Malaria is the causative agent of the disease. Specific and non-specific methods of protection

Malaria was once called swamp fever, and in the Dark Ages it was nicknamed “mala aria,” which translated from Italian means bad air. Both then and now this disease is considered extremely severe because it affects red blood cells.

Today in medicine there are several types of diseases, on which they depend. characteristic features malaria.

Types of malaria

The type of malaria, in turn, depends on who caused the disease. Among its types there are the most dangerous, often fatal, as well as those that can be successfully treated with medication.

Tropical malaria– P.L. Falciparum. The most severe form of malaria, often fatal. It is also the most common type of disease.

Four-day form– the causative agent of malaria Plasmodium malariae. Its characteristic feature is attacks that recur after 72 hours.

Three-day malaria– Plasmodium vivax. The attacks recur every 40 hours.

Ovale malaria– Plasmodium ovale. Attacks recur every 48 hours.

The carrier of all types of malaria is the malaria mosquito, which lives mainly in areas of Africa, slightly south of the Sahara. This territory accounts for about 90% of cases of infection, high probability Children under 5 years of age are infected due to weak immunity.

Despite the fact that the malaria mosquito lives in almost all climatic zones (except deserts, arctic and subarctic zones), greatest distribution It produces malaria in places where there are no low temperatures, since low temperatures do not contribute to its reproduction and transmission of the disease.

Scientists have found that over the next 20 years, mortality from malaria will double.

Incubation period of malaria

The incubation period of malaria, as well as its symptoms, depends on the pathogen:

• in tropical form incubation period ranges from 6 to 16 days;
• with a three-day form, the incubation period ranges from 7 to 21 days, but with a long incubation period this time increases to 14 months;
• with four-day malaria, the incubation period ranges from 2 to 6 weeks;
• with oval malaria, the incubation period lasts from 7 to 21 days, and with a long incubation period it can be 14 months.

Malaria disease - general symptoms

The first signs of malaria are chills, which may be varying degrees expressiveness. It depends on how strong the immune system is. First external signs Malaria is considered to be cyanosis and cooling of the extremities. The pulse becomes rapid, breathing becomes shallow. This period lasts about an hour, but can reach 3 hours.

During the first day, the general condition worsens - the temperature can rise to 41 degrees, and is accompanied by:

• vomiting;
• diarrhea;
• confusion;
• shortness of breath;
• redness of the face.

The attack ends with a drop in temperature to normal or subfebrile, but then increased sweating occurs, lasting up to 5 hours.

After this, the person falls asleep. Often the attack lasts about 10 hours, and occurs again after some time, depending on the pathogen.

Between attacks, the patient experiences weakness, despite the normalization of temperature. With each attack, the body weakens more and more.

After several attacks, the patient's skin becomes sallow or yellowish. Without treatment, a person can experience up to 12 attacks, but after they stop within six months, the likelihood of relapse is very high.

Clinical signs of malaria depending on its form:

Symptoms of tropical malaria. This is the most severe form, and it first manifests as headache, nausea, vomiting, and then prolonged fever– up to several days. The intervals between attacks are short, and the duration of fever can be up to 36 hours.

Signs of quartan malaria. This form begins immediately with an attack, chills are mild. Attacks begin every 2 days and last 2 days.

Signs tertian malaria. An attack of three-day malaria begins in the afternoon - the temperature rises and chills occur, and repeats every other day. This is one of the mild forms of malaria.

Signs of oval malaria. This is the most light form malaria. In its course it is similar to the three-day period, but differs in that the attacks occur in the evening.

Malaria is a disease that in our latitudes is usually confused with influenza and other acute respiratory viral infections. This is especially widespread in winter period: at this time of year people more often go on vacation to tropical countries, in which malaria feels at home, because the tropics are the habitat of malaria pathogens.

What is malaria?

Difference between the Anopheles mosquito and other species

Getting infected with malaria in our latitudes, as in any others, is possible if a person infected with plasmodia is bitten by a mosquito of the genus Anopheles (only this one). The mosquito drank a certain amount of infected blood, after which, driven away, it flew to another poor fellow, to whom it had already transferred the brutal plasmodia along with its saliva. Or when injecting two people with the same syringe (as with HIV, hepatitis). There are no other ways of transmitting malaria. Also, if you caught Plasmodium in the tropics, it means that it was transmitted to you by a mosquito from some person with malaria. Malaria is not transmitted by airborne droplets or in any other way!

There are 5 types of malaria, each of which differs in the degree of danger:

Immunity to malaria occurs only partially, after a large number of infections over several years. It occurs only for a specific type (strain) of malaria and intensifies with each new time. Symptoms become less pronounced over time, and the possibility fatal outcome is practically reduced to a minimum. There is no vaccine for malaria, development and clinical trials of a vaccine against the tropical form are underway, but it will not protect you from all types of plasmodiasis at once. However, it showed weak efficiency (about 35%).

Symptoms of malaria

When I traveled to Papua New Guinea, I was, of course, well aware that this region is very rich not only in Natural resources, but also for malarial plasmodium. And before going to such a wilderness, I stocked up on a good anti-malarial drug. Those. I was prepared for this disease, I knew its symptoms and knew how to treat it. But theory is theory, but in practice everything often turns out to be completely different, because it is impossible to foresee everything.

When I first felt the symptoms of fever and chills, the first thing I immediately thought of was malaria and nothing else. Local residents in this endemic region get sick very often and malaria in New Guinea is the most common disease. I went to the local hospital to get a rapid test for malaria. The test showed negative result. I asked the doctor what should I do about my symptoms, to which the doctor replied that I needed to take Panadol (Paracetamol) two tablets every 6 hours. Those. usual, classic therapy for acute respiratory viral infections - just remove unpleasant symptoms(temperature) with paracetamol and wait until the immune system itself cures you of viruses. In addition, I also took the antibiotic amoxicillin, believing that cold symptoms could be caused by bacteria, i.e. I drank just in case, having no idea of ​​the realities.

Possible symptoms of malaria

• Fever- temporary increase in body temperature due to intoxication of the body with waste products of plasmodium. Fever has a cyclical appearance. As a rule, the temperature rises sharply, reaches its peak value (38-40°) and drops, down to normal temperature body (36.6-37°). Cycles can be 4 days, 3 days or permanent. The temperature can change several times within one day, even with three-day malaria (all types);
• Chills- feeling of cold when the temperature rises in the first stage of fever (all types);
• Heat- feeling of heat when the temperature drops, redness of the skin, after chills, the second stage of fever (all types);
• Sweating- during heat transfer, the third stage of fever (all types);
• Tingling in the skin - unpleasant feeling, similar to weak mosquito bites (all types);
• Cramps, muscle tremors- if the temperature rises to 39-40° and above. The body begins to shake, the muscles contract. This arises from the fact that the body, feeling cold, begins to contract muscles (as in real cold, frost) in order to thereby release the necessary heat to warm the internal organs (all types);
• Dry cough - common occurrence;
• Joint pain- not all types of malaria ( P. falciparum);
• Nausea, vomiting- sometimes, in the background elevated temperature as a side effect;
• Diarrhea- sometimes with blood ( P. falciparum);
• Headache- does not always appear (mostly P. falciparum);
• Anemia- decreased hemoglobin in the blood, pallor skin, does not appear immediately (all types);
• Low blood sugar- does not appear immediately;
• Hemoglobin in urine- does not appear immediately;
• Hepatosplenomegaly- enlargement of the spleen and liver in advanced forms (all types);
• Hepatitis nephroso-nephritis- renal-liver failure, jaundice ( P. falciparum);
• Hemorrhagic syndrome - bleeding of mucous membranes, leads to death ( P. falciparum);
• Coma- when the form is neglected, leads to death ( P. falciparum);
• Paralysis- rarely, with advanced form ( P. falciparum).
• Brain edema- manifests itself rarely, with a fulminant course of the disease on early stages can lead to death ( P. vivax);

Not all symptoms appear immediately and not in all forms of malaria. Main symptoms - fever, anemia, enlarged liver and spleen. Death most often occurs from overheating when the temperature rises above 42°, as well as from encephalopathy - coma or cerebral edema. Malaria during pregnancy can cause fetal death, P. falciparum And P. vivax. The most susceptible to the disease are post-infant children (from 1 year to 5 years), pregnant women and adults who have not previously been ill (for example, tourists).

So I just lived, taking paracetamol whenever symptoms occurred. And the symptoms continued constantly. The temperature dropped and then rose again - cyclically. Then one day in Bangkok, instead of 2 paracetamol tablets, I took 1 - and then I started shaking! I didn’t have a thermometer, but I’m sure it was over 40 degrees, and I had a strong fever, with cramps, like after cold water.

Then I came home and lived at home for another week with these symptoms, which appeared and disappeared. I took paracetamol while taking them off. I would like to say that daily dose paracetamol is 1 g, but I took 3 g per day, i.e. 6 tablets (2 at a time). Sometimes 4. Why didn’t I see a doctor immediately upon arriving home? Because I thought that after constantly taking antibiotics, my immune system was slightly weakened, and therefore my body fought the flu virus more slowly.

P. falciparum under a microscope (Gametocyte)

Red blood cell infected with P. vivax

I would like to note that in such situations, many people attribute these symptoms to ARVI and exclude the possibility of malaria. Even when they go to the doctor, doctors often also make a diagnosis of ARVI, while sarcastically mocking ignorant patients. Even when they hint to them: maybe I have malaria?! However, whoever is ignorant here, this still needs to be established! It is not uncommon for such patients to die after an incorrect diagnosis by would-be therapists! People are treated for colds and end up dying from malaria when their body is no longer able to resist a huge number malarial plasmodia, which during this time greatly multiplied in their body.

About 100 years ago, malaria was used to treat syphilis. Patients with syphilis were specially infected with malaria in order to cause an increase in body temperature to 41-42°, at which the causative agent of syphilis dies. Malaria was then treated traditionally - with quinine.

And then one day, when I again felt a strong fever with shaking (muscle tremors), in which I could not even get out of bed, I realized that things were bad, and it was most likely not a cold. As soon as I felt better, I took my temperature: it was 40.2°. This is despite the fact that it was already on the decline, in accordance with its cycle. This means that during the trembling she was obviously higher. I decided to call an ambulance to take me to infectious diseases department our city hospital (I have already been there), and there they could accurately diagnose me, without my ignorant amateur fortune-tellers, and I could receive appropriate therapy.

Bursting red blood cells release a new generation of plasmodia

I was admitted to the hospital with a preliminary diagnosis, which was made by ambulance workers - "Fever of unknown origin". This is the most appropriate diagnosis for similar symptoms in a similar situation (the patient arrived from an endemic region), no ARVI or typhoid fever(often confused with malaria) was out of the question. The hospital took all the necessary tests and ruled out the presence of pneumonia, tuberculosis, and, of course, a cold. Before the first results of the blood test were ready, there were two versions of my diagnosis: sepsis (blood poisoning) and malaria. After the sterility test (for sepsis) and the “Thick Drop” were ready, the exact diagnosis was established - malaria. That means I was wrong, that means the rapid test was wrong, and I still have malaria. However, some test strips can only detect antigens (proteins) of the causative agent of tropical malaria and not the other three types. So, perhaps I came across just such a test, for the tropical form.

Test strip: 1 - absence of plasmodium; 2 - P. falciparum; 3 - combined; 4,5 - spoiled test.

Treatment of malaria

was found in my blood Plasmodiumvivax - the causative agent of three-day malaria. Adequate therapy is taking drugs like Quinine. Quinine is a drug that is obtained from the bark of the cinchona tree. People have been treating malaria with this substance since time immemorial. In Russia, Chloroquine is used, which is produced under various names, the most popular is - Delagil. I also informed the doctors that I have Quinine purchased abroad. I drank it too, taking 4 tablets even before taking Delagil. After which I felt a clear improvement in my health, a drop in temperature - it no longer rose.

Treatment of malaria in Russia (Delagil)

• 4 days (P. malariae) - 1st day: 1.5 gr, 2nd day: 0.5 gr, 3rd day: 0.5 gr;
• 3 days (P. vivax, P. ovale) - 1st day: 1.5 gr, 2nd day: 0.5 , 3rd day: 0.5 , 4th day and onwards (within 2 weeks) + Primaquin(to prevent relapse);
• Tropical (P. falciparum) - 1st day: 1.5 gr, 2nd day: 0.5 gr, 3rd day: 0.5 gr, 4th day: 0.5 gr, 5th day: 0.5 gr, next + Primaquin. -

This therapy outdated due to the emergence of resistance in some strains P.falciparum And P.vivax to delagil.

Other drugs (adult dose)

• Fansidar(Sulfadoxine + Pirematamine) - once, 3 tablets;
• Primaquin- 3 tablets/day, for 2 weeks;
• Quinine- 500-700 mg, every 7-8 hours, for 7-10 days;
• Lariam(Mefloquine) - 1 g once;
• Coartem(Artemether + Lumefantrine) - 4 tablets, morning and evening, for 3 days;
• Malaron(Atovaquone + Proguanil) - 4 tablets per day, for 3 days.
• Bigumal(Proguanil) - 1.5 g for 4-5 days
• Quinocid- 300 mg, 1-2 times a day

The World Health Organization recommends treating all types of malaria with artemisinin combination therapy (ACT). Artemisinin(or its derivatives) + Primaquin(for the treatment of relapses). Artemisinin is not a quinine derivative; it is isolated from Artemisia annua ( Artemisia annua). WHO.

The use of delagil for tropical malaria is now practically useless! As far as I know (the doctors themselves told me this), in our hospitals, except for Delagil, there are no more antimalarial drugs, but they can be purchased separately in city pharmacies. For example, the same Quinine is available in a form together with analgin, but the quinine content is very low. Chloroquine (Delagil), Primaquine are less harmful drugs than Quinine, but due to resistance Plasmodium falciparum to Chloroquine, Quinine, which kills all types of plasmodium, began to be used again. Primaquine is used to prevent relapses of malaria after primary recovery. Popular in Africa Coartem, which copes well with tropical malaria, which is widespread there.

IMPORTANT! In the Russian Federation, as well as in the CIS countries, you can only buy Delagil, Fansidar, Analgin with quinine among antimalarial drugs. Other drugs must either be ordered from abroad or brought with you from countries where malaria is endemic.

Typically, two types of drugs are used to treat malaria. First one, then the other (for example, first delagil, then primaquine). The fact is that different forms of plasmodium, sexual and asexual, can live in our blood. By killing some forms, we do not kill others, and the person still remains infected, which can lead to recurrence and infection of other people during the mosquito active season (summer).

In my case, for three-day malaria, delagil is a completely adequate medicine. After taking Delagil they started giving me an antibiotic doxycycline(in conjunction with suprastin), it is also possible to take tetracycline or clindamycin. In addition, I took one quinine tablet each while in Papua New Guinea and Bangkok - at the time of high fever, just in case. I believed in the test results and believed that it was not malaria, but the flu, complicated due to a weakened immune system, but I took quinine just in case. Why one tablet? Because I gave this medicine to local residents, and they always only needed one tablet, after which they said that they felt fine. However, the locals are less susceptible to the disease than I, a newbie! They have a partial immune response, antibodies to this species Plasmodium.

Relapses of malaria

Malarial plasmodia can go into hibernation and remain in the human body for many years, after which symptoms of the disease may again appear. For the prevention of exoerythrocytic distant relapses, it is prescribed Primaquin or Quinocid. The catch is that it is impossible to buy primaquine and quinocide in the Russian Federation - they are not certified drugs. They can, for example, be brought from abroad. Therefore, it turns out that to prevent relapses, our doctors try the use of antibiotics doxycycline, tetracycline, etc. However, this therapy does not always show positive effect, without killing the "dormant" forms of plasmodium.

As an option, you can use complex therapy with Quinine/Chloroquine (elimination of erythrocyte, blood forms) + fansidar(elimination of non-erythrocyte forms), it does not guarantee elimination of relapses, but can be used. Without the use of appropriate drugs there is big risk the emergence of more and more new clinical manifestations illnesses months and even years later. P. vivax, P. ovale can lie dormant in the body for up to 3 years, P. malariae- dozens.

I relapsed after 2 months from the end of treatment. The temperature rose, chills, fever, sweating, pain in the left side, tingling on the skin, like weak mosquito bites. I didn’t even have my blood tested, but immediately started taking delagil - it’s easy to buy in pharmacies.

Prevention of malaria

If you go traveling to the tropical wilderness, be sure to stock up in advance antimalarial drugs in the major cities you will pass through. Take time, go to the pharmacy and buy a couple of packages of the drug. Tropical malaria is very common in Africa and India, so do not take delagil there, but stock up on quinine. If you don’t know how to use a particular drug, then drink according to maximum 0.5 g per day, do not drink any more because it may cause side effects.

In 2015, about 214 million people had malaria, of whom 438,000 died. 90% of them were in Africa. WHO

To prevent malaria, you can use all the same drugs as to treat it. But it is worth remembering that if you do get malaria, despite taking medications, you need to use a different type of medicine to treat it. For prophylaxis, the same quinine, primaquine, Lariam (mefloquine), malarone, etc. are used.

However, despite small doses of the drug taken in preventive measures (2 once a week, starting at 2 weeks before the trip, and 2 after), the drugs still have a harmful effect on the body due to side effects. It is best to treat malaria after it appears. You should start taking it immediately, at the first symptoms. As soon as you feel an increase in temperature, feel free to take your treasured tablets according to the previously selected dosage.

Life cycle of Plasmodium falciparum

Accompanied by fever, chills, an increase in the size of the spleen and liver, and anemia. A characteristic feature of this protozoal invasion is cyclicity. clinical course, i.e. periods of feeling better alternate with periods sharp deterioration with high temperature rise.

The disease is most common in countries with hot climates. These are South America, Asia and Africa. According to World Organization health, malaria is a serious health problem in 82 countries where the mortality rate from this infection is very high.

Relevance of malaria for Russian man due to the possibility of infection during tourist trips. Often the first symptoms appear upon arrival home, when a person’s temperature rises.

IN mandatory, when this symptom, you should inform your doctor about your trip, because this will make it easier to install correct diagnosis and will save time.

Causes, clinical picture of the disease

The causative agent of malaria is Plasmodium falciparum. It belongs to the class of protozoa. The causative agents can be 4 types of plasmodia (although there are more than 60 species in nature):

• P. Malariae – leads to malaria with a 4-day cycle;
• P.vivax – causes malaria with a 3-day cycle;
• P. Falciparum – causes tropical malaria;
• R. Ovale - causes the oval form of tertian malaria.

The life cycle of malarial plasmodia includes a successive change of several stages. At the same time, a change of owners occurs. At the stage of schizogony, pathogens are found in the human body. This is the stage of asexual development, it is replaced by the sporogony stage.

It is characterized by sexual development and occurs in the body of a female mosquito, which is the carrier of the infection. The causative mosquitoes belong to the genus Anopheles.

Penetration of malarial plasmodia into the human body can occur on different stages in different ways:

1. When bitten by a mosquito, infection occurs at the sporozontal stage. Penetrated plasmodia after 15-45 minutes end up in the liver, where their intensive reproduction begins.
2. Penetration of plasmodiums of the erythrocyte cycle at the schizont stage occurs directly into the blood, bypassing the liver. This path is realized when introducing donated blood or by using non-sterile syringes that may be contaminated with Plasmodium. At this stage of development, it passes from mother to child in utero (vertical route of infection). This is the danger of malaria for pregnant women.

In typical cases, division of plasmodia that enter the body through a mosquito bite occurs in the liver. Their number is increasing many times over. At this time, there are no clinical manifestations (incubation period).

The duration of this stage varies depending on the type of pathogen. It is minimal in P. falciparum (from 6 to 8 days) and maximum in P. malariae (14-16 days).

The characteristic symptoms of malaria are described by the well-known triad:

• paroxysmal (crisis-type) increase in temperature, repeated at certain intervals (3 or 4 days);
• enlargement of the liver and spleen (hepatomegaly and splenomegaly, respectively);
• anemia.

The first symptoms of malaria are nonspecific. They correspond to the prodromal period and are manifested by signs characteristic of any infectious process:

• general malaise;
• severe weakness;
• lower back pain;
• joint and muscle pain;
• slight increase in temperature;
• decreased appetite;
• dizziness;
• headache.

A specific increase in temperature develops due to the release of plasmodium into the blood. This process is repeated several times, reflected in the temperature curve. The cycling time is different - in some cases it is 3 days, and in others - 4.

Based on this, the corresponding types of malaria are distinguished (three-day and four-day). This is the period of obvious clinical manifestations when the patient consults a doctor.

Fever in malaria has a characteristic appearance, due to the sequential change of three phases. At the beginning there is a stage of chills (a person cannot warm up, despite warm wrappings), which is replaced by fever (the second stage). The temperature rises to high values ​​(40-41°C).

The attack ends excessive sweating. It usually lasts from 6 to 10 hours. After an attack, a person immediately falls asleep due to severe weakening that develops as a result of intoxication and muscle contractions.

Enlargement of the liver and spleen is not determined from the very beginning of the disease. These symptoms can be identified after 2-3 febrile attacks. Their appearance is due to the active reproduction of malarial plasmodia in the liver and spleen.

When infected, anemia immediately appears in the blood, associated with the destruction of red blood cells (malarial plasmodia settle in them).

At the same time, the level of leukocytes, mainly neutrophils, decreases. Other hematological signs are accelerated ESR, complete absence eosinophils and a relative increase in lymphocytes.

These signs indicate activation immune system. She fights the infection, but fails. The disease progresses, and the risk of complications increases.

With a certain degree of probability, they can be predicted based on unfavorable prognostic signs. These are considered:

• fever that occurs every day, and not cyclically (every 3-4 days);
• absence of an interfebrile period between attacks (an elevated temperature is constantly determined, which corresponds to subfebrile values ​​between attacks);
• severe headache;
• widespread convulsions observed 24-48 hours after the next attack;
• a critical decrease in blood pressure (70/50 mm Hg or less), approaching a state of shock;
• high level of protozoa in the blood according to microscopic examination;
• the presence of plasmodia in the blood, which are at different stages of development;
• progressive increase in the number of leukocytes;
• decrease in glucose below 2.1 mmol/l.

Main complications malaria are:

• malarial coma, which most often affects pregnant women, children and young people;
• acute kidney failure when diuresis decreases to less than 400 ml per day;
• hemoglobinuric fever, which develops with massive intravascular destruction of red blood cells and the formation of a large amount of toxic substances;
• malarial algid, which resembles brain damage in this disease, but differs from it in the preservation of consciousness;
• pulmonary edema with acute onset and course (often fatal);
• rupture of the spleen associated with torsion of its legs or congestion;
• severe anemia caused by hemolysis;
• intravascular coagulation as part of DIC syndrome, followed by pathological bleeding.

Complications of tropical malaria may be specific:

• corneal damage;
• vitreous opacification;
• choroiditis ( inflammatory lesion capillaries of the eye);
• optic neuritis;
• paralysis of the eye muscles.

Laboratory diagnosis of malaria is carried out according to indications. These include:

1) Any increase in body temperature in a person located in an endemic geographic area (countries with increased incidence).

2) Increased temperature in a person who has received a blood transfusion within the last 3 months.

3) Repeated episodes of fever in a person receiving therapy in accordance with the final diagnosis ( established diagnosis– any disease except malaria).

4) Fever persists for 3 days during the epidemic period and more than 5 days at other times.

5) The presence of certain symptoms (one or more) in people who have visited endemic countries within the last 3 years:

• fever;
• malaise;
• chills;
• liver enlargement;
• headache;
• enlarged spleen;
• decrease in hemoglobin;
• yellowness of the skin and mucous membranes;
• the presence of herpetic rashes.

To verify the diagnosis can be used various methods laboratory examination:

1. Microscopic examination of blood smears (allows direct detection of malarial plasmodium).
2. Express test.
3. (the study of genetic material by repeatedly obtaining copies of the DNA of the malarial plasmodium when it is present in the blood).
4. A biochemical analysis is performed to determine the severity of the disease (determines the severity of liver damage, which is always observed with malaria).

All patients with a confirmed diagnosis of malaria are indicated to undergo a series of instrumental studies. Their results help the doctor identify possible complications and start their treatment on time.

• ultrasound scanning abdominal cavity (Special attention pay attention to the size of the liver, kidneys and spleen);
• electrocardiogram;
• X-ray of the lungs;
• echocardioscopy;
• neurosonography;
• electroencephalography.

Treatment of patients with malaria is carried out only in a hospital. The main goals of therapy are:

• prevention and liquidation acute attacks diseases;
• prevention of complications and their timely correction;
• prevention of relapse and carriage of malarial plasmodia.

It is recommended for all patients immediately after diagnosis bed rest and purpose antimalarials. These include:

• Primaquine;
• Chloroquine;
• Mefloquine;
• Pyrimethamine and others.

At the same time, the use of antipyretics and symptomatic drugs. They are quite diverse due to the multiorgan nature of the lesion. Therefore, doctors of various specialties are often involved in treatment, and not just infectious disease specialists.

In cases where this does not happen, a change in antimalarial drug is required. It is also indicated when plasmodia are detected in the blood on the 4th day. This may indicate possible pharmacological resistance. It increases the risk of distant relapses.
If everything goes smoothly, then special criteria are determined to finally confirm cure. These include:

• normalization of temperature;
• reduction of the spleen and liver to normal sizes;
• a normal blood picture - the absence of asexual stages of malarial plasmodia in it;
• normal indicators biochemical analysis blood, indicating restoration of liver function.

Prevention of malaria

Map of malaria distribution in the world

Tourists should pay close attention to malaria prevention. Even before traveling, you should find out from a travel agency whether the country poses a danger for this disease.

If yes, then you should visit an infectious disease specialist in advance. He will recommend taking antimalarial drugs that will protect the person from infection.

There is no specific vaccine against malaria.

• Avoid being on the street after 17.00, because this is the time when mosquito activity peaks;
• If you need to go outside, cover your body with clothes. Pay special attention to the ankles, where mosquitoes most often bite, as well as the wrists and hands, where the skin is very thin;
• use of repellents.

If the child is small, then parents should refrain from traveling to dangerous countries. IN childhood taking antimalarial drugs is not advisable due to the frequent development of side effects and hepatotoxicity. Therefore, parents should weigh the possible risks.

World Malaria Day

The World Health Organization established International Malaria Day in 2007 (at its 60th session). It falls on April 25th.

The prerequisite for the establishment of the date was disappointing statistical data. Thus, new infections occur annually in 350–500 million cases. Of them fatal outcome observed in 1-3 million people.

The main purpose of World Malaria Day is to promote preventive measures regarding the disease.

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 pathology and is the main cause of disability and mortality.

Etiology

Malaria mosquitoes are ubiquitous. They breed in stagnant, well-warmed bodies of water, where they persist. favorable conditions- high humidity and heat air. 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 in rare cases occurs:

1. Transplacental route - from a sick mother to a child,
2. Blood transfusion route - during blood transfusion,
3. Infection through contaminated medical instruments.

The infection is characterized by high susceptibility. IN to the greatest extent Residents of the equatorial and subequatorial zones are 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 past infection unstable, type-specific.

Clinic

Malaria has an acute onset and is characterized by fever, chills, malaise, weakness and headache. rises suddenly, the patient shakes. Later, dyspepsia and pain syndromes 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.

IN interictal period body temperature normalizes, patients experience fatigue, weakness, and weakness. The spleen and liver become denser, the skin and sclera become subicteric. IN general analysis blood reveals erythropenia, anemia, leukopenia, 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. Possible development toxic hepatitis, respiratory and renal pathology with corresponding symptoms. In children, malaria has everything character traits: febrile paroxysms, special character of fever, hepatosplenomegaly.

Diagnostics

Diagnosis of malaria is based on 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.

Fast, reliable and reliable method laboratory diagnostics malaria is PCR. This expensive method is not used for screening, but only as an addition to the main diagnosis.

Serodiagnosis is of auxiliary value. Lead linked immunosorbent assay, 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, including detoxification measures, restoration of microcirculation, decongestant therapy, and the fight against hypoxia.

Colloidal, crystalloid, complex salt solutions are administered intravenously,"Reopoliglyukin", isotonic saline, "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. IN daily diet It is recommended to add nuts, dried fruits, oranges, lemons. During illness, it is necessary to avoid eating “heavy” foods, and prefer soups, vegetable salads, and cereals. You should drink as much as possible more water. 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 detection 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 malaria is 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 essential oil added to vegetable oil and apply it to exposed areas of the body.

Video: life cycle of falciparum plasmodium

Malaria includes a group of acute infectious diseases transmitted primarily through blood. Variant names: intermittent fever, paludism, swamp fever. Pathological changes are caused by Anopheles mosquitoes and are accompanied by damage to blood cells, attacks of fever, and enlargement of the liver and spleen in patients.

Historical aspects

The historical focus of this disease is Africa. From this continent, malaria spread throughout the world. At the beginning of the 20th century, the number of cases was about 700 million per year. One out of 100 infected people died. The level of medicine of the 21st century has reduced morbidity to 350-500 million cases per year and reduced mortality to 1-3 million people per year.

For the first time as separate disease malaria was described in 1696, at the same time official medicine At that time, it was proposed to treat the symptoms of pathology with cinchona bark, which was used traditional medicine a long time ago. The effect of this medicine could not be explained, because healthy person When taken, quinine caused complaints similar to fever. In this case, the principle of treating like with like, which was preached by Samuel Hahnemann, the founder of homeopathy, was applied in the 18th century.

The name of the disease that is familiar to us has been known since 1717, when the Italian physician Lancini established the cause of the development of the disease, coming from the “rotten” air of swamps (mal`aria). At the same time, suspicion arose that mosquitoes were responsible for transmitting the disease. The 19th century brought many discoveries in establishing the causes of malaria, describing the development cycle and classifying the disease. Microbiological studies made it possible to find and describe the infectious agent, which was named malarial plasmodium. In 1897 I.I. Mechnikov introduced the pathogen into the classification of microorganisms as Plasmodium falciparum(class of Sporozoans, type of protozoa).

In the 20th century they developed effective medicines for the treatment of malaria.

Since 1942 P.G. Müller proposed the use of the powerful insecticide DDT to treat areas of disease outbreaks. In the middle of the 20th century, thanks to the implementation of the global malaria elimination program, it was possible to limit the incidence to 150 million per year. In recent decades, an adapted infection has launched a new attack on humanity.

Pathogens of malaria

IN normal conditions Human malaria is transmitted by 4 main types of microorganisms. Cases of infection with this disease have been described in which the pathogens are not considered pathogenic for humans.

Features of the life cycle of malarial plasmodium

The causative agent of the disease goes through two phases of its development:

• sprorogony– development of the pathogen outside the human body ;
• schizogony

Sprorogony

When a mosquito (female Anopheles) bites a person who is a carrier of malaria germ cells, they enter the stomach of the insect, where the fusion of female and male gametes. The fertilized egg implants into the submucosa of the stomach. There the maturation and division of the developing plasmodium occurs. From the destroyed wall, more than 10 thousand developing forms (sporozoites) penetrate into the hemolymph of the insect.

The mosquito is infectious from now on. When another person is bitten, the sporozoites enter the body, which becomes the intermediate host of the developing malarial microorganism. The development cycle in the mosquito body lasts about 2-2.5 months.

Schizogony

In this phase we observe:

• Tissue stage. Sporozoites penetrate liver cells. There, they successively develop into trophozoites - schizonts - merozoites. The stage lasts from 6 to 20 days, depending on the type of plasmodium. Can be introduced into the human body simultaneously different types causative agent of malaria. Schizogony can occur immediately after introduction or after some time, even months, which contributes to repeated returns of attacks of malaria.
• Erythrocyte stage. Merozoites penetrate the red blood cell and transform into other forms. Of these, from 4 to 48 merozoites are obtained, then morulation occurs (exit from the damaged erythrocyte) and re-infection of healthy erythrocytes. The cycle repeats. Its duration, depending on the type of plasmodium, ranges from 48 to 72 hours. Some merozoites turn into germ cells, which infect a mosquito that bites a person and transmits the infection to other people.

Note:In the case of malaria infection not from mosquitoes, but through a blood transfusion containing Plasmodium merozoites, only the erythrocyte stage occurs in the infected person.

In every detail life cycle Plasmodium is described in the video review:

How does malaria become infected?

Children are especially susceptible to infection. The incidence in the foci is very high. Some people are resistant to malaria. It especially develops after repeated infections. Immunity does not last a lifetime, but only for an indefinite period.

Note:Malaria is characterized by a seasonal onset. Summer and hot months are most favorable for vectors of infection. In hot climates, the disease can occur all year round.

Malaria occurs in certain foci, monitoring of which makes it possible to predict the beginning of the seasonal surge, its maximum and attenuation.

In the classification, foci are divided into:

• seaside;
• flat;
• hilly-river;
• plateau;
• mid-mountain river.

The intensity of transmission and spread of malaria is assessed according to four types:

• hypoendmic;
• mesoendemic;
• hyperendemic;
• holoendemic.

The holoendemic type has the highest risk of infection and is characterized by the most dangerous forms diseases. The hypoendemic type is characteristic of isolated (sporadic) cases of malaria.

Development of the disease and characteristic changes in the body

Note:the main pathological reactions occur as a result of the onset of erythrocyte schizogony.

Released biogenic amines contribute to the destruction vascular wall, cause electrolyte disturbances, irritation nervous system. Many components of the life activity of plasmodia have toxic properties and contribute to the production of antibodies and protective immunoglobulin complexes against them.

The system reacts by activating protective properties blood. As a result of phagocytosis (destruction and “eating” of diseased cells), the destruction of damaged red blood cells begins, causing anemia (anemia) in humans, as well as increased function of the spleen and liver. General content blood cells (erythrocytes) decrease.

Clinically, at these stages a person develops different kinds fever. Initially, they are irregular, non-cyclical, and are repeated several times a day. Then, as a result of the action of immune forces, one or two generations of plasmodia remain, which cause attacks of fever after 48 or 72 hours. The disease acquires a characteristic cyclical course.

Note:the invasion process can last from 1 year to several decades, depending on the type of pathogen. Immunity after past illness unstable. Repeated infections often occur, but with them the fever is mild.

Against the background of malaria, pathological processes occur in the brain, symptoms of edema and damage to the walls appear small vessels. The heart also suffers, in which severe degenerative processes occur. Necrobiosis forms in the kidneys. Malaria attacks the immune system, causing the development of other infections.

The disease occurs with periods of exacerbation of fever and normal state.

Main symptoms of malaria:

• attacks of fever (chills, fever, sweating);
• anemia (anemia);
• enlargement of the spleen and liver (hepatosplenomegaly);
• decrease in the number of red blood cells and platelets (pancytopenia).

As with most infectious diseases, there are three forms of severity of malaria - mild, moderate, severe.

The onset of the disease is sudden. It is preceded by an incubation period (the period of time from infection to the onset of the disease).

It amounts to:

• vivax malaria – 10-21 days (sometimes up to 10-14 months);
• four-day malaria – from 3 to 6 weeks;
• tropical malaria – 8-16 days;
• ovale malaria – 7-20 days.

Sometimes there is a prodromal period (the time of onset of malaria, accompanied by initial, mild symptoms). The patient experiences weakness, chilling, thirst, dry mouth, pain in the head.

Then a fever of the wrong type suddenly appears.

Note:The first week of the febrile period is characterized by attacks occurring several times a day. In the second week, paroxysms acquire a clear cyclic course, repeating every other day or two (with four-day fever)

How does a fever attack proceed?

The duration of the paroxysm is from 1-2 hours to 12-14 hours. A longer period is determined for tropical malaria. It can last a day or even more than 36 hours.

Attack phases:

• chills – lasts 1-3 hours;
• fever - up to 6-8 hours;
• profuse sweating.

Complaints and symptoms during malarial paroxysm:

After sweating comes sleep. During the interictal period, patients are able to work, but as the disease progresses, their condition worsens, there is loss of body weight, jaundice, and the skin becomes sallow in color.

Tropical malaria is the most severe.

In her case, the following are added to the described symptoms of malaria:

• severe pain in the joints and throughout the body;
• signs characteristic of meningitis;
• delusional state of consciousness;
• attacks of suffocation;
• frequent vomiting with blood;
• pronounced enlargement of the liver.

In the first week of illness, attacks can occur, layering on each other. A few months after the onset of the disease, paroxysms begin to recur, but in a milder form.

Of all the described forms of malaria, vivax is the most mild. The largest number of relapses is observed with Chesson malaria (Pacific form).

note:Cases of a fulminant course have been described, which led to death from cerebral edema within a few hours.

Complications of malaria

In weakened or untreated patients, as well as in case of treatment errors, the following complications may develop:

• malarial coma;
• edema syndrome;
• extensive hemorrhages (hemorrhages);
• different types of psychoses;
• renal and liver failure;
• infectious complications;
• splenic rupture.

A separate complication of malaria should be noted hemoglobinuric fever. It develops against the background of massive proliferation of plasmodia, during treatment with medications, due to the destruction of red blood cells (hemolysis). In severe cases of this complication, general symptoms and complaints of an attack of malaria are added by a progressive decrease in urine production. Lightning develops renal failure, often with early death.

Diagnosis of malaria

Malaria is determined based on:

• collection of anamnestic data - the survey reveals pre-existing malaria, cases of blood transfusion to the patient;
• epidemiological history – the patient’s residence in areas with existing outbreaks of the disease;
• clinical signs - presence characteristic complaints and symptomatic picture of malaria;
• laboratory diagnostic methods.

The first three points are discussed in detail in the article. Let's touch on laboratory testing methods.

These include:

Confirmation of diagnosis using specific methods

To confirm the diagnosis, blood is tested using "thick drop" And "smear".

The analysis allows you to determine:

• a type of malarial plasmodium;
• stage of development;
• level of invasiveness (number of microbes).

Invasiveness is assessed in 4 degrees (in the field of view of the microscope):

1. IVdegree– up to 20 cells per 100 fields .
2. IIIdegree– 20-100 plasmodia per 100 fields.
3. IIdegree– no more than 10 in one field;
4. Idegree– more than 10 in one field.

The method is quite simple, cheap and can be used frequently to monitor the patient’s condition and the effectiveness of treatment.

Analysis "thin drop" is prescribed as an addition to the previous one in case of necessary differential diagnosis.

An express diagnostic method is immunological analysis determination of specific proteins of falciparum plasmodium. It is carried out in foci of tropical malaria.

Serological tests for malaria

Material – deoxygenated blood.

The goal is to detect antibodies to malaria .

Result assessment – ​​titer less than 1:20 – negative test; more than 1:20 – positive.

Polymerase chain reaction ()

The test is specific in nature, allowing it to detect malaria in 95% of cases. Venous blood is used. The negative point is the high cost. Required in doubtful cases.

Mosquitoes are also tested for the presence of Plasmodium falciparum cells.

Treatment of malaria

Modern treatments for malaria are very effective. They are indicated at different stages of the disease. Developed today a large number of medical supplies that allow you to cope with the disease even in advanced situations. Let us dwell on the principles of treatment and a description of the main drug groups.

Note: Therapy must be started immediately after diagnosis in an infectious diseases hospital.

Goals of malaria treatment:

• destruction of the pathogenic plasmodium in the patient’s body;
• treatment of associated complications;
• prevention or mitigation of relapse clinics;
• stimulation of specific and nonspecific immunity.

Groups of medications for the treatment of malaria

To main groups medicines include:

1. Quinolylmethanols - derivatives of Quinine, Delagil, Plaquenil, Lariam, Primaquine.
2. Biguanides – Bigumal.
3. Diaminopyrimidines – Daraprim.
4. Terpene lactones – Artesunate.
5. Hydroxynaphthoquinones – Mepron.
6. Sulfonamides.
7. Tetracycline antibiotics.
8. Lincosamides – Clindamycin.

People with malaria need care. Diet – table 15 according to Pevzner during periods of remission and table 13 during a febrile period. Recommended - lean meat and fish, soft-boiled eggs, porridge, kefir, fermented baked milk, boiled vegetables, fresh pureed fruits, juices, fruit drinks, crackers, honey.

Preventive actions

Preventive work is carried out at the site of infection through the use of mosquito nets and insecticides, which are used to treat areas where mosquitoes accumulate. At home, it is necessary to use repellents, aerosols and ointments that repel mosquitoes and cause their death.

If a possible infection is suspected, medications are taken in doses prescribed by an infectious disease specialist.

Vaccine prevention is currently being developed.

People located in the epicenter of the epidemic should be isolated and laboratory examination. The earlier treatment is started, the better result. People arriving from countries with malaria outbreaks must be examined. Those who have recovered from the disease must be observed by an infectious disease specialist for 3 years.