacks, rational use of chemoprophylaxis. Before entering endemic areas, children and adults are given chemoprophylaxis with chloridine (Delagil) for 7 days; upon departure, an antimalarial drug is prescribed for another 4-6 weeks.
In malarial areas, chloroquine, amodiaquine, bigumal, and chloridine are taken daily in a dose equal to 1/3 - lU of the therapeutic dose. The fight against mosquitoes of the genus Anopheles, carrying out measures aimed at draining the area and thereby eliminating mosquito habitats are important.
Treatment prognosis. For malaria, the prognosis is unfavorable, but with timely initiation and proper treatment, complete recovery occurs. Mortality is 0.2 - 0.3% and is observed in cases of complicated or malignant disease (in children with fulminant, comatose or algid forms of malaria).
Symptoms of malaria in children
Typical forms of malaria are characterized by a cyclical course with a change in the following periods: incubation, prodromal, primary attack, relapses (early and late).
The incubation period is from the moment of infection until the appearance of the first clinical symptoms of malaria. The duration of the incubation period depends on the type of plasmodium (for vivax malaria - from 10 - 20 days to 8-10 months, for ovale malaria - 11 - 16 days, falciparum - 8 - 16 days, four-day - 21 - 42 days), and also the dose of the pathogen and the state of immunity.
The prodromal period lasts from several hours to 1 week and is characterized by malaise, headache, arthralgia, myalgia, loss of appetite, sometimes nausea, vomiting, and diarrhea. There may be slight chilling, an increase in body temperature to subfebrile levels and higher (initial fever). The prodromal period is especially characteristic of vivax and ovale malaria, but is not observed in four-day malaria.
Course of the disease before treatment of malaria in children
Primary attack (primary malaria). After the prodromal period or from the first days of illness (with four-day malaria), symptoms of malaria develop, such as typical malarial paroxysms, occurring with a change in phases: chills, heat, sweat.
Chills are manifested by a trembling symptom. The patient's skin is pale, cold, cyanotic, rough ("goose bumps"). Chills last from 10-15 minutes to 2-3 hours, the longest and most pronounced - with tropical malaria.
Fever - the second phase of paroxysm - is manifested by the following symptoms: a rapid rise in body temperature, cessation of chills, and the appearance of a feeling of warmth. Body temperature rises to 39-40° C, intoxication, tachycardia, and shortness of breath increase. Blood pressure decreases. Delirium and impaired consciousness are possible. The heat phase is especially long in tropical malaria: it can reach 12-24 hours and even 36 hours.
Sweat is the third phase, characterized by the following symptoms: a critical decrease in body temperature to subnormal numbers, profuse sweating, improvement in well-being against the background of severe weakness.
Malarial paroxysm lasts 6-12 hours, and with tropical malaria - up to a day or more. The peculiarity of malarial fever is the onset of paroxysm at certain time intervals, at the same time of day (with vivax and quartan malaria - in the morning and afternoon hours, with ovale malaria - in the evening, with tropical malaria - at any time of the day). Fever usually has an irregular intermittent nature with the onset of paroxysms after 48 hours in vivax and ovale malaria and after 72 hours in quartan malaria. Fever in tropical malaria may be of the wrong type. At the beginning of the disease, attacks are not always strictly periodic.
Hepatolienal syndrome is characteristic of all types of malaria (the degree of enlargement of the spleen is greater than that of the liver). By palpation, an enlarged spleen is detected by the end of the 1st - beginning of the 2nd week. diseases with vivax- and falciparum-malaria and at a later date with ovale- and four-day malaria. The liver also increases significantly in size by the end of the 1st week. diseases. Liver functions are moderately impaired only in tropical malaria: the levels of direct and indirect bilirubin and the level of transferases in the blood serum increase, the concentration of total protein decreases (due to albumin), later hypergammaglobulinemia appears, and jaundice is possible. As the disease progresses, the liver and spleen continue to increase in size and become dense.
Hemolytic anemia develops due to the destruction of red blood cells at the end of the cycle of erythrocyte schizogony, hypersplenism, as well as autoimmune mechanisms of hemolysis. There is a pale icteric discoloration of the skin and visible mucous membranes with unchanged color of urine and feces.
Duration of malaria:
- tropical malaria - from 6 months. up to 20 months (usually 1 year);
- three-day malaria - 1.5-3.0 years;
- oval malaria - 2-4 years;
- four-day malaria - 4-5 years.
Malaria in young children
Characterized by a number of features:
- typical attacks may be absent (body temperature first rises to febrile levels, then subfebrile, instead of chills there are attacks of cyanosis and coldness of the extremities, the equivalent of sweat is moistening of the scalp and torso);
- the frequency of attacks is not typical;
- anxiety, sleep disturbance, breast refusal, even anorexia are often noted;
- vomiting, convulsions, meningeal symptoms are possible;
- frequent regurgitation, abdominal pain, loose stools;
- dehydration may develop;
- anemia increases rapidly;
- hepatolienal syndrome is expressed;
- Severe forms of the disease are common;
- Possible death.
In a number of cases, an impregnable course of malaria is noted: the child has hiccups at certain hours without an increase in body temperature, chills and sweat. In this case, hepatolienal syndrome and progressive anemia are always pronounced.
Complications of malaria in children
Specific complications: cerebral malaria, mental disorders, acute hemolysis and hemoglobinuric fever, acute renal failure, cerebral edema, rupture of the spleen, secondary hypochromic anemia, nephrotic syndrome. Specific complications are often the cause of death, mainly in tropical malaria.
Cerebral malaria is a complication of malaria
Occurs due to severe disturbances of cerebral hemodynamics after filling the capillary network with red blood cells infected with schizonts, lasts from 1-2 to 4-5 days. During cerebral malaria, three stages are distinguished: somnolent (precoma), stupor, deep coma. In the precoma stage, lethargy and darkening of consciousness are noted, but there are phenomena of mental and motor excitation, convulsions, hyperkinesis, and stiff neck. The temperature curve in somnolence is of an intermittent nature, in cases of stupor and coma it is constant or of an irregular type. Cerebrospinal fluid pressure is normal, sometimes slightly elevated. The cerebrospinal fluid is transparent, contains 0.15-0.2% protein, and single leukocytes. Blood pressure decreases, toxic breathing appears. Swallowing disorders and gastroenteritis are observed. The liver and spleen are enlarged. Changes in the blood, as in severe malaria.
Mental disorders - complications of malaria
Mental disorders also occur more often with tropical malaria and are characterized by motor agitation, confusion, and the appearance of hallucinations.
Acute hemolysis and hemoglobinuric fever - complications of malaria
The main symptom of hemoglobinuria is the appearance of black or red urine as a result of the predominance of methemoglobin or oxyhemoglobin in it, respectively. After sedimentation of urine, two layers are observed: the upper one is transparent red and the lower one is dark brown, consisting of blood detritus, granular and hyaline cylinders. Urine contains high concentrations of protein and bile pigments. With developing renal failure, oliguria is observed (excretion of a small amount of thick, dark, tarry urine), then anuria. Uremia develops, coma and after 3-4 days the patient dies. Mortality reaches 50%. If the course is favorable, the attack ends after 3-5 days. The urine becomes lighter and the body temperature decreases, blood repair begins.
Acute renal failure - a complication of malaria
Acute renal failure (ARF) can develop as an independent complication of tropical malaria or accompany cerebral malaria or hemoglobinuric fever. Low urine density, decreased urea concentration, severe proteinuria and cylindruria are determined, and oligo- or anuria develops. The level of urea and creatinine in the blood serum increases. Later, the electrolyte balance changes.
Cerebral edema is a complication of malaria
Cerebral edema was observed in past years with primary or recurrent three-day malaria in central Russia. The complication occurred mainly in preschool children and adolescents. At the height of one of the attacks, a severe headache, convulsions, loss of consciousness, foam from the mouth suddenly appeared. Death quickly occurred with symptoms of respiratory arrest and cardiac activity.
Splenic rupture is a complication of malaria
Rupture of the spleen is more often observed in those initially ill with three-day malaria. The immediate causes of rupture of a sharply enlarged spleen can be even a small injury to the abdomen, vomiting, and vigorous palpation of it during examination. Signs of a ruptured spleen are acute and severe pain with symptoms of peritoneal irritation and internal bleeding, a decrease in heart rate and blood pressure, and a state of shock.
Secondary hypochromic anemia - a complication of malaria
Nephrotic syndrome - a complication of malaria
Nephrotic syndrome develops with quartan malaria. Pathogenetically due to the deposition of immunoglobulin complexes IgG and IgM with a specific antigen and complement on the basement membrane of the renal glomeruli. It is characterized by a slow, steadily progressive course and an increase in proteinuria, hypoproteinemia, widespread edema, hypertension, and renal failure.
Also complications of malaria are nephrosis, which can be relieved under the influence of specific therapy, cirrhosis of the liver, life-threatening damage to the central nervous system with the development of psychosis, focal symptoms (aphasia, mono- and hemiplegia, etc.), coma, which occurs gradually or instantly, due to circulatory disorders, hemoglobinuric fever (vomiting, colicky abdominal pain, hemoglobinuria, possible anuria).
Causes of malaria in children
Malaria has been known since ancient times. The disease mainly affects the population of countries with tropical climates, but is also observed in temperate latitudes. In Europe, over much of the continent, the disease was widespread until the 19th century.
The causative agent of malaria
The causative agent of malaria was isolated by the French scientist Laveran in 1880. A few years later, the role of mosquitoes of the genus Anopheles as a carrier of the causative agent of malaria to humans was established. Russian scientists V. A. Afanasyev, V. A. Danilevsky, N. A. Sakharov, E. A. Pavlovsky, S. P. Botkin, N. F. Filatov, E. I. Martsinovsky made a great contribution to the study of malaria.
At the beginning of the 20th century, the incidence of malaria fell sharply, but during the First and Second World Wars it increased again. The malaria eradication efforts carried out by WHO in 1955-1969, although they helped reduce the incidence in many countries around the world, did not bring significant results, especially in Africa.
Etiology. The causative agent - malarial plasmodium - belongs to the half-kingdom Protozoa, phylum Apicomplexa, family Plasmodiidae, genus Plasmodium.
More than 100 species of malaria pathogens are known in monkeys, rodents, and lizards.
- P. vivax, which causes tertian malaria,
- P. falciparum - tropical malaria,
- P. malariae - four-day malaria,
- P. ovale - three-day malaria in tropical Africa.
The types of pathogens differ in sensitivity to chemotherapeutic drugs, morphological signs and symptoms, and the diseases they cause differ in the duration of the incubation period, immunological and epidemiological characteristics, and outcomes.
Epidemiology. Malaria is a typical anthroponosis with natural focality.
Transmission mechanism: hemocontact.
Transmission routes:
- vector-borne (carriers are female mosquitoes of the genus Anopheles);
- blood transfusion (during the transfusion of infected blood and its preparations);
- transplacental - from mother to fetus.
Morbidity. Currently, the disease is widespread in Africa, the Near and Middle East, Southeast Asia, and Latin America. Of the 180 countries, 90 are endemic for malaria. The total number of infected people in the world is 300-400 million people. Every year, 120 million people fall ill with malaria, of which 1-2 million die, 80% of which are children.
Seasonality. In countries with temperate climates, the incidence of malaria is characterized by pronounced seasonality with an increase in the summer-autumn months. In countries with tropical climates, malaria infection occurs all year round. Depending on natural, climatic and social conditions, malaria foci are formed with a certain level of transmission intensity, which remains unchanged for decades (endemic foci).
Mortality. Most types of malaria are benign, but tropical malaria is fatal in 0.5-7% of cases.
Tropical malaria
Tropical malaria often occurs with severe, life-threatening symptoms. This is malignant (pernicious) malaria, ending in death. The pathogenetic features of infection caused by P. falciparum are:
The outcome of infection and the nature of the clinical course of the infection are determined by the characteristics of the child’s immunological status, in particular the activity of factors of nonspecific congenital resistance, the intensity of post-infectious immunity and the level of specific antibodies received from the mother (in newborns).
The beginning of the immune response is the phagocytosis of malarial plasmodium by macrophages of the liver, spleen, and bone marrow. The formation of IgM class antibodies begins from the first days of infection, IgG are produced later. There are antisporozontic, antimerozoite, antischizont, antitoxic and antigametocyte antibodies.
Types of malaria in children
Classification of malaria:
By type of pathogen:
- three-day malaria;
- ovalemalaria;
- tropical malaria;
- quartan.
Type:
Typical.
Atypical:
By severity:
Light form.
Moderate form.
Severe form.
By flow (by character):
Unsmooth:
- with complications;
- with a layer of secondary infection;
- with exacerbation of chronic diseases;
- with relapses (early and late).
Diagnosis of malaria in children
Musculoskeletal diagnostic signs and symptoms of malaria:
- stay in an endemic area;
- intermittent nature of the temperature curve with peaks after 48 or 72 hours;
- the presence of malarial paroxysm (chills, fever, sweat);
- progressive enlargement of the spleen;
- progressive enlargement of the liver;
- anemia.
Laboratory diagnosis of malaria
The diagnosis of malaria can be made clinically, but must be confirmed by laboratory testing before registration.
Indications for blood testing for malarial plasmodia are:
- increased body temperature and malaise in those arriving from areas where malaria is endemic;
- fever for more than 5 days, and in the epidemic season for more than 2 days;
- treatment-resistant fever;
- increase in body temperature after 2 months. after a blood transfusion;
- any increase in body temperature in patients with a history of malaria;
- the presence of hepatolienal syndrome in the patient against the background of increased body temperature, anemia, and jaundice of the sclera.
The serological method for diagnosing malaria is mainly used when examining donors. Immunofluorescence reaction and enzyme immunoassay are used.
In the blood test, at the beginning of the disease, leukocytosis with neutrophilia is noted, then leukopenia with neutropenia and relative lymphocytosis develops; ESR increases significantly from the 2nd week of the disease; the number of reticulocytes increases.
Differential diagnosis is carried out with brucellosis, typhoparatyphoid diseases, influenza, visceral leishmaniasis, leptospirosis, tick-borne spirochetosis, sepsis, dengue and pappataci fevers, hemolytic disease and anemia. Malarial coma is differentiated from hepatic, diabetic, uremic, and cerebral coma.
Congenital malaria
It is rare, more often in hypo- and meso-endemic areas where pregnant women with malaria are not treated.
Infection is possible in utero through a damaged placenta (more often with tropical malaria). If the fetus becomes infected in the first half of pregnancy, spontaneous miscarriage may occur. When infected in the second half of pregnancy, children are often born premature, with manifestations of intrauterine malnutrition and anemia. The disease is manifested by attacks of anxiety, cyanosis, convulsions, dyspeptic disorders, regurgitation; Hepatolienal syndrome, hypochromic anemia, and dystrophy are constantly observed.
Malaria is a disease of the African continent, South America and Southeast Asia. Most cases of infection occur in young children living in West and Central Africa. In these countries, malaria leads among all infectious pathologies and is the main cause of disability and mortality in the population.
Etiology
Malaria mosquitoes are ubiquitous. They breed in stagnant, well-warmed bodies of water, where favorable conditions remain - high humidity and high air temperature. That is why malaria was previously called “swamp fever.” Malaria mosquitoes differ in appearance from other mosquitoes: they are slightly larger, have darker colors and transverse white stripes on their legs. Their bites also differ from ordinary mosquitoes: malaria mosquitoes bite more painfully, the bitten area swells and itches.
Pathogenesis
There are 2 phases in the development of Plasmodium: sporogony in the mosquito body and schizogony in the human body.
In more rare cases, this occurs:
- Transplacental route - from a sick mother to a child,
- Blood transfusion route - during blood transfusion,
- Infection through contaminated medical instruments.
The infection is characterized by high susceptibility. Residents of the equatorial and subequatorial zones are most susceptible to malaria infection. Malaria is the leading cause of death among young children living in endemic regions.
malaria regions
The incidence is usually recorded in the autumn-summer period, and in hot countries - throughout the year. This is an anthroponosis: only people get sick from malaria.
Immunity after an infection is unstable and type-specific.
Clinic
Malaria has an acute onset and is characterized by fever, chills, malaise, weakness and headache. rises suddenly, the patient shakes. Later, dyspeptic and pain syndromes are added, which are manifested by pain in muscles and joints, nausea, vomiting, diarrhea, hepatosplenomegaly, and convulsions.
Types of malaria
Three-day malaria is characterized by paroxysmal course. The attack lasts 10-12 hours and is conventionally divided into 3 stages: chills, fever and apyrexia.
During the interictal period, body temperature normalizes, patients experience fatigue, weakness, and weakness. The spleen and liver become denser, the skin and sclera become subicteric. A general blood test reveals erythropenia, anemia, leukopenia, and thrombocytopenia. During attacks of malaria, all systems of the body suffer: reproductive, excretory, hematopoietic.
The disease is characterized by a long-term benign course, attacks are repeated every other day.
In children, malaria is very severe. The pathology clinic for children under 5 years of age is unique. Atypical attacks of fever occur without chills and sweating. The child turns pale, his limbs become cold, general cyanosis, convulsions, and vomiting appear. At the beginning of the disease, the body temperature reaches high numbers, and then a persistent low-grade fever persists. Intoxication is often accompanied by severe dyspepsia: diarrhea, abdominal pain. Sick children develop anemia and hepatosplenomegaly, and a hemorrhagic or macular rash appears on the skin.
Tropical malaria is much more severe. The disease is characterized by less severe chills and sweating, but longer bouts of fever with an irregular fever curve. During a drop in body temperature, chilling occurs again, a second rise and a critical decline. Against the background of severe intoxication, patients develop cerebral signs - headache, confusion, convulsions, insomnia, delirium, malarial coma, collapse. The development of toxic hepatitis, respiratory and renal pathology with corresponding symptoms is possible. In children, malaria has all the characteristic features: febrile paroxysms, a special type of fever, hepatosplenomegaly.
Diagnostics
Diagnosis of malaria is based on the characteristic clinical picture and epidemiological data.
Laboratory research methods occupy a leading place in the diagnosis of malaria. Microscopic examination of a patient's blood allows one to determine the number of microbes, as well as their type and type. For this, two types of smears are prepared - thin and thick. A thick drop of blood is examined if malaria is suspected, to identify Plasmodium and determine its sensitivity to antimalarial drugs. The type of pathogen and the stage of its development can be determined by examining a thin drop of blood.
A general blood test in patients with malaria reveals hypochromic anemia, leukocytosis, and thrombocytopenia; in a general urine test - hemoglobinuria, hematuria.
PCR is a fast, reliable and reliable method for laboratory diagnosis of malaria. This expensive method is not used for screening, but only as an addition to the main diagnosis.
Serodiagnosis is of auxiliary value. An enzyme immunoassay is performed, during which the presence of specific antibodies in the patient’s blood is determined.
Treatment
All patients with malaria are hospitalized in an infectious diseases hospital.
Etiotropic treatment of malaria: "Hingamin", "Quinine", "Chloridine", "Chloroquine", "Akrikhin", sulfonamides, antibiotics - "Tetracycline", "Doxycycline".
In addition to etiotropic therapy, symptomatic and pathogenetic treatment is carried out, including detoxification measures, restoration of microcirculation, decongestant therapy, and the fight against hypoxia.
Colloidal, crystalloid, complex salt solutions are administered intravenously,"Reopoliglyukin", isotonic saline solution, "Hemodez". Patients are prescribed Furosemide, Mannitol, Eufillin, and undergo oxygen therapy, hemosorption, and hemodialysis.
To treat complications of malaria, glucocorticosteroids are used - intravenous Prednisolone, Dexamethasone. According to indications, plasma or red blood cells are transfused.
Patients with malaria should strengthen their immunity. It is recommended to add nuts, dried fruits, oranges, and lemons to your daily diet. During illness, it is necessary to avoid eating “heavy” foods, and prefer soups, vegetable salads, and cereals. You should drink as much water as possible. It lowers body temperature and removes toxins from the patient's body.
Persons who have had malaria are monitored by an infectious disease specialist and undergo periodic examinations for plasmodium carriage for 2 years.
Folk remedies will help speed up the healing process:
Timely diagnosis and specific therapy shorten the duration of the disease and prevent the development of severe complications.
Prevention
Preventive measures include timely identification and treatment of patients with malaria and carriers of malarial plasmodium, conducting epidemiological surveillance of endemic regions, extermination of mosquitoes and the use of remedies for their bites.
A vaccine against malaria has not yet been developed. Specific prevention of malaria involves the use of antimalarial drugs. Persons traveling to endemic areas must undergo a course of chemoprophylaxis with Hingamin, Amodiaquine, and Chloridine. For greatest effectiveness, it is recommended to alternate these drugs every month.
You can protect yourself from mosquito bites by using natural or synthetic repellents. They are collective and individual and are available in the form of spray, cream, gel, pencils, candles and spirals.
Mosquitoes are afraid of the smell of tomatoes, valerian, tobacco, basil oil, anise, cedar and eucalyptus. A couple of drops of essential oil are added to vegetable oil and applied to exposed areas of the body.
Video: life cycle of falciparum plasmodium
What is Malaria in children -
Malaria- an infectious disease that lasts a long time, manifests itself in periodic attacks of fever, provokes an enlargement of the liver, spleen and progressive anemia.
Malaria caused Plasmodium falciparum, may occur with or without cerebral complications. Salaria caused by Plasmodium vivax, can lead to splenic rupture or other complications, and can also occur without complications. Malaria caused Plasmodium malariae, may occur with nephropathy, with or without other complications. The disease can also be caused Plasmodium ovale.
The duration of passive immunity received by a baby in the womb lasts from 5 to 8 months. Children with a genetically determined deficiency of certain erythrocyte enzymes and indigenous residents of natural foci of malaria are relatively resistant to the disease.
Malaria is most common in the summer and fall, as this is when mosquitoes are active. In winter, the pathogen lives in the human body. In countries with a tropical climate, malaria is one of the most common infectious diseases. In our country, malaria practically does not occur; almost all cases are a disease of children who came from countries with a tropical climate.
What triggers / Causes of Malaria in children
The causative agent - malarial plasmodium - belongs to the type of protozoa, the genus Plasmodium. There are 4 types of malaria pathogens in children: P. malariae, P. vivax, P. falciparum, P. ovale.
Pathogenesis (what happens?) during Malaria in children
Attacks of the disease are caused by the erythrocyte phase of development of malarial plasmodia. An attack begins when infected erythrocytes disintegrate and merozoites, free hemoglobin, metabolic products of the pathogen, fragments of erythrocytes with pyrogenic substances, etc. are released into the blood. They affect the thermoregulatory center, which causes a pyrogenic reaction. They also have a general toxic effect.
The response to the process described above is hyperplasia of the reticuloendothelial and lymphoid elements of the liver and spleen and the phenomenon of sensitization with possible hyperergic reactions.
Pathomorphology. When you have malaria, brown pigment is deposited in many organs. Its greatest amount is in the liver, bone marrow and spleen. This leads to the fact that the internal organs are painted in the corresponding shade. A sharp enlargement of the liver and spleen is recorded. With a long course of malaria, areas of sclerosis are formed in the parenchymal organs, which alternate with foci of anemic infarctions. Congestion of the internal organs of a child with malaria is observed.
Symptoms of Malaria in Children
The duration of incubation depends on the immunoreactivity of the child and the type of pathogen that has entered the body. The incubation period for 3-day malaria is from 1 to 3 weeks, for 4-day malaria - from 2 to 5 weeks, for tropical - less than 2 weeks. Also, its duration depends on the climate in which the child lives, the use of chemotherapy for prophylactic purposes, etc. The warmer the climate, the shorter the incubation period.
The symptoms observed during the illness largely depend on the age of the patient. If the child is over 3 years old, then he exhibits the same clinical picture as in adults with malaria. Before the first symptoms, sometimes headaches, malaise occur, and body temperature rises slightly.
The onset of the disease is acute, severe chills, body temperature may be slightly elevated. The skin becomes cool and rough. The extremities become especially cold, slight cyanosis of the tip of the nose and fingers, severe headache, and shortness of breath appear. There is a possibility of muscle pain and vomiting.
Chills after 1-2 hours are replaced by a feeling of heat, at the same time the temperature rises to a level of 40-41 ˚С. The face turns red, the patient becomes thirsty, hiccups and vomiting appear. The child is excited, tossing about, loss of consciousness, delirium, and convulsions are possible. The pulse weakens, becomes frequent, and blood pressure decreases. There is enlargement and tenderness of the liver and spleen.
The attack lasts 1-15 hours and ends in heavy sweat. The temperature drops significantly, the child feels severe weakness, which quickly passes, and the condition becomes satisfactory. The frequency and sequence of attacks depend on the type of malaria, the age of the child and the duration of the disease. The attacks become more cyclical the older the child.
With a long course of the disease, anemia of the hemolytic type develops; the liver and spleen can be very enlarged. Also, in frequent cases, herpetic-type rashes are recorded on the lips and wings of the nose, subicteric skin and sclera with unchanged color of urine and feces.
A blood test at the onset of the disease shows leukocytosis and neutrophilia. At the peak of the attack, the number of leukocytes in the blood decreases; during the period of apyrexia, leukopenia with neutropenia and relative lymphocytosis is detected with great consistency. In almost all cases, the ESR is higher than normal. In severe forms of malaria in children, the number of red blood cells and hemoglobin is greatly reduced.
Late relapses occur after 5-9 months or more from the onset of the disease. Attacks are milder than at the beginning of malaria or with early relapses. The occurrence of late relapses is presumably associated with the release of tissue forms of malarial plasmodia into the blood from the liver.
If treatment is not carried out, the disease can last about 2 years with 3-day malaria, about 1 year with tropical malaria, and with 4-day malaria - many years.
Complications. The most difficult complications of malaria in children are:
- malarial coma,
- cerebral edema,
- malarial algid,
- acute renal failure,
- mental disorders.
Malarial coma, as a rule, occurs in children from 5 to 12 years old with tropical malaria. The cause is severe disturbances in cerebral hemodynamics after filling almost the entire capillary network with red blood cells infected with schizonts.
In patients in such cases, the following symptoms dominate:
- disorder of consciousness,
- stupefaction,
- meningeal symptoms,
- cramps,
- disappearance of skin and then tendon reflexes,
- clonus stop,
- disorders of the kidneys, lungs, etc.,
- increase in cardiovascular disorders
- spontaneous passage of stool and urine.
If the necessary treatment is not carried out in time, the disease can result in death.
Malarial algid is a rare complication of tropical malaria. A collaptoid state appears. The patient is indifferent, but consciousness remains, the skin is pale and cyanotic, facial features are sharpened, the skin is covered with cold sweat, blood pressure and body temperature are low, the pulse is thready, tendon reflexes are not evoked, diarrhea occurs, and dehydration is possible.
Acute renal failure in malaria in children appears due to intense hemolysis of red blood cells, severe hemoglobinuria, and impaired renal microcirculation.
Mental disorders in malaria they are manifested by motor agitation, hallucinations, clouding of consciousness, etc. This complication almost always appears with tropical malaria (much more often than with other types of disease).
Brain swelling marks a malignant, fulminant form of the disease. At the height of one of the attacks, symptoms such as convulsions, severe headache, foam at the mouth, and loss of consciousness suddenly appear. Soon, edema and swelling of the brain develop acutely, leading to death.
Malaria in children under 12 months. Typical attacks of malaria in infants under 1 year of age are rare. No chills. There is no typical frequency of attacks. Coldness of the extremities, attacks of cyanosis appear, there is a possibility of repeated vomiting, convulsions, and meningeal symptoms. Symptoms such as sleep disturbance, breast refusal, and anxiety are common. Also, often from the first days of the disease the body temperature becomes very high, then the temperature curve becomes irregular, often subfebrile.
Infants under 1 year of age with malaria almost never sweat, but the scalp and torso may be moist. Appetite is greatly reduced, there may be anorexia, regurgitation, and sometimes vomiting, especially after eating. Characteristic symptoms include loose stools and abdominal pain. Persistent dyspeptic disorders can lead to dehydration. Anemia develops rapidly, the liver and spleen are enlarged.
Malaria in children under 1 year of age is often severe, toxicosis is pronounced, damage to the central nervous system is noted, hepatolienal syndrome, severe anemia and dystrophy are pronounced. In a child under 12 months of age, malaria may occur without attacks, but at certain times hiccups appear. There is no increase in temperature, sweats or chills. But in such cases, the liver and spleen are always enlarged, and progressive anemia is recorded.
Congenital malaria in children. A baby can become infected while in the womb if the placenta is damaged. If the fetus is infected in the first half of pregnancy, miscarriage may occur. If the fetus becomes infected with malaria in the second half of pregnancy, children are born in most cases weak, premature, with manifestations of intrauterine malnutrition and anemia.
Congenital malaria is characterized by cyanosis, restlessness, toxic-clonic seizures, regurgitation and stomach upset. Fever is often absent, and the temperature reaction is of the wrong type. Characteristic phenomena are hypochromic anemia, hepatolienal syndrome, and dystrophy. If the baby becomes infected during birth, the body weight after birth is normal and symptoms of malaria do not appear. The incubation period passes, the disease begins and manifests itself with the same clinical symptoms as in children under 12 months.
Diagnosis of Malaria in children
The simplest diagnostic option is when a child has periodic repeated attacks (with chills, sweats and fever), attacks of hypochromic anemia, an enlarged liver and spleen, and subicteric skin and sclera appear.
Diagnosing malaria in infants is difficult. It is important for a doctor to know about the stay of a sick baby in an endemic focus of malaria. For a final diagnosis, laboratory tests are necessary - the malaria pathogen is detected in the peripheral blood. It is better to take blood for research during an attack, but it is also possible in a non-attack period.
For serological diagnosis, RIF (most often), RNGA and enzyme-labeled antibody reaction (ERA) are used. Blood preparations containing many schizonts are taken as antigens in the RIF. RIF becomes positive at week 2 of erythrocyte schizogony.
During diagnosis, malaria is differentiated from relapsing fever, brucellosis, hemolytic jaundice, visceral leishmaniasis, sepsis, leukemia, liver cirrhosis, tuberculosis, etc. Malarial coma is differentiated from comatose states that occur with typhoid fever, viral hepatitis B, meningoencephalitis, less commonly with purulent meningitis.
Treatment of Malaria in Children
For treatment, drugs are used that affect the asexual erythrocyte forms of plasmodium, the sexual forms found in the blood, and tissue forms found in hepatocytes. Chingamine (rezoquin, delagil, chloroquine) is often used.
Other treatment regimens for malaria in children are also used. If plasmodia are resistant to quinine, quinine sulfate is prescribed in a dose appropriate to the age, the course is 2 weeks. In some cases, quinine is combined with sulfonamide drugs.
Malaria is one of the most dangerous human diseases. Plasmodium parasites are transmitted to humans through the bites of infected Anopheles mosquitoes. Plasmodium vivax causes tertian malaria, Plasmodium malariae causes tertian malaria, Plasmodium ovale causes tertian malaria, and Plasmodium falciparum causes tropical malaria. Each form of the disease has its own characteristics, but symptoms of malaria such as fever attacks, anemia and hepatosplenomegaly are common to all.
The life cycle of the development of malarial plasmodium consists of 2 stages that occur in the body of the mosquito and the human body. In the human body, clinical manifestations of the disease are associated only with erythrocyte schizogony. Malaria is a polycyclic infection. During the course of the disease, there is an incubation period (primary and secondary), a period of primary acute manifestations, a secondary latent period and a period of relapse. If the infection occurred naturally (through), they speak of a sporozoite infection. If the disease develops when a donor's blood containing plasmodia is introduced into the human body or as a result of vaccination, they speak of schizont malaria.
Rice. 1. The malaria mosquito is a carrier of malarial plasmodia.
Rice. 2. Plasmodium parasites are the cause of malaria.
Incubation period
When a mosquito bites, sporozoites penetrate into the blood, where they move freely for 10 to 30 minutes, and then settle in hepatocytes (liver cells). Part of the sporozoites of Pl. ovale and Pl. vivax hibernate, another part of them and Pl. falciparum and Pl. malaria immediately begins hepatic (exoerythrocytic) schizogony, during which from 1 sporozoite is formed from 10 to 50 thousand hepatic merozoites. Destroying liver cells, merozoites are released into the blood. The whole process lasts from 1 to 6 weeks. This ends the incubation period of malaria and begins the period of erythrocyte schizogony - the period of clinical manifestations.
Different types of pathogens have their own duration of the incubation period of malaria:
- With Plasmodium vivax, the short incubation period is 10 - 21 days, long incubation - 8 - 14 months.
- With Plasmodium malariae - 25 - 42 days (in some cases more).
- With Plasmodium falciparum - 7 - 16 days.
- For Plasmodium ovale - from 11 to 16 days.
The duration of the incubation period for malaria increases with inadequate chemotherapy.
Before an attack of malaria at the end of the incubation period with Plasmodium vivax and Plasmodium falciparum, a prodromal period is recorded: symptoms of intoxication and asthenia, headache, muscle and joint pain, general weakness, fatigue, and chilling appear.
Rice. 3. Malaria is common in more than 100 countries in Africa, Asia and South America.
Signs and symptoms of malaria during a febrile attack
Pathogenesis of fever in malaria
While in red blood cells, plasmodia absorb hemoglobin, but not completely. Its remains turn into dark brown pigment grains that accumulate in the cytoplasm of young schizonts.
When an erythrocyte ruptures, foreign proteins, hemoglobin, malarial pigment, potassium salts, and red blood cell residues enter the blood along with the merozoites. They are foreign to the body. By affecting the thermoregulation center, these substances cause a pyrogenic reaction.
Malaria in most cases occurs with characteristic febrile attacks. Rarely, the disease occurs with constant fever lasting from 6 to 8 days, and only then febrile paroxysms appear.
Rice. 4. Up to 30 thousand cases of “imported” malaria are registered annually, 3 thousand of which are fatal. In 2016, 100 cases of imported malaria were registered in the Russian Federation.
Development of a fever attack
- During the initial period of fever paroxysm The patient develops chills lasting from 30 minutes to 2–3 hours, often severe, the skin and mucous membranes become pale in color, and goose bumps appear. The patient is freezing and wraps himself in a blanket over his head.
Rice. 5. A rise in temperature during infectious diseases is always accompanied by chills.
- Feverish attack most often occurs around 11 am. Body temperature rises to 40°C or more, quickly, nausea, vomiting and dizziness occur. In severe cases of malaria, convulsions, delirium and confusion occur. The patient is excited, the skin is hyperemic, hot and dry to the touch, and herpes rashes often appear on the lips. The tongue is coated with a brownish coating. Tachycardia, shortness of breath and urinary retention are noted, and blood pressure drops. The patient becomes hot. He is tormented by thirst.
Rice. 6. An attack of malaria in a woman (India).
- After 6 - 8 hours, and in case of tropical malaria by the end of the first day, body temperature decreases. The patient develops profuse sweating. Symptoms of intoxication gradually disappear. The patient calms down and falls asleep. After half a day, the patient’s condition becomes satisfactory.
Rice. 7. A decrease in temperature is accompanied by profuse sweating.
- Repeated attacks of fever occur after 2 days for 3-day, oval and tropical malaria or after 3 days for 4-day malaria.
- Secondary latency period occurs after 10 - 12 attacks of fever.
- With inadequate treatment weeks (sometimes months) later, short-term (up to 3 months) or distant (6-9 months) relapses occur.
After several attacks, patients' liver and spleen enlarge, anemia develops, the cardiovascular and nervous systems suffer, symptoms of nephritis appear, and hematopoiesis suffers. After the cessation of febrile attacks, anemia and hepatosplenomegaly persist for quite a long time.
Rice. 8. Temperature curve for malaria.
Signs and symptoms of malaria affecting internal organs
Causes of damage to internal organs
With insufficient treatment, pathological changes are detected in various organs of a malaria patient, the cause of which is:
- pathological substances circulating in the blood, leading to hyperplasia of the lymphoid and reticuloendothelial elements of the spleen and liver,
- sensitization of the body by foreign proteins, often accompanied by autoimmunopathological reactions of the hyperergic type,
- breakdown of red blood cells, leading to damage to internal organs, the development of anemia and thrombocytopenia, impaired blood circulation in the capillaries and the development of intravascular thrombus formation,
- disturbance of water-electrolyte balance.
Plasmodium, while in red blood cells, absorbs hemoglobin, but does not completely assimilate it. As a result, its remains gradually accumulate in the cytoplasm of young schizonts. When merozoites are formed, the pigment enters the blood and is then captured by macrophages of the liver, lymph nodes, spleen and bone marrow, which acquire a characteristic smoky or brown color. Over a long period of time, the pigment in the interstitial tissue forms massive accumulations. Its processing and disposal is slow. The specific coloring of the internal organs persists for a long time after treatment.
Foreign substances circulating in the blood irritate the reticular cells of the spleen and liver, causing their hyperplasia, and, over a long period of time, the proliferation of connective tissue. Increased blood supply to these organs leads to their enlargement and pain.
Lack of appetite, nausea and a feeling of fullness in the epigastric region, often diarrhea are the main signs of liver damage in malaria. The liver and spleen gradually begin to enlarge. By the 12th day, yellowness of the skin and sclera appears.
The liver and spleen are enlarged and hard in malaria. The spleen may rupture with minor trauma. Its weight often exceeds 1 kg, sometimes the weight reaches 5 - 6 kg or more.
Rice. 10. Liver preparation affected by plasmodia.
Rice. 11. Enlargement of the liver and spleen in patients with malaria.
Bone marrow damage
Anemia due to malaria
The breakdown of red blood cells during the period of erythrocyte schizogony, increased phagocytosis and hemolysis caused by the formation of autoantibodies are the main causes of anemia in malaria. The degree of anemia is influenced by the type of plasmodium. Iron and folic acid deficiency in residents of several developing countries in Africa aggravates the disease.
Gametocytes of plasmodium of 3-day, 4-day malaria and malaria oval develop in the erythrocytes of peripheral capillaries for 2 - 3 days and after maturation die after a few hours, therefore anemia in these types of malaria often reaches a significant degree. Blood regeneration slows down significantly during three-day malaria, since plasmodia settle mainly in young red blood cells - reticulocytes. In addition, Plasmodium vivax causes ineffective bone marrow erythropoiesis. Anemia due to malaria is exacerbated by the destruction of healthy (uninfected) red blood cells.
The degree of anemia is related to the size of the spleen. The spleen in the human body is the only blood filtering organ. Its increase is a hallmark of malaria infections. When benign red blood cells are damaged in the spleen, extramedullary hematopoiesis starts to work, compensating for the losses.
Characteristic changes in the blood in malaria appear from 6 to 8 days of the disease. And by the 12th day, hypochromic anemia, significant leukopenia, thrombocytopenia are registered, and ESR is significantly accelerated.
Rice. 12. When infected with Plasmodium vivax and Plasmodium ovale, erythrocytes are deformed. When infected with Plasmodium malariae and Plasmodium falciparum, the shape and size of red blood cells do not change.
Rice. 13. Destruction of red blood cells when merozoites are released into the blood is one of the causes of anemia in the disease.
Signs and symptoms of malaria affecting the heart
The functioning of the heart is affected by toxic substances and anemia. Expansion of the borders of the heart to the left, muffled sounds at the apex and a slight systolic murmur at the apex are the first signs of organ damage in malaria. Long-term malaria negatively affects the functioning of the cardiovascular system. The patient begins to experience swelling in the feet and legs.
Signs and symptoms of malaria affecting the nervous system
Malaria affects the autonomic nervous system. Irritability, headache, and fatigue are the main symptoms of malaria when the nervous system is affected in long-term patients.
Rice. 14. Brain damage due to malaria. Multiple hemorrhages are visible in the brain tissue.
Relapses of malaria
The cause of early relapses that occur during the first 3 months after the expected recovery is the surviving schizonts, which, when the immune system is weakened, actively reproduce again.
The course of relapses is usually benign. General toxic syndrome is moderately expressed. Malarial paroxysms occur rhythmically. Anemia, an enlarged spleen and liver are the main signs of recurrent malaria.
The duration of the disease caused by Plasmodium vivax lasts 1.5 - 3 years, Plasmodium ovale - from 1 to 4 years.
Rice. 15. Children with malaria.
Complications of malaria
Malaria causes complications that are closely related to the pathogenesis of the disease. These include severe anemia, persistent enlargement of the spleen and its cirrhosis, cirrhosis and melanosis of the liver, nephrosonephritis, encephalopathy with the development of mental disorders and hemoglobinuric fever.
At acute diffuse nephrosonephritis Patients develop edema, protein and red blood cells in the urine, and in some cases arterial hypertension develops. Symptoms that are responsive to adequate treatment and diet.
At malarial hepatitis yellowness of the sclera and skin appears, the liver enlarges, its pain is noted on palpation, bilirubin in the blood increases, and liver function tests are distorted.
Available splenic rupture with minor injury.
Hemoglobinuric fever is the most severe complication of tropical malaria, rarely found in other types of disease. With the disease, acute hemolysis of red blood cells develops, a flood of hemoglobin in the blood and its excretion in the urine, which occurs under the influence of the drug quinine. The patient develops a jaundiced coloration of the sclera and skin, and the liver and spleen become enlarged.
Acute pulmonary edema develops in tropical malaria. The trigger mechanism is an increase in vascular permeability as a result of exposure to toxins. The problem is aggravated by the increased introduction of fluid into the patient's body.
Hypoglycemia develops mainly in tropical malaria. Its cause is a violation of glucogenesis in the liver, an increase in glucose consumption by plasmodia and stimulation of insulin secretion by the pancreas. When the disease occurs, a large amount of lactic acid accumulates in the patient’s tissues. Developed acidosis is often the cause of death.
Timely detection and adequate treatment of malaria always results in recovery. With late detection and inadequate treatment, tropical malaria is always fatal. The other three types of malaria are benign infections.
Rice. 17. Yellowness of the sclera and skin indicates liver damage
Malaria in pregnant women
Malaria adversely affects the course of pregnancy and its outcome. It can cause abortion, miscarriage and premature birth. Fetal developmental delay and death are often observed. Malaria is often the cause of eclampsia in pregnant women and death. Pregnant women living in areas where malaria is endemic are the most endangered population. Late diagnosis and inadequate treatment quickly lead to the development of “malignant malaria.” The development of hypoglycemia is especially dangerous in pregnant women, which often causes death.
Rice. 18. Placenta infected with malarial plasmoids.
Malaria in children
The most vulnerable age is children from 6 months to 4 - 5 years. Malaria is especially dangerous for young children.
In malaria-endemic regions, the disease in children is one of the causes of high mortality. Children under 6 months of age born from immune mothers do not develop malaria.
Types of malaria in children
Malaria in children can be congenital or acquired.
Malaria in children often develops a fulminant course. Severe anemia and a cerebral form of the disease may develop within a few days. Malaria in children often occurs in a peculiar way:
- the skin is pale, often with an earthy tint, yellowness and waxiness persist for a long time, despite treatment;
- malarial paroxysms (fever attacks) are often absent;
- symptoms such as cramps, diarrhea, regurgitation, vomiting and abdominal pain come to the fore;
- during attacks of malaria there are often no chills at first, and at the end of an attack of fever there is often no sweating;
- a rash in the form of hemorrhages and spotty elements often appears on the skin;
- anemia increases quickly;
- with congenital malaria, the spleen is significantly enlarged, the liver - to a lesser extent.
Symptoms of malaria in older children
In older children, the disease progresses as in adults. During the interictal period, the children's condition remains satisfactory. The fulminant form of three-day malaria is rare, and malarial coma is extremely rare.
Differential diagnosis
Malaria in children should be distinguished from hemolytic disease of the newborn, sepsis, septic endocarditis, miliary tuberculosis, pyelonephritis, hemolytic anemia, typhus, brucellosis, food poisoning, leishmaniasis in children living in the tropics.
Rice. 19. Up to 90% of malaria cases and deaths from it occur in countries of the African continent.
