The effect of malaria on the body. Symptoms of malaria, treatment and prevention rules
Russia is a malaria-free region, although occasionally there are rare cases of morbidity among the population.
In adults, the central symptom of malaria is fever, which proceeds cyclically and has several phases of its course. Patients are also worried about headache, aching joints, fever, urination disorders, dysfunction of the heart and blood vessels. Rashes, insomnia may appear on the background of a nervous breakdown.
Malaria in children
Malaria in its symptoms in children can be different, and the clinical picture will depend on the level of the immune defense of the child, and on his age. Among the main signs of malaria are fever, disorders of the stomach and intestines, rashes on the body, convulsions and anemia.
If malaria is congenital, then the child is born mainly prematurely, with an underestimated body weight, sometimes with obvious anomalies in the development of organs and reduced muscle tone.
causative agent of malaria
To date, there are more than 4,000 species of protozoa of the order Coccidiidae and the genus Plasmodium, but it has been proven that only 5 of them are the causative agents of malaria.
Plasmodium malaria is:
- Falciparum (a tropical type of disease develops);
- Vivax (three-day type of disease);
- Malariae (four-day type of disease);
- Oval.
Doctors also isolate the Plasmodium malaria Knowlesi, but this option has been studied very little.
How is malaria transmitted?
A person becomes infected with malaria mainly through the bite of an infected mosquito of the genus Anopheles. But malaria is not always spread this way. Allocate doctors and ways of infection during blood transfusions, as well as the transplacental method.
Stages of development and manifestations of malaria
In the prodromal period, the so-called precursors of the disease appear. The general condition of the infected person worsens, pain in the head, chills may appear. It lasts up to 5 days on average.
Then there are specific signs of malaria - a special acute period, which is characterized by serial febrile attacks. The duration of these can be different, usually from 3-4 to 10 hours. After relief comes, the symptoms of malaria subside.
This disease can be different. Types of malaria have significant differences, which should definitely be considered in detail. Each type of malaria has its own specific course and appears against the background of the negative impact of the corresponding type of plasmodium.
tropical malaria
This disease, otherwise called coma, is characterized by the most severe clinical picture. This type of malaria accounts for more than 90% of the total number of deaths. Clinically, the disease is manifested primarily by a pronounced toxic syndrome. At the same time, the alternations of such phases as chills, fever, sweating, characteristic of other forms of the disease, are very weakly expressed here.
The onset of the disease is accompanied by fever, severe headache and muscle pain. After about 2 days, symptoms of toxicosis appear: the patient begins to feel sick, vomiting and a feeling of suffocation occur, pressure drops, coughing begins. In addition, tropical malaria has one characteristic symptom - an allergic rash that appears on the body.
During the first 7 days of the disease, hemolytic anemia develops, accompanied by. The occurrence of anemia is associated with the rapid destruction of red blood cells, that is, their hemolysis (hence the name of anemia). From the 2nd week, the picture changes: the spleen and liver increase, which creates significant difficulties in the early diagnosis of the disease.
In people whose immunity is weakened, tropical malaria can develop more rapidly: already on the 2nd, and sometimes on the 1st week of the disease, either toxic shock, or coma, or acute kidney dysfunction begins to progress. Patients with malarial coma become weak, indifferent, lethargic, apathetic, constantly experiencing drowsiness. Literally in a matter of hours, consciousness becomes confused, becomes inhibited, convulsions may begin. This is a very dangerous condition, because it often has an unfavorable outcome.
The massive destruction of red blood cells usually leads to acute renal failure. The mechanism of this process is as follows: hemoglobin, which is released as a result of hemolysis, first enters the bloodstream and then into the urine. As a result, a violation of urinary processes occurs in the kidneys and diuresis (the volume of urine per day) decreases. The products of natural metabolism, which should normally leave the body with urine, are not excreted, as a result of which a serious condition called uremia begins to develop.
This type of disease is considered a mild form. In most cases, complications do not appear, the disease does not lead to the death of the patient, despite the fact that it often proceeds quite hard.
The onset of three-day malaria is preceded by a short prodromal phase. There is no such period in a tropical species. It is characterized by symptoms such as weakness and muscle pain, after which fever immediately begins.
Three-day malaria is characterized by a cyclical increase in temperature, which occurs every two days, that is, every 3rd day. This was the reason to call this type of disease three-day. In the phase of the temperature rise, the patient is excited, his breathing quickens, the skin becomes hot and very dry. The heart begins to contract with a frequency of up to one hundred beats per minute, blood pressure drops, urinary retention appears. The phases of chills, heat and sweating are more pronounced. On average, an attack lasts 5-10 hours. After repeated attacks, that is, approximately on the 10th day, an increase in the liver and spleen is determined, the development of jaundice begins.
However, in some patients, bouts of fever occur daily. This phenomenon in three-day malaria is due to the fact that several generations of plasmodium penetrate into the bloodstream at the same time. In such cases, the patient's body temperature may periodically rise even several months after the illness.
Malaria oval
This type of malaria is very similar to the three-day form of the disease. The difference is that the disease is much easier. Another characteristic feature of the oval is the frequency of fever attacks that appear every other day. An increase in temperature usually occurs in the evening, which is not inherent in other types of malaria.
Quartan
This disease, like the two previous species, is classified as a mild malarial form of invasion. Such a disease begins to develop sharply and brightly, without any prodromal symptoms. Every three days there are bouts of fever, during which the temperature rises to high levels. While the attack lasts, the patient's condition is severe: consciousness is confused, the skin becomes dry, the tongue is lined, and blood pressure is significantly reduced.
It should be noted that in addition to the listed traditional types of malaria, there is another one - schizont. This form develops after already formed schizonts, that is, malarial plasmodia that have passed the asexual phase of development, penetrate into the bloodstream. As a rule, schizont disease occurs as a result of infection during blood transfusion. For this reason, this type of malaria is called syringe or vaccination. A distinctive feature of the schizont type of malaria is the absence of a period in which plasmodium develops in the liver. The clinical manifestation of the disease in such cases depends entirely on the volume of blood that was administered to the person.
Sometimes there is mixed malaria, which occurs due to the fact that a person simultaneously becomes infected with two or more types of malarial plasmodia. Such a disease proceeds quite severely, with symptoms characteristic of those forms that begin to develop as a result of infection.
Signs of malaria are especially pronounced in infected preschool children and women who are in the period of gestation.
Fever most often worries cyclically. The initial chill is replaced by fever. The skin becomes dry and acquires a reddish tint. Further, the heat passes into the stage of increased sweating. The patient feels slight relief. Anemia may not be visible, although hemoglobin levels are low on laboratory tests. Further, the skin becomes yellow due to an increase in the level of bilirubin in the blood. Relieve joint pain. A person infected with malaria complains of nausea, vomiting, headaches, drowsiness, loss of strength.
Malaria: symptoms with complications
On the lips has several stages of its manifestation. Here it is worth highlighting the initial tingling, then the appearance of vesicles, sores, the formation of scabs and the healing stage. Such "malaria on the lips" can be accompanied by headaches, an increase in body temperature, pain symptoms in the muscles. Often, with the so-called malaria, increased salivation can be traced on the lips.
Diagnosis of malaria
Diagnosis of malaria is carried out according to a number of criteria, including:
- Clinical, expressed by characteristic symptoms, including the appearance of fever.
- Epidemic, when the patient has traveled to a malaria-endemic country in the last 3 years.
- Anamnestic, involving the study of the patient's life history. This checks for factors such as a previous form of malaria and blood transfusions.
In addition, for the diagnosis of malaria, the specialist should familiarize himself with the results of the following basic tests:
- general blood test for malaria;
- urine test;
- biochemical analysis.
It should be noted that it is the results of a laboratory study that are the main criterion for the diagnosis of malaria.
For diagnosis in this case, the following laboratory tests are used:
1. Blood microscopy - examination of a thick drop.
It is used if a disease is suspected: there are epidemiological indications and the following signs are observed: the temperature rises paroxysmal, the spleen and liver increase, anemia develops. This is the cheapest and easiest research method that allows you to detect the presence of malaria, determine the type of plasmodia and determine at what stage of development they are.
2. Examination of a thin (stained) blood smear.
It is carried out if, after examining a drop of blood, it is required to confirm and clarify the type of pathogen, as well as the phase of its development. This analysis is not as revealing as the first one.
3. Immunological research methods:
Detection of specificity of proteins in the analysis of peripheral blood is a method for the rapid diagnosis of the disease, used in those regions where malaria is widespread. A person can resort to this method himself.
Serological tests - detection of the presence in the venous blood of specific antibodies to malaria. It is used mainly in non-endemic regions when the disease is suspected. When antibodies are detected, this may indicate both a current illness and the fact that a person has had malaria in the past. The absence of antibodies is a sign of the complete absence of malaria.
4. Study of the blood polymerase chain reaction to the disease.
5. Autopsy of carriers - mosquitoes.
This procedure allows epidemic control of malaria.
How to donate blood for malaria
It is best to draw blood from a patient for malaria when he has an attack, but this can also be done in the period between attacks. If the concentration of malarial plasmodia is low, blood for malaria is taken for analysis within 24 hours, with a frequency of 4-5 hours.
In order to diagnose malaria, the blood taken is subjected to a study. For this, both the drop method and the colored (thin) smear method can be used. Sometimes both methods are used. They allow you to accurately determine the type of disease. If during the tests it is found that more than 2 percent of red blood cells are affected, the doctor makes a diagnosis of tropical malaria.
Treatment for malaria is selected strictly on an individual basis, taking into account the type of disease and the presence or absence of complications. Quinolylmethanols can be recommended - these are Quinine, Chloroquine, Mefloquine, etc. Biguanides, diaminopyrimidines, terpene lactones, sulfonamides, tetracyclines, sulfones and other groups of drugs are prescribed. Each drug used in the treatment of malaria has its own mechanism of action, the level of effectiveness in relation to a particular pathogen and the regimen of administration. Only a qualified doctor can prescribe a cure for malaria. Self-medication is unacceptable.
Caring for a sick person
A person suffering from malaria needs constant and most thorough, proper care. Only in this way can the patient's condition be alleviated, the intensity of the pain experienced by an infected person during each attack of fever can be reduced.
When the chills begin, the patient must be wrapped up, a heating pad should be applied to the legs. During the period of heat, the patient should be opened, the heating pads should be taken away, however, make sure that there are no drafts. It is important to prevent hypothermia. For headaches, it is allowed to put something cold on the head. When the period of sweating passes, you should immediately change your underwear and bed linen, and then let the person rest in peace.
It is important to carry out preventive measures in the room in which the patient stays. These include not only ventilation, but also preventing the entry of mosquitoes so that malaria cannot spread to other people. To do this, use insecticides and mosquito nets installed on window openings.
In the case when there is a complex form of malaria, the patient should not be at home: he is observed in a hospital facility - either in a ward or in an intensive care unit, depending on the severity of the course of the disease.
In addition to the above rules for caring for a sick person, it is necessary to provide him with proper nutrition (diet) and plenty of fluids. Moreover, the dietary table is prescribed only during attacks, and between them a person can eat in the usual way and do not forget to drink plenty of fluids.
Preventive measures against malaria are important for those people who live permanently or temporarily stay in endemic countries for the disease. Therefore, before you go to a malaria-prone region, you should prepare in advance and take this issue very seriously. It is strongly not recommended for small children under four years of age, pregnant women and HIV-infected people to travel to countries that are dangerous in terms of malaria incidence.
Before traveling, it is advisable to visit the embassy of the country of destination in order to obtain comprehensive information about the current epidemic situation and consult on ways to prevent malaria that are effective and relevant for a particular region.
The main way to prevent the disease is effective protection against malaria mosquito bites. Of course, it is impossible to provide such protection one hundred percent, but such prevention of malaria will significantly reduce the likelihood of getting sick. The means of protection are:
- Mosquito nets installed in window and door openings.
- Net curtains, carefully tucked under the mattress, under which you can sleep safely.
- Repellents are special compounds of chemicals that repel mosquitoes, but cannot kill them. The agent should be applied either to the skin or to clothing. Repellents can be presented in the form of aerosols and sprays, creams, gels, and so on. Use the drug should be in accordance with the instructions attached to it.
- Insecticides are chemicals used to kill insects. Presented in the form of aerosols. To kill mosquitoes, rooms, thresholds and mosquito nets should be treated with insecticide. After 30 minutes after completion of the treatment, the room should be ventilated. Instructions for use are also included with insecticides.
Medical prevention
There is also a drug prevention of malaria, involving the use of antimalarial drugs. Before using this or that medication, it is necessary to clarify the degree of resistance to it of the disease in a particular country.
It should be noted that drug prevention of malaria cannot fully protect against infection, however, with the right choice of medicines, it significantly reduces the likelihood of getting sick. It is also important to understand that this is not about the malaria vaccine. Taking drugs to prevent illness should be started one week before departure and, without interrupting it throughout the trip, continue for another 1-1.5 months after returning home. These medicines include:
Chloroquine or Delagil. In order to prevent malaria, it is taken every 7 days at a dosage of 0.5 g for adults and 5 mg per 1 kg of body weight for children.
Hydroxychloroquine or Plaquenil. It is taken every 7 days at a dosage of 0.4 g for adults and 6.5 mg per 1 kg of body weight for children.
Mefloquine, or Lariam. It is taken every 7 days at a dosage of 0.25 g for adults and from 0.05 to 0.25 mg for children.
Primakhin. It is used every 2 days at a dosage of 30 mg for adults and 0.3 mg per 1 kg of body weight for children.
Proguanil, or Bigumal. It is used once a day at a dosage of 0.2 g for adults and from 0.05 to 0.2 g for children.
Pyrimethamine or Chloridine. It is used every 7 days at a dosage of 0.0125 g for adults and from 0.0025 to 0.0125 g for children. Children should be given the drug in combination with Dapsone.
Thus, malaria prevention should be started early and not put off until the last day. Before taking certain medications, you should consult with a specialist to clarify the dosage.
If infection nevertheless occurred or there is even the slightest suspicion of it, it is important to pay attention to the symptoms in a timely manner and examine the patient in time. This will allow you to quickly prescribe adequate treatment that will be effective. In addition, it is mandatory to conduct a survey of patients with any hyperthermic syndrome who arrived from malaria-endemic regions, and do this for 3 years. Timely and effective therapy will prevent the further spread of the pathogen.
Malaria vaccination would certainly be an effective tool to prevent the disease. However, there is currently no official vaccine for malaria. As a result of ongoing clinical studies, an experimental specimen was created, which is not intended for widespread use. In fact, it cannot yet be called a vaccine in the truest sense of the word, and it still has a long way to go before mass production.
When a real vaccine is developed and people can protect themselves by vaccinating themselves against malaria, it will be a significant event, as vaccination will help to cope with the disease throughout the world. It is to be hoped that an effective malaria vaccine will soon become a reality.
Malaria is a common cause of death from travel-acquired infection in the UK. Malaria cannot be ruled out in all febrile patients returning from malaria-endemic areas.
Pathogenesis:
- in all forms, the pathogen enters the body at the stage of sporozoites;
- sporozoites are introduced into hepatocytes - tissue schizogony develops here, merozoites are formed;
- during the decay of hepatocytes, merozoites develop in erythrocytes - the pathogen multiplies in erythrocytes, which leads to rupture of erythrocytes - the cycle lasts 48 hours, and in tropical conditions - 72 hours;
- the onset of an attack indicates a rupture of red blood cells;
- during schizogony, gamonts (male and female) are formed;
- gamonts.
Epidemiology of malaria
Transmission mechanism: transmissible, there may be a parenteral route of transmission - through blood transfusion or through instruments, blood-contaminated objects. There may be infection during childbirth.
Causes of malaria
causative agent of malaria
Plasmodium falciparum is the causative agent of the most severe and potentially fatal or malignant form of malaria.
P. vivax, P. ovale, and P. malariae can cause chronic relapsing disease but are not life-threatening.
There are no reliable clinical criteria to distinguish between each type of infection. The morphology of different types of pathogens in the study in a blood smear is different, but this requires expert interpretation. A reliable blood test for malaria antigen can be used to differentiate between P. falciparum and P. vivax. Infection with several types of pathogen is possible. If there is doubt about the species of pathogen, therapy should be directed against P. falciparum.
Malaria mosquitoes
It is generally accepted that malarial mosquitoes mostly live in hot, humid countries, and in Russia there are no suitable conditions for them. However, this opinion is erroneous. In fact, only the Far North and part of Eastern Siberia have winter temperatures so low as to hinder the survival of the mosquito family.
The malarial mosquito has its own name - anopheles. This is just one genus of mosquitoes from their large family, but in Russia there are 9 varieties of them. No other mosquitoes are capable of transmitting malarial plasmodium to humans. In appearance, it is almost impossible to distinguish anopheles from other brethren. Its biological features (long hind legs, black dots on the wings, a special position of the body during a bite, etc.) are known only to biologists, and even then they specialize in the study of Diptera.
An ordinary person does not particularly consider a mosquito in detail, but tries to swat it as quickly as possible.
Fortunately, in order for a person to be infected by a malarial mosquito, the most important condition is necessary: the presence of a person with malaria, and in Russia it is practically eliminated and only variants of an imported infection are possible. However, in our time of widespread migration of different segments of the population, such a possibility cannot be ruled out. In addition, an infectious mosquito can be accidentally brought into an uninfected area. Therefore, local outbreaks of malaria are quite possible and occur periodically. Cases of this disease, for example, are constantly recorded in the Astrakhan region.
If Anopheles does not get drunk on blood infected with malarial plasmodium, he will not be able to become a carrier of malaria, but will remain an ordinary mosquito for everyone. Its bite is as harmless as those of its fellow tribesmen.
Why does malaria cause fever?
Feverish chills in malaria are due to pathology in the heat exchange system. Plasmodium toxins, and most importantly, their "fragments" are a foreign protein, therefore, they change the specific reactivity of the body and destabilize the work of the heat regulation center in the body.
The minimum amount of pathogen that can cause symptoms of malaria is called the pyrogenic threshold. This threshold depends on the level of human immunity and the individual characteristics of the organism.
As a result of the temperature reaction, blood circulation worsens, and this condition leads to malnutrition of tissues, changes in metabolism, as well as to stagnation of part of the blood and the development of an inflammatory process in these areas.
The destruction of red blood cells by the causative agent of malaria leads to hemolytic anemia. It is this process that causes lethargy, weakness, shortness of breath, dizziness, and a tendency to faint.
A foreign protein leads to an increase in the sensitivity of tissues (sensitization of the body) and the development of autoimmune pathology.
Strokes to the portrait of malaria
Only at the end of the last century, scientists discovered that dormant forms of some types of malarial plasmodium can exist (persist) in the liver for a long time. They have the ability to wake up, go into the bloodstream and cause a relapse of malaria after many months and even years. In the world every year millions of people die from malaria, several times more than from AIDS. Over the past decade, malaria, traditionally ranked third in terms of mortality among infectious diseases, has become a leader in this indicator.
Due to the increased greenhouse effect and climate warming, areas favorable for the reproduction of malaria mosquitoes are gradually moving north. A person who has had malaria cannot be a donor for 3 years after the disease. In the future, when donating blood, it is necessary to warn doctors that a person has had malaria. Malaria mosquitoes are attached to standing water. They are not able to fly more than 8 km, therefore they are not in the mountains, deserts and steppes.
Symptoms and signs of malaria
The incubation period for a three-day one is 7-21 days, for a four-day one - 14-42 days, for a tropical one - 6-16 days, for an oval - 7-21 days.
Acute start. Sometimes prodromal period: malaise, aches, pain in the lower back, legs, back.
Fever attacks last up to 12 hours. Change of chill - heat phase - sweat phase with a frequency of 48-72 hours. In the interictal period, there is an improvement in well-being. After three attacks, the liver and spleen are palpated. Hemolytic anemia, increased bilirubin. Mucous membranes and skin pale yellow. Intermittent fever. Then the skin is pale icteric staining. In severe condition, there may be hemorrhages. During the chill, the skin is pale, cold, during the heat - dry, hot, hyperemic face. With a decrease in temperature - profuse sweating. Possible shortness of breath, impaired pulmonary ventilation, blood circulation. With paroxysms: nausea, vomiting, flatulence, pain in the epigastric region. After three attacks, hepatosplenomegaly develops. In the tropical form - dyspeptic phenomena, decreased diuresis. With nephritis - increased blood pressure, edema, albuminuria, there may be acute renal failure. In the tropical form, there may be hemoglobinuric fever: decreased diuresis, black or red urine. With paroxysms: headache, delirium, anxiety, agitation, sometimes a manifestation of a manic or depressive paranoid state. The pupillary reflex fades away, patients do not react to external irritation, their eyes are closed, motionless. There may be meningeal symptoms and pathological reflexes, there may be arousal. Possible coma: lethargy, deep sleep.
High fever and chills are replaced by sweating. Alternating daytime fever has been described but is rarely seen.
Headache is an extremely common symptom. With concomitant impairment of consciousness or behavior, as well as convulsions, it is necessary to exclude hypoglycemia. The cerebral form of malaria is manifested by coma. Retinal hemorrhage, drowsiness, and other neurological symptoms may be early manifestations of brain damage from malaria, which may progress later.
Abdominal symptoms: anorexia, pain, vomiting and diarrhea.
An attack of malaria usually lasts 6-10 hours or longer. In the interictal period, severe weakness is noted. After 3-4 attacks of malarial fever, the liver and spleen enlarge, sometimes myocardial dystrophy, acute transient nephritis and other pathological changes in organs develop. In the midst of seizures, feverish delirium, vegetative neurosis and psychosis are possible.
eye symptoms. Pathological changes are associated with both intoxication and developed anemia (the walls of blood vessels are damaged and multiple thromboses of the smallest vessels are formed). This is manifested already at the first attack of fever by pinpoint and more extensive hemorrhages against the background of hyperemic conjunctiva. In patients with three-day malaria, herpesvirus infection is activated, which is manifested by the appearance of dendritic keratitis. In the fundus, a spasm of the retinal vessels is detected with a violation of blood microcirculation in them and the phenomenon of endarteritis, retinal ischemia with preretinal and retinal hemorrhages. These changes are found in the central parts of the fundus.
In severe malaria with a coma, the pathological process involves the optic nerves in the form of bilateral optic neuritis.
In the chronic course of malaria, accommodation paralysis, blepharitis, pigmentation and xerosis of the conjunctiva, corneal pigmentation and keratitis, iridocyclitis, choroiditis, and alternating strabismus develop.
Diagnosis based on:
- passport data (place of residence, profession);
- complaints - fever, its characteristics, the frequency of attacks, the sequence of appearance of clinical signs;
- history of disease, life - acute onset, past illness;
- epidemic history - stay in areas with a tropical and subtropical climate, blood transfusion;
- clinical data;
- OAK - anemia, leukopenia, neutropenia, coagulogram, hemoglobin;
- microscopy;
- OAM - proteinuria, cylindruria, albuminuria;
- serological studies: RNIF, enzyme immunoassay (ELISA), used in the examination of donors;
- acid-base studies;
- biochemical indicators.
Differential diagnosis - with typhoid fever, SARS, pneumonia, Q fever, relapsing fever, pyelitis, pyelonephritis, perirenal abscess, cholecystitis, cholangitis, cholelithiasis, sepsis, hemolytic jaundice, leukemia, influenza, acute intestinal infections, viral hepatitis, pneumonia, brucellosis, arbovirus diseases.
Malaria: laboratory and instrumental research methods
General blood analysis. Anemia, non-immune hemolysis, leukopenia, and thrombocytopenia suggest P. falciparum.
Glucose. Hypoglycemia can be seen with P. falciparum infection or intravenous quinine, especially during pregnancy.
Urea, creatinine, liver function tests Acute renal failure and hemoglobinuria may occur in severe P. falciparum malaria.
Bacteriological examination of blood. Malaria may be accompanied by other infections such as gram-negative sepsis.
Computed tomography of the brain and lumbar puncture. These studies may be required if a cerebral form of malaria is suspected /
Arterial blood gases. Metabolic acidosis indicates severe malaria.
Malaria in children
All children with malaria can be divided into two large groups: those who fell ill for the first time, and those who have malaria again. The first group includes, as a rule, babies, in the second group - children over 10 years old. In the first group, malaria is much more severe, while the second group is at least slightly, but protected, albeit by a weak, but immune system.
In general, malaria in children is much more serious, more aggressive than in adults. The main symptoms - attacks of fever - are the same: with 3-day malaria - every two days for 5-6 hours in a row, with 4-day - every 3 days for 12 or more hours. Also characteristic are headache, high fever, agitation, pain in the joints and muscles, thirst and, of course, bouts of severe chills, from which neither heating pads nor a warm bed can save. The attack ends with profuse sweating, weakness and drowsiness. Between attacks, the temperature is kept at normal levels, the general condition is satisfactory.
Clinical onset of symptoms occurs 8-15 days after infection, but may appear several months later. Small children, unable to explain what is happening to them, become whiny, irritable, they lose their appetite, sleep is disturbed, their limbs become cold, their skin turns pale. The decrease in temperature is accompanied by some sweating of the head and neck. In the initial period, the temperature in babies in some cases can be near the norm, in others it starts abruptly with an increase to 40 ° C. In infants, there are practically no attacks of chills, convulsions are observed instead.
With the development of the disease, the child weakens and loses weight due to the development of anemia caused by the destruction of red blood cells. Moreover, the change in the blood formula occurs very quickly.
Malaria in pregnancy
It is very undesirable for pregnant women to suffer from this disease, as this is fraught with the loss of a child.
Spontaneous abortion (miscarriage and stillbirth) with malaria occurs 3 times more often than usual. This is explained by the fact that the malarial plasmodium is able to overcome the placental barrier. The child dies in utero from intoxication, hypoglycemia, anemia.
If the infection of the mother occurs at a later date, the baby may be born alive, but still sick and with low birth weight. They have jaundice, fever, epileptic seizures, because the same adverse changes (destruction of red blood cells) occur in the child's body as in an adult.
In early pregnancy and severe malaria, doctors often recommend termination of pregnancy, because the earlier the infection occurs, the worse it is for the fetus. In general, the outcome of the disease for the fetus depends not only on the timing of infection, but also on the state of health of the mother and the time of treatment started.
A feature of this disease in pregnant women is its severe atypical course due to anemia and an increased risk of malignant forms, fraught with serious complications on the liver and the appearance of malarial coma. Therefore, pregnant women should not travel to regions where they can be bitten by the malaria mosquito. And if such a trip cannot be avoided, it is necessary to undergo a course of preventive treatment.
In the standard course of the disease, pregnant women are treated in the same way as ordinary patients, since most drugs used for malaria are considered to be quite safe. In any case, the prevailing opinion among doctors is that the therapeutic results are more significant than the possible negative drug effect. No matter how many discussions have been held on this issue, the risk of developing intrauterine malaria in a child exceeds the risk level of exposure to antimalarial drugs.
Malaria treatment
If P. vivax is resistant to chloroquine, use mefloquine or quinine.
Quinine is also used to treat chloroquine-resistant cases.
With oligoanuria, azotemia and hyperkalemia, plasma ultrafiltration or hemodialysis is prescribed.
Hignin inside, 600 mg every 8 hours, with the appearance of signs of an overdose of quinine (nausea, tinnitus, deafness), the interval is increased to 12 hours. once 3 tablets of fansidar (pyrimethamine and sulfadoxine) or if the pathogen is resistant to fansidar (especially often observed in East Africa) or allergic to fansidar, doxycycline is prescribed.
Complicated or severe P. falciparum malaria in adults
Mefloquine can also be effective, but resistance is more likely to occur, so it is recommended to consult with a malaria specialist regarding the choice of drug, including depending on the country in which the patient contracted malaria.
Antimalarial immunity
Despite the high contagiousness of malarial infection, not all people get this disease, as some have innate immunity. Others develop acquired active or passive immunity.
Active immunity occurs after a disease. It is associated with the restructuring of the body, the production of specific antibodies, an increase in the level of immunoglobulin. However, this immunity develops slowly, only after several months of repeated attacks, and is also unstable and short-lived. Passive immunity is given to newborns from a mother who has antimalarial immunity, but it lasts only about three months.
The pathogenesis of hemorrhagic generalized capillary toxicosis is due to obliteration (blockage) of blood vessels, malnutrition of nerve cells and brain tissues, followed by necrosis of the medulla and swelling of the meninges.
In addition to encephalitis itself, other disorders in the nervous system can also appear, causing neuralgia, neuritis, sciatica, polyradiculoieuritis, serous meningitis, etc.
With malarial encephalitis, cerebral disorders are observed in the form of impaired speech and coordination of movements, dizziness, headache, nausea, vomiting, etc., up to delirium and seizures similar to epileptic ones. Mental disorders can lead to disability. True, malarial psychoses practically do not occur in primary malaria, they are characteristic of repeated attacks.
Malarial encephalitis is treated in the intensive care units of clinics, where detoxification, hormone therapy, neuroprotectors and other drugs are used.
With successful treatment of the primary disease, the signs of encephalitis also disappear almost safely.
Specific and non-specific methods of protection
If you have to travel to an epidemically unfavorable region for malaria, you should take preventive measures, that is, antimalarial drugs, and then avoid mosquito bites by using means of protection against bloodsucking.
If the trip does not take more than a month, a few days before departure and throughout the trip, you should drink 1 tablet of doxycycline daily. If you have to live longer in an unfavorable place, it is better to stock up on Lariam. This drug should be started a week before departure and then throughout the entire period, 1 tablet per week.
How to escape from mosquito bites, most people know. First of all, repellents are used: sprays, ointments, lotions, and they must be applied not only to the skin, but also to clothes, shoes, backpacks, bags, etc.
Indoors, fumigators and mosquito nets on windows help to fight insects.
If you have to spend the night outdoors, it is necessary to use mosquito nets that are thrown over the bed or over the sleeping bag.
Prevention of malaria
If it is very difficult to get rid of mosquitoes, then in epidemically unfavorable areas, the population is recommended to protect themselves from bloodsucking individuals individually: wear appropriate clothing, use repellent creams and sprays, and cover your face with a mosquito net.
From the development of plasmodium inside the body, you can protect yourself by preventive preventive measures. There are special drugs that are used if you have to travel to areas that are dangerous for the development of malaria. The course of their reception begins 2 weeks before and a month after the epidemically disadvantaged place.
Usually, the same means are used for prevention as for treatment, but other, smaller doses and a different regimen for their administration are used. In the future, doctors take into account the fact that if some drug was used for prevention and did not work (that is, the person got sick anyway), then this medication is then useless to prescribe as a medicine. Combinations with artemisinin and quinine are not used for prophylaxis.
There is as yet no vaccine to prevent malaria infection, although active work is underway to develop one, and there are already some encouraging results in the interim.
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 the type of malaria | Receive mode |
| Quinolylmethanols | Quinine
(quinine sulfate, quinine hydrochloride and dihydrochloride, quinimax, hexaquine) | Hematoschisotropic antimalarial drugs
effective against Plasmodium in the period of erythrocyte schizogony. They prevent the penetration of plasmodia into erythrocytes. 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 oral doses, 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) | Hematoschiisotropic and moderate gametocidal action. | All types of Plasmodium. | adults
- 0.5 g / day. inside, 20-25 mg / kg in 3 injections every 30-32 hours in / in drip. Children – 5 mg/kg/day 2-3 days. |
|
| Hydroxychloroquine (plaquenil) | Hematoschiisotropic and moderate gametocidal action. | All types of Plasmodium. | adults
- 0.4 g / day. inside 2-3 days. Children – 6.5 mg/kg/ day 2-3 days. |
|
| Mefloquine (Lariam) | Hematoschiisotropic action | | Adults:
the first dose - 0.75, after 12 hours - 0.5 g. Children - the first dose - 15 mg / kg, after 12 hours - 10 mg / kg. |
|
| Primakhin | Histoschizotropic drug acts on tissue schizonts of Plasmodium, incl. and on hypnozoites (sleeping forms). Effective for the prevention of 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) | Histoschizotropic action . Slow hematoschizotropic action. | Tropical malaria, including 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) | Histoschizotropic 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 (artemometer, artesunate) | Hematoschiisotropic
action. Reserve drug | All types of malaria. | Adults and children:
the first dose is 3.2 mg/kg, then 1.6 mg/kg 1-2 times a day for 5-7 days. |
| Hydroxynaphthoquinones | Atovahon (mepron) | Hematoschiisotropic
action. Reserve drug used in the presence of resistance to other drugs. | All types of malaria. | Adults:
0.5 g 2 r / day for 3 days. Children: 0.125-0.375 g 2 r / day for 3 days. |
| Sulfonamides | Sulfadoxine | Hematoschiisotropic | tropical malaria. | Adults:
1.5 g once. Children: 0.25 - 1.0 g once. |
| Sulfones | Dapsone | Hematoschiisotropic action in combination with pyrimethamine. | Adults:
0.1 g/day Children: 1-2 mg / kg / day. |
|
| Tetracyclines | Tetracycline | Hematoschiisotropic histoschizotropic action. | Tropical malaria, resistant to the above drugs. | Adults:
0.3 - 0.5 g 4 r / day. Children over 8 years old: 25-50mg/kg/day |
| Linkosamides | Clindamycin | Hematoschiisotropic
action, has low activity, moderate histoschizotropic action. | Tropical malaria, resistant to the above drugs, low activity. | Adults:
0.3 - 0.45 g 4 r / day. Children over 8 years old: 10-25 mg / kg / day. |
Caring for someone 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 to your feet. During the heat, it is necessary to open the patient, remove the heating pads, but prevent hypothermia and drafts. With a headache, you can put a cold on the head. After profuse sweating, change underwear, give rest to the patient.
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- the diet is not prescribed, the common table number 15 with plenty of drink.
- During a fever – table number 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, croutons,
- grated 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 are advised not to travel to malaria-affected countries. Mosquito bite protection
- Mosquito nets on windows and doorways, you can sleep under a curtain of mesh, tucking it under the mattress.
- Repellents- chemical compounds that repel mosquitoes, but do not kill them, which are applied to the skin or clothing of a person. There are various forms: creams, sprays, aerosols, gels, etc. They are used according to the instructions.
- Insecticides- Mosquito killers. It is recommended to treat rooms, nets, thresholds with an insecticide aerosol. Half an hour after treatment, it is necessary to ventilate the room.
Medical prevention of malaria
Antimalarial drugs are used. Regional drug resistance of malaria needs to be clarified. Drug prophylaxis 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 4-6 weeks after arrival 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 1 time per week.
- Primakhin 30 mg for adults and 0.3 mg/kg for children 1 time in 48 hours.
- Proguanil (bigumal) 0.2g/day adults and 0.05-0.2 g for children.
- Primetamine (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 1 time per week.
Identification and effective treatment of patients with malaria
It is necessary to timely examine patients with suspected malaria, as well as be sure to examine patients with each hyperthermic syndrome who arrived from places endemic for malaria within 3 years. Effective treatment helps stop further transmission of the pathogen through mosquitoes.Malaria vaccine
There is currently no official malaria vaccine. However, clinical trials are under way for an experimental vaccine against tropical malaria. Perhaps in 2015-2017 this vaccine will help to cope with the malaria epidemic in the world.
What is malaria on the lips and how does it manifest itself?
Malaria on the lips manifests itself in the form of small bubbles in size, located close to each other and filled with a clear liquid. The cause of such lesions on the skin is the herpes simplex virus of the first type. Therefore, the use of the term "malaria" to refer to this phenomenon is not correct. Also among the vernacular designations of 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 be disturbed by some general manifestations of this disease. The stages of manifestation of herpes on the lips are:
- tingling;
- bubble formation;
- the 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 feeling of light tingling in the corners of the mouth, on the inner and outer surfaces of the lips. Simultaneously with pinching, the patient may be disturbed 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 can occur against the background of 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.
Ulcer formation
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.
Scab formation
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 fact that the healing process is 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 are the types of malaria?
There are four main types of malaria. Each species is caused by a specific type of malarial plasmodium, which determines the specifics of the disease. The types of malaria are:
- tropical malaria;
- three-day malaria;
- malaria oval;
- quartan.
Tropical or, as it is also called, comatose malaria is the most severe. It accounts for about 95 - 97 percent of all deaths. The clinic is dominated by severe toxic syndrome. Changes in the phases of "chill", "heat" and "sweat" characteristic of other forms of malaria are not expressed.
The disease begins with the onset of fever, diffuse headache and myalgia ( severe muscle pain). After a couple of days, symptoms of a toxic syndrome appear - nausea, vomiting, low blood pressure. Tropical malaria is characterized by the appearance of a rash on the body ( allergic exanthema), coughing, 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 of anemia) erythrocytes. Enlargement of the liver and spleen is noted only in the second week, which greatly complicates the early diagnosis of malaria.
Many immunocompromised people may develop toxic shock, malarial coma, or acute renal failure as early as the first or second week of illness. Patients who develop 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 the massive destruction of red blood cells, acute renal failure most often develops. So, from the destroyed erythrocytes, hemoglobin enters first into the blood, and then into the urine. As a result, the processes of urination are disturbed in the kidneys 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. Hence the name of this type of malaria. During the rise in temperature, patients are excited, breathing heavily, their skin is hot and dry. The heart rate is drastically increased ( up to 100 - 120 beats per minute), blood pressure falls, urinary retention develops. The phases of "chill", "heat" and "sweat" become more distinct. The average duration of an attack varies from 6 to 12 hours. After two or three episodes ( respectively on the 7th - 10th day) appears enlarged liver, spleen, develops jaundice.
However, it can also happen that bouts of fever occur every day. This phenomenon is due to the ingestion of several generations of malarial plasmodium into the blood at once. A few months after the disease, the patient may have periodic rises in temperature.
Malaria oval
This type of malaria is in many ways similar to three-day malaria, but it has a milder course. The difference between malaria oval is that fever attacks 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, refers to benign forms of malarial invasion. It develops acutely, without any prodromal phenomena. Fever attacks develop every 72 hours. The temperature rises to 39 - 40 degrees. During the attacks, the patient is also in a serious condition - the consciousness is confused, the skin is dry, the tongue is lined, 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 ( Plasmodium that have gone through an asexual developmental cycle). Schizontal malaria mainly develops as a result of blood transfusions or by the transplacental route. Therefore, this species is also called syringe or graft. Its difference is the absence of a phase of development of plasmodium in the liver, and the clinical picture depends entirely on the volume of injected blood.
Mixed malaria is also found, which develops as a result of infection at the same time by 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. The onset of the disease
Malaria is characterized by a prodromal period ( mild disease interval), which is characterized by general malaise, mild headaches. Feverish states typical of this disease, followed by periods of calm ( paroxysms), occur after 2-3 days. With tropical malaria, the onset of the disease is more acute. From the first days, patients begin to be disturbed by nausea, vomiting, indigestion in the form of diarrhea. Headaches differ in their intensity. These symptoms are accompanied by a febrile state of a permanent nature, which can last for several days. In the future, 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 the phases of chills, heat and sweat. The duration of the second stage rarely exceeds 12 hours. After the end of the heat, the body temperature drops sharply and increased sweating begins. Attacks occur according to a certain pattern. So, with a three-day malaria, paroxysm worries the patient every 3 days, with a 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 heat stage, bypassing the chills. At the same time, the temperature sharply reaches high values ( above 40 degrees) and can last all day. There is no definite systematic occurrence of seizures. They can occur every other day, daily or twice a day. The decrease in temperature can occur without excessive sweating. |
| The patient may not feel anemia and in most cases this symptom is detected during a laboratory test. Sometimes blood changes are manifested by pallor of the skin and weakness. | Anemia | In tropical malaria, anemia is more pronounced. In blood tests, pathologies can be detected from the first days of the disease. Patients due to a reduced amount of hemoglobin experience lethargy, apathy. There is a bluish tint to the extremities. |
| The spleen increases in size after several attacks. At the same time, the abdomen becomes large and a twofold increase in this organ can be detected on palpation. | Enlargement of the spleen | This form of malaria is characterized by a rapid increase in the spleen, which can be determined by ultrasound as early as 2-3 days. At the same time, patients complain of pain in the area of the right hypochondrium, which become stronger with a deep breath. |
| With malaria, there is an increase in the liver, which entails nausea and pain, which are localized in the right hypochondrium. The functions of the liver are not greatly disturbed, but there is yellowness of the skin and mucous membranes. 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, the enlargement of the liver is more progressive. Also, this form is characterized by liver damage, which entails damage to the hepatic lobules ( functional units of the liver). |
| With malarial infection, there is a decrease in blood pressure during the heat phase and its slight increase in the chill stage. Also, patients complain of heart palpitations and pain in the region of the heart, 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 a more pronounced lesion of the nervous system. Often there is a severe headache, a sense of anxiety and restlessness, convulsions, and a disorder of consciousness. |
| 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 | In this form, kidney dysfunction is diagnosed in 22 percent of patients. |
Complications
Severe complications, which often end in the death of the patient, most often develop with tropical malaria.
Complications of tropical malaria are:
- malarial coma- the unconscious state of the patient in the complete absence of reaction to any stimuli;
- algid- toxic-infectious shock, in which the patient remains conscious, but is in prostration ( severely depressed state of indifference);
- hemoglobinuric fever- development of acute renal and hepatic failure.
The duration of this form of malaria differs from other types of the disease. So, the total duration of three-day malaria varies from 2 to 3 years, four-day malaria - from 4 to 5 years, oval malaria - about 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 fever ( paroxysms) followed by a state of rest. They are characteristic of all forms of the disease, except for tropical malaria. Before the first attack, the patient may be disturbed by a headache, pain in the muscles and joints, and general malaise. Body temperature may also rise to subfebrile values ( no higher than 38 degrees). This condition continues for 2-3 days, after which febrile paroxysms begin. Malaria attacks are characterized by the presence of phases that develop and replace each other in a certain sequence. At first, the attacks may be of an irregular nature, but after a few days a clear pattern for the 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 is repeated 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 malaria attack are:
- chills;
This stage can be manifested as a slight trembling, and a strong chill, from which the patient shakes the whole body. At the same time, the hands, feet and face of the patient 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 is deteriorating markedly. The face becomes red, the skin is dry and hot to the touch. The patient begins to experience severe headaches, heaviness in the muscles, rapid painful heartbeat. The tongue is covered with a grayish coating and is not moist enough. Often the stage of heat is accompanied by vomiting and diarrhea. The patient is in a state of excitement, convulsions and loss of consciousness may be noted. The heat provokes an insatiable thirst. This state can continue from 5 - 6 to 12 hours.
Sweat
The stage of heat is replaced by the final phase, which is manifested by profuse sweating. The temperature drops sharply to normal values, sometimes it can reach 35 degrees. The patient at the same time feels relief, calms down and falls asleep.
Other signs of malaria
Along with attacks, one of the most characteristic features of malaria is anemia ( anemia), splenomegaly ( enlargement of the spleen) and hepatomegaly ( liver enlargement). Also, this disease has a number of symptoms that manifest themselves both on the physical and mental levels.
The signs of malaria include:
- anemia;
- splenomegaly;
- hepatomegaly;
- urination disorders;
- dysfunction of the cardiovascular system;
- icteric staining of the skin and mucous membranes;
- skin hemorrhages;
- herpetic eruptions ( manifestations of herpes);
- nervous disorders.
In patients with malaria, anemia develops sharply, which is characterized by a deficiency of hemoglobin and red blood cells. It develops due to the massive destruction of red blood cells, due to the presence of malarial plasmodium in them ( so-called hemolytic anemia). The most obvious signs of anemia in the period between attacks. However, anemia can persist for a long time after recovery. The patient's skin becomes yellowish or earthy in color, there is weakness, increased fatigue. With anemia, the tissues of the body experience severe oxygen deficiency, because hemoglobin is an oxygen carrier.
Splenomegaly
Enlargement of the spleen is noted 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, soreness of this organ is observed. The spleen becomes more dense, 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 of the spleen. In this case, the edge of the liver falls below the costal arch, becomes more dense and 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, with attacks during chills, patients experience frequent urination. At the same time, urine has an almost transparent color. With the onset of heat, the volume of urine becomes more scarce, and the color becomes darker.
Dysfunction of the cardiovascular system
Most sharply violations of the cardiovascular system are expressed in malarial paroxysms. Characteristic signs of this disease are an increase in blood pressure during chills and its fall during fever.
Icteric coloration of the skin and mucous membranes
It is an early sign of malaria in adults. When red blood cells are destroyed, not only hemoglobin, but also bilirubin is released from them ( bile pigment). It gives yellow color to the skin and mucous membranes. In people with dark skin color, it is sometimes difficult to detect icteric staining. 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 staining of the skin, therefore it is an important diagnostic sign.
Skin hemorrhages
Due to vasospasm, a hemorrhagic rash forms on the patient's body ( subcutaneous hemorrhages). The rash does not have a specific localization and spreads unevenly throughout the body. Outwardly, this sign looks like star-shaped spots of blue, red or purple.
Herpetic eruptions
If a patient with malaria is a carrier of the herpes virus, it is exacerbated during a feverish state. Vesicles with a 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 persistent headaches, insomnia, lethargy in the morning and throughout the day. The psyche of patients undergoes negative changes during attacks. They are in a depressed state, poorly oriented, confusedly answer the questions asked. Often, during the heat, patients rave, 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;
- nervous system disorders;
- convulsions;
- enlargement of the spleen and liver.
It is the main symptom of childhood malaria. It can be both constant and in the form of seizures. Classical seizures, which are characteristic of adults, are rare. Such seizures take place in several stages. The first stage is chills; the second is fever heat); the third is pouring sweat. Children are characterized by high temperature rises up to 40 degrees or more. The younger the child, the more fever he has. During the second stage - the children are excited, they have rapid breathing, dry and red skin. The fall in temperature is accompanied by profuse sweat and great, exhausting debility. These classic seizures are rare in children. More often, the temperature is unstable, and in 10-15 percent of children, malaria does not occur at all without fever. Infants often have a constant temperature, drowsiness, lethargy. The equivalent of an attack in infants is a sharp blanching of the skin, turning into cyanosis ( bluish discoloration of the skin). In this case, the skin becomes sharply cold, there is a tremor of the limbs.
Anemia
As a rule, malaria in children occurs with severe anemia. It appears already from the first days of the disease and is often an early diagnostic sign. It develops due to the massive destruction of red blood cells. The number of red blood cells is sometimes reduced to 30 - 40 percent of the norm.
A hallmark of malarial invasion in children are changes in the blood not only in erythrocytes and hemoglobin, but also in other blood elements. So, 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 occurs in only 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, spotted, hemorrhagic. The development of a rash is due to a decrease in the number of platelets and increased permeability of the vascular wall.
Gastrointestinal disorders
Disorders from the digestive system are almost always noted. The younger the child, the more diverse these disorders are. They manifest themselves in the form of diarrhea, repeated vomiting, nausea. Loose stools with an admixture of mucus are often noted, which is accompanied by bloating, soreness. In infants, this may be the first sign of a malaria infection. There is also repeated vomiting, which does not bring relief.
Disorders from the nervous system
They can appear both at the height of febrile attacks, and in the temperatureless period. These disorders manifest themselves in the form of meningeal symptoms, which are characteristic of all types of malaria. There is photophobia, stiff neck, vomiting. Similar symptoms disappear simultaneously with a drop in temperature. There may also be motor excitation, delirium, clouding of consciousness. Such a variety of disorders of the nervous system is due to the action of malarial toxin on nerve cells.
convulsions
Seizures or convulsions are also very common in children with malaria. Basically, convulsions appear at the height of fever. They may be clonic or tonic. Their appearance is due to high temperature, and not the presence of any disease. These seizures are categorized as febrile seizures, which are common in childhood. The younger the child, the more likely it is to have seizures.
Enlargement of the spleen and liver
It is a common but inconsistent symptom. The spleen and liver enlarge only after a few repeated attacks of fever.
A separate type of malaria infection in children is congenital malaria. In this case, the malarial plasmodium enters the child's body in utero through the placenta. This malaria is extremely difficult, often fatal. Children with congenital malaria are born prematurely, with insufficient weight and abnormalities of the internal organs. The skin of such children is pale, with a waxy or icteric tint, and a hemorrhagic rash is often observed. The spleen and liver are sharply enlarged. When born, children do not emit the first cry, usually lethargic, with reduced muscle tone.
Why is malaria dangerous during pregnancy?
The danger of malaria during pregnancy lies in the increased risk of developing malignant forms of the disease. The physiological changes that accompany the process of bearing a child make a woman more susceptible to infection. The nature of the consequences determines the gestational age at which malaria infection occurred. Also, the outcome of the disease is influenced by the state of the woman's body and the timing at which treatment was started. Infectious agents can have a negative impact both on a pregnant woman and directly on the fetus itself. The consequences of malaria for women
The infection poses the greatest danger when it is infected in the early stages of bearing a child. The most common consequence is spontaneous abortion. Termination of pregnancy occurs due to irreversible changes that have occurred in the body of a woman under the influence of malarial plasmodia. When pregnancy persists, children are often born prematurely, among 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 that of other women in labor. Often the children of patients with malaria are born underweight and often get sick during the first years of life.
Complications of malaria during pregnancy are:
- anemia (anemia among the people);
- nephropathy (a form of late toxicosis caused by kidney dysfunction);
- eclampsia (critical complications due to brain damage);
- hypoglycemia (decrease in blood sugar).
The lack of hemoglobin in the blood provokes multiple pathological processes in the body of a woman. The liver stops producing the necessary amount of protein for the formation of new cells, as a result of which intrauterine growth retardation of the embryo may occur. Toxins are no longer excreted in full, which can lead to insufficient supply of oxygen to the fetus.
Other consequences of malaria due to anemia are:
- abruption of the placenta ahead of time;
- the birth of a dead child;
- weakness of labor activity.
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 elevated levels of protein and uric acid in the urine. The consequences of nephropathy can be intrauterine growth retardation, pregnancy fading, fetal death.
Eclampsia
This disorder develops against the background of damage to brain cells that provokes a malaria infection. Eclampsia is manifested by convulsive seizures, after which the patient falls into a coma. After some time, the patient returns to consciousness. In some cases, it is possible to develop a prolonged coma from which a woman cannot get out. Spasms of blood vessels that occur during convulsions can lead to asphyxia ( suffocation) or hypoxia ( oxygen starvation) embryo. Often, eclampsia 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 detachment of the placenta 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 is manifested by attacks, the repeated repetition of which can harm both the fetus and the expectant mother. The lack of the required amount of glucose can provoke heart failure or lag in physical and mental development in the embryo. For women, this condition is fraught with depression of cognitive functions, a depressed state, and a disorder of attention.
Also, the consequences of congenital malaria include:
- jaundice;
- epileptic seizures;
- anemia ( often severe);
- enlarged liver and/or spleen;
- increased susceptibility to infections.
What drugs are available for malaria?
There is a wide range of different drugs against malaria that act at different stages of development of the malarial Plasmodium. First of all, etiotropic drugs are used, the action of which is aimed at the destruction of malarial plasmodium from the body. In the background are 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 which 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 malarial plasmodium - chloroquine;
- drugs to prevent recurrence of malaria - primaquine;
- drugs used to prevent malaria - plasmocid, bigumal.
- drugs that are used both to treat and prevent malaria are antifolates.
Main drugs used in the treatment and prevention of malaria
| A drug | Characteristic |
| Chloroquine | It is mainly used to prevent all types of malaria. The drug is started to be taken a week before entering the endemic zone ( country or region with a high incidence of malaria). |
| Mefloquine | Used to prevent malaria when 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 | 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, 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 as a last resort in drug-resistant forms of malaria. 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 - avamys, beclazone;
What are the malaria pills?
There are different tablets for malaria, depending on the main active ingredient. | The name of the tablets | Characteristic | ||||||
| Quinine sulfate | Taken at 1 - 2 grams per day, lasting 4 - 7 days. They can be found in the form of tablets of 0.25 grams and 0.5 grams. The daily dose is divided into 2 - 3 doses. Tablets should be washed down 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 each. 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 each. Children's doses are 6.5 milligrams per kilogram. Treatment with hydroxychloroquine tablets lasts 3 days. |
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| Primakhin | 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 prevention - 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 should be taken? For malaria, it is necessary to pass 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, erythrocytes are destroyed in large numbers, which leads to shifts in the overall ratio of cellular elements in the blood. The main abnormalities in the hemoleukogram in malaria are:
With malaria, it is also necessary to pass a biochemical blood test, which confirms the active destruction of red blood cells in the vascular bed. Immunological blood test Blood drop polymerase chain reaction What are the stages of malaria? There are several stages in the clinical picture of malaria. The stages of malaria are:
The incubation period is the length 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 duration of the incubation period may change if inadequate prophylaxis has been previously undertaken. Stage of primary manifestations During periods of absence of temperature, symptoms such as muscle and headaches, weakness, and nausea persist. If malaria develops in children, then during this period the symptoms of the disorder of the gastrointestinal tract predominate. These symptoms are vomiting, diarrhea, bloating. As the liver enlarges, dull pain in the right hypochondrium increases and jaundice develops, as a result of which the skin of patients becomes icteric. 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 due to the destruction of erythrocytes by malarial plasmodium. Erythrocytes are destroyed, and hemoglobin is released from 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 experienced by the body. Secondly, hemoglobin released from red blood cells enters the kidneys, disrupting their functionality. Therefore, a frequent complication of this period is acute renal failure. 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, such conditions as malarial coma, toxic shock, hemorrhagic syndrome develop. The toxic syndrome in this stage is expressed moderately, complications are rare. As in the stage of early manifestations, anemia develops, the liver and spleen moderately enlarge. recovery stage Occasionally, a latent stage may occur between 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 oval malaria. 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 it 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, recurrent vomiting, dizziness. They have lethargy, apathy and severe drowsiness. Within a few hours, drowsiness worsens, a soporous condition develops. During this period, convulsions, meningeal symptoms ( photophobia and muscle stiffness), consciousness becomes confused. If there is no treatment, then a deep coma develops, during which blood pressure drops, reflexes disappear, breathing becomes arrhythmic. During coma, there is no reaction to external stimuli, vascular tone changes, and temperature regulation is disturbed. This condition is critical and requires resuscitation. toxic shock Also, with toxic shock, damage to the nervous system occurs, which is manifested by confusion, psychomotor agitation, fever ( due to temperature regulation). Acute renal failure Symptoms of acute renal failure are rapid deterioration, decreased diuresis, dark urine. In the blood, there is a violation of the water-electrolyte balance, a shift in alkaline balance, an increase in the number of leukocytes. Acute massive hemolysis Hemorrhagic syndrome These thrombi are formed due to increased 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 erythrocytes, numerous decay 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 malaria vaccine? There is a vaccine against malaria, but it is not currently universal. Its planned use is not approved in the European countries of the world. The first malaria vaccine was created in 2014 in the UK by pharmaceutical company GlaxoSmithKline. British scientists have created the drug mosquirix ( mosquirix), which is designed 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. Mosquirix 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 contracting 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, and in children under 3 months only in 31 percent of cases. Thus, the currently created malaria vaccine has a number of negative qualities, which stops its large-scale use. New developments are underway to create a more universal malaria vaccine. According to scientists' forecasts, the first mass vaccinations should appear by 2017. |
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Malaria
Malaria causes about 350-500 million infections and about 1.3-3 million deaths in humans every year. Sub-Saharan Africa accounts for 85-90% of these cases, with the vast majority affecting children under 5 years of age. The death rate is expected to double over the next 20 years.
The first chronicle evidence of a fever caused by malaria was found in China. They date back to around 2700 BC. e., during the Xia Dynasty.
What provokes / Causes of Malaria:
The causative agents of malaria are the protozoa of the genus Plasmodium (Plasmodium). Four species of this genus are pathogenic for humans: P.vivax, P.ovale, P.malariae and P.falciparum In recent years, it has been established that a fifth species, Plasmodium knowlesi, also causes malaria in humans in Southeast Asia. A person becomes infected with them at the time of inoculation (injection) by a female malarial mosquito of one of the stages of the life cycle of the pathogen (the so-called sporozoites) into the blood or lymphatic system, which occurs during blood sucking.
After a short stay in the blood, the sporozoites of the malarial plasmodium penetrate into the hepatocytes of the liver, thereby giving rise to the preclinical hepatic (exoerythrocytic) stage of the disease. In a process of asexual reproduction called schizogony, from 2,000 to 40,000 hepatic merozoites, or schizonts, are eventually formed from one sporozoite. In most cases, these daughter merozoites re-enter the blood after 1-6 weeks. In infections caused by some North African strains of P. vivax, the primary release of merozoites from the liver into the blood occurs approximately 10 months after infection, coinciding with a short period of mass breeding of mosquitoes in the following year.
The erythrocyte, or clinical, stage of malaria begins with the attachment of merozoites that have entered the bloodstream to specific receptors on the surface of the erythrocyte membrane. These receptors, which serve as targets for infection, appear to be different for different species of malarial plasmodia.
Epidemiology of malaria
Under natural conditions, malaria is a naturally endemic, protozoal, anthroponotic, transmissible infection.
The causative agents of malaria find hosts in various representatives of the animal world (monkeys, rodents, etc.), but as a zoonotic infection, malaria is extremely rare.
There are three ways of contracting malaria: transmissible, parenteral (syringe, post-transfusion) and vertical (transplacental).
The main transmission route is transmissive. Human malaria vectors are female mosquitoes of the genus Anopheles. Males feed on the nectar of flowers.
The main vectors of malaria in Ukraine:
an. messae, An. maculipennis, An. atroparvus, An. Sacharovi, An. superpictus, An. pulcherrimus and others.
The life cycle of mosquitoes consists of a number of stages: egg - larva (I - IV age) - pupa - imago. Fertilized females attack a person in the evening or at night and feed on blood. In females that are not fed with blood, eggs do not develop. Blood-fed females remain in the dark corners of residential or utility rooms, thickets of vegetation until the end of the digestion of blood and the maturation of eggs. The higher the air temperature, the faster the development of eggs in the body of the female is completed - (gonotrophic cycle): at a temperature of + 30 ° C - up to 2 days, at + 15 ° C - up to 7 in P. vivax. Then they rush to the reservoir, where they lay their eggs. Such reservoirs are called anophelogenic.
The maturation of the aquatic stages of vector development also depends on temperature and lasts 2-4 weeks. At temperatures below +10°C, mosquitoes do not develop. During the warm season of the year, up to 3-4 generations of mosquitoes may appear in the middle latitudes, 6-8 in the south, and up to 10-12 in the tropics.
For sporogony, a temperature of at least + 16 ° C is required. Sporogony of P. vivax at +16°C is completed in 45 days, at +30°C - in 6.5 days. The minimum temperature for P. falciparum sporogony is +19 - 20°C, at which it is completed in 26 days, at +30°C - in 8 days.
The season for malaria transmission depends on this. In the tropics, the malaria transmission season reaches 8-10 months, in the countries of equatorial Africa it is year-round.
In temperate and subtropical climate zones, the malaria transmission season is limited to the summer-autumn months and lasts from 2 to 7 months.
In wintering mosquitoes, sporozoites die; therefore, females that hatch in the spring are not carriers of malarial plasmodia, and in each new season, mosquitoes are infected from malaria patients.
Perhaps intrauterine infection of the fetus through the placenta in the presence of infection in a pregnant mother, but more often this occurs during childbirth.
With these forms of infection, schizont malaria develops, in which there is no phase of tissue schizogony.
Susceptibility to malaria is universal. Only representatives of the Negroid race are immune to P. vivax.
The spread of malaria is determined by geographical, climatic and social factors. The boundaries of distribution are 60 - 64 ° north latitude and 30 ° south latitude. However, the species range of malaria is uneven. P. vivax, the causative agent of three-day malaria, has the widest range, the distribution of which is determined by geographic boundaries.
Tropical malaria has a smaller range because P. falciparum requires higher temperatures to develop. It is limited to 45° - 50° N. sh. and 20°S sh. Africa is the world's hotbed of tropical malaria.
The second place in distribution in Africa is occupied by four-day malaria, the range of which reaches 53 ° N. sh. and 29°S sh. and which has a focal, nesting character.
P. ovale is found mainly in the countries of West and Central Africa and on some islands of Oceania (New Guinea, Philippines, Thailand, etc.).
In Ukraine, malaria has been practically eliminated and mainly imported malaria and isolated cases of local infection are recorded - secondary from imported ones.
Malaria is imported to the territory of Ukraine from tropical countries and from neighboring countries - Azerbaijan and Tajikistan, where there are residual foci.
The largest part of imported cases is three-day malaria, which is the most dangerous due to possible transmission by mosquitoes sensitive to this type of pathogen. In second place is the importation of tropical malaria, the most severe clinically, but less dangerous epidemiologically, since Ukrainian mosquitoes are not sensitive to P. falciparum imported from Africa.
Cases of importation with an unidentified cause of infection are registered - “airport”, “baggage”, “accidental”, “transfusion” malaria.
The WHO European Office, due to the political and economic instability in the world, the growth of migration and the implementation of large-scale irrigation projects, highlights malaria as a priority problem due to the possibility of a return of the infection.
Under the influence of these factors, the formation of new foci of malaria, i.e., settlements with adjacent anophelogenic reservoirs, is possible.
In accordance with the WHO classification, 5 types of malaria foci are distinguished:
pseudo-focus - the presence of imported cases, but there are no conditions for the transmission of malaria;
potential - the presence of imported cases and there are conditions for the transmission of malaria;
active new - emergence of cases of local infection, transmission of malaria has occurred;
active persistent - the presence of cases of local infection for three years or more without interruption of transmission;
inactive - malaria transmission has ceased, there have been no cases of local infection during the last two years.
An indicator of the intensity of the risk of contracting malaria according to the WHO classification is the splenic index in children from 2 to 9 years old. According to this classification, 4 degrees of endemia are distinguished:
1. Hypoendemia - splenic index in children from 2 to 9 years old up to 10%.
2. Mesoendemia - splenic index in children from 2 to 9 years old is 11 - 50%.
3. Hyperendemia - the splenic index in children from 2 to 9 years old is above 50% and high in adults.
4. Holoendemia - the splenic index in children from 2 to 9 years old is constantly above 50%, the splenic index in adults is low (African type) or high (New Guinean type).
Pathogenesis (what happens?) during Malaria:
According to the method of infection, sporozoite and schizont malaria are distinguished. Sporozoite infection- This is a natural infection through a mosquito, with the saliva of which sporozoites enter the human body. In this case, the pathogen passes through the tissue (in hepatocytes), and then the erythrocyte phase of schizogony.
Schizont malaria due to the introduction of ready-made schizonts into the human blood (hemotherapy, syringe malaria), therefore, unlike sporozoite infection, there is no tissue phase here, which determines the features of the clinic and treatment of this form of the disease.
The immediate cause of attacks of malarial fever is the entry into the blood during the breakdown of morula merozoites, which are a foreign protein, malarial pigment, hemoglobin, potassium salts, erythrocyte residues, which change the specific reactivity of the body and, acting on the heat-regulating center, cause a temperature reaction. The development of a fever attack in each case depends not only on the dose of the pathogen (“pyrogenic threshold”), but also on the reactivity of the human body. The alternation of fever attacks characteristic of malaria is due to the duration and cyclicity of the erythrocyte schizogony of the leading generation of plasmodia of one species or another.
Alien substances circulating in the blood irritate the reticular cells of the spleen and liver, cause their hyperplasia, and with a long course - the growth of connective tissue. Increased blood supply to these organs leads to their increase and soreness.
Important in the pathogenesis of malaria is the sensitization of the body by a foreign protein and the development of autoimmunopathological reactions. The breakdown of erythrocytes in erythrocyte schizogony, hemolysis as a result of the formation of autoantibodies, increased phagocytosis of erythrocytes of the reticuloendothelial system of the spleen are the cause of anemia.
Relapses are typical for malaria. The reason for the near relapses in the first 3 months after the end of the primary acute symptoms is the preservation of a part of erythrocyte schizonts, which, due to a decrease in immunity, begin to actively multiply again. Late or distant relapses, characteristic of three-day and oval malaria (after 6-14 months), are associated with the completion of the development of bradysporozoites.
Symptoms of Malaria:
All clinical manifestations of malaria are associated only with erythrocyte schizogony.
There are 4 specific forms of malaria: three-day, oval-malaria, four-day and tropical.
Each species form has its own characteristics. However, fever attacks, splenohepatomegaly and anemia are typical for all.
Malaria is a polycyclic infection, in its course there are 4 periods: the period of incubation (primary latent), primary acute manifestations, secondary latent and relapse period. The duration of the incubation period depends on the type and strain of the pathogen. At the end of the incubation period, symptoms appear - precursors, prodromes: weakness, muscle, headache, chilling, etc. The second period is characterized by recurring attacks of fever, for which a staging development is typical - a change in the stages of chills, heat and sweat. During the chill, which lasts from 30 minutes. up to 2 - 3 hours, the body temperature rises, the patient cannot warm up, the extremities are cyanotic and cold, the pulse is rapid, breathing is shallow, blood pressure is elevated. By the end of this period, the patient warms up, the temperature reaches 39 - 41 ° C, a period of fever sets in: the face turns red, the skin becomes hot and dry, the patient is excited, restless, headache, delirium, confusion, sometimes convulsions. At the end of this period, the temperature drops rapidly, which is accompanied by profuse sweating. The patient calms down, falls asleep, a period of apyrexia begins. However, then the attacks are repeated with a certain cyclicity, depending on the type of pathogen. In some cases, the initial (initial) fever is irregular or permanent.
Against the background of attacks, the spleen and liver increase, anemia develops, all body systems suffer: cardiovascular (myocardial dystrophic disorders), nervous (neuralgia, neuritis, sweating, chilliness, migraine), genitourinary (symptoms of nephritis), hematopoietic (hypochromic anemia, leukopenia, neutropenia, lymphomonocytosis, thrombocytopenia), etc. After 10-12 or more attacks, the infection gradually subsides, and a secondary latent period sets in. With incorrect or ineffective treatment, a few weeks or months later, short-term (3 months), late or distant (6-9 months) relapses occur.
Three day malaria. The duration of the incubation period: minimum - 10 - 20 days, in case of infection with bradysporozoites - 6 - 12 months or more.
Characterized by prodromal phenomena at the end of incubation. A few days before the onset of attacks, chilling, headache, back pain, fatigue, nausea appear. The disease begins acutely. The first 5-7 days of fever may be of an irregular nature (initial), then an intermittent type of fever is established with a typical alternation of attacks every other day. For an attack, a clear change in the stages of chills, heat and sweat is characteristic. The heat period lasts 2-6 hours, less often 12 hours and is replaced by a period of sweating. Attacks usually occur in the morning. The spleen and liver after 2-3 temperature paroxysms increase, are sensitive to palpation. On the 2nd - 3rd week moderate anemia develops. This species form is characterized by near and distant relapses. The total duration of the disease is 2-3 years.
Malaria oval. In many clinical and pathogenetic features, it is similar to three-day malaria, but differs in a milder course. The minimum incubation period is 11 days, there may be a long incubation, as with a three-day incubation - 6 - 12 - 18 months; from publications, the deadline for incubation is 52 months.
Attacks of fever occur every other day and, unlike 3-day malaria, occur mainly in the evening. Early and distant relapses are possible. The duration of the disease is 3-4 years (in some cases up to 8 years).
tropical malaria. The minimum duration of the incubation period is 7 days, fluctuations up to 10 - 16 days. Characterized by prodromal phenomena at the end of the incubation period: malaise, fatigue, headache, joint pain, nausea, loss of appetite, feeling chilly. Initial fever is constant or irregular, initial fever. Patients with tropical malaria often lack typical malaria symptoms of an attack: no or mild chills, feverish period lasts up to 30-40 hours, temperature drops without sudden sweating, muscle and joint pains are pronounced. Cerebral phenomena are noted - headache, confusion, insomnia, convulsions, hepatitis with cholemia often develops, there are signs of respiratory pathology (phenomena of bronchitis, bronchopneumonia); quite often expressed abdominal syndrome (abdominal pain, nausea, vomiting, diarrhea); impaired renal function.
Such a variety of organ symptoms makes diagnosis difficult and is the cause of erroneous diagnoses.
Duration of tropical malaria from 6 months. up to 1 year.
malarial coma- cerebral pathology in tropical malaria is characterized by rapid, rapid, sometimes lightning-fast development and a difficult prognosis. Three periods are distinguished in its course: somnolence, sopor and deep coma, the lethality in which is close to 100%.
Often, cerebral pathology is aggravated by acute renal failure.
No less severe course is characterized by hemoglobinuric fever, pathogenetically associated with intravascular hemolysis. Most often, it develops in individuals with genetically determined enzymopenia (deficiency of the G-b-PD enzyme) while taking antimalarial drugs. May result in the death of the patient from anuria due to the development of acute renal failure.
The algid form of tropical malaria is less common and is characterized by a cholera-like course.
Mixed malaria.
In malaria-endemic areas, simultaneous infection by several species of Plasmodium occurs. This leads to an atypical course of the disease, making it difficult to diagnose.
Malaria in children.
In malaria-endemic countries, malaria is one of the causes of high child mortality.
Babies under 6 months of age born to immune women in these areas acquire passive immunity and very rarely get malaria. Most severely, often with a fatal outcome, children aged 6 months and older are ill. up to 4 - 5 years. Clinical manifestations in children of this age differ in originality. Often there is no most striking symptom - malarial paroxysm. At the same time, symptoms such as convulsions, vomiting, diarrhea, abdominal pain are observed, there are no chills at the beginning of the paroxysm and sweating at the end.
On the skin - rashes in the form of hemorrhages, spotty elements. Anemia is on the rise.
In older children, malaria usually proceeds in the same way as in adults.
Malaria in pregnancy.
Malaria infection has a very adverse effect on the course and outcome of pregnancy. It can cause abortions, premature births, eclampsia of pregnancy and death.
Vaccinated (schizontal) malaria.
This malaria can be caused by any human malaria pathogen, but P. malariae is the predominant species.
In past years, for the treatment of patients with schizophrenia, neurosyphilis, the method of pyrotherapy was used, infecting them with malaria by injecting the blood of a malarial patient. This is the so-called therapeutic malaria.
Currently, depending on the conditions of infection with plasmodia-infected blood, blood transfusion and syringe malaria are isolated. The literature describes cases of accidental malaria - professional infection of medical and laboratory personnel, as well as cases of infection of recipients of transplanted organs.
The viability of Plasmodium in the blood of donors at 4°C reaches 7-10 days.
It should be noted that post-transfusion malaria can also be severe, and in the absence of timely treatment, give an unfavorable outcome. It is difficult to diagnose it, primarily because the doctor does not have an assumption about the possibility of nosocomial infection with malaria.
The increase in cases of schizont malaria is currently associated with the spread of drug addiction.
In the treatment of such patients, there is no need to prescribe tissue schizontocides. One form of schizont malaria is a congenital infection, i.e., infection of the fetus during fetal development (transplacental if the placenta is damaged) or during childbirth.
Immunity against malaria.
In the process of evolution, humans have developed different mechanisms of resistance to malaria:
1. innate immunity associated with genetic factors;
2. acquired active;
3. acquired passive immunity.
Acquired active immunity caused by infection. It is associated with humoral restructuring, the production of antibodies, an increase in the level of serum immunoglobulins. Only a small part of the antibodies plays a protective role; in addition, antibodies are produced only against erythrocyte stages (WHO, 1977). Immunity is unstable, quickly disappears after the release of the body from the pathogen, has a species- and strain-specific character. One of the essential factors of immunity is phagocytosis.
Attempts to create artificial acquired active immunity through the use of vaccines do not lose their value. The possibility of creating immunity as a result of vaccination with attenuated sporozoites has been proven. Thus, immunization of people with irradiated sporozoites protected them from infection for 3-6 months. (D. Clyde, V. McCarthy, R. Miller, W. Woodward, 1975).
Attempts have been made to create merozoite and gamete antimalarial vaccines, as well as a synthetic multispecies vaccine proposed by Colombian immunologists (1987).
Complications of malaria: malarial coma, rupture of the spleen, hemoglobinuric fever.
Diagnosis of Malaria:
Diagnosis of malaria is based on an analysis of the clinical manifestations of the disease, epidemiological and geographical history data and is confirmed by the results of a laboratory blood test.
The final diagnosis of the specific form of malaria infection is based on the results of a laboratory blood test.
With the study mode recommended by WHO for mass examinations, it is necessary to carefully examine 100 fields of view in a thick drop. Examination of two thick drops for 2.5 minutes. per each is more effective than examining one thick drop for 5 minutes. When Plasmodium malaria is detected in the very first fields of view, the viewing of preparations is not stopped until 100 fields of view are viewed so as not to miss a possible mixed infection.
If indirect signs of a malarial infection are detected in a patient (stay in the malarial zone, hypochromic anemia, the presence of pigmentophages in the blood - monocytes with clumps of almost black malarial pigment in the cytoplasm), it is necessary to examine a thick drop more carefully and not two, but a series of 4 - 6 at one prick. In addition, with a negative result in suspicious cases, it is recommended to take blood samples repeatedly (4-6 times a day) for 2-3 days.
The laboratory response indicates the Latin name of the pathogen, the generic name of Plasmodium is reduced to "P", the species name is not reduced, as well as the stage of development of the pathogen (required when P. falciparum is detected).
To control the effectiveness of treatment and identify possible resistance of the pathogen to the antimalarial drugs used, the number of Plasmodium is counted.
The detection of mature trophozoites and schizonts - morula in the peripheral blood in tropical malaria indicates a malignant course of the disease, which the laboratory must immediately inform the attending physician.
In practice, the former have found greater use. More often than other test systems, an indirect immunofluorescence reaction (IRIF) is used. As an antigen for the diagnosis of three-day and four-day malaria, smears and drops of blood with a large number of schizonts are used.
For the diagnosis of tropical malaria, the antigen is prepared from an in vitro culture of P. falciparum, since in most patients there are no schizonts in the peripheral blood. Therefore, for the diagnosis of tropical malaria, the French company BioMerieux produces a special commercial kit.
Difficulties in obtaining an antigen (a patient's blood product or from an in vitro culture), as well as insufficient sensitivity, make it difficult to introduce NRIF into practice.
New methods for diagnosing malaria have been developed on the basis of luminescent enzyme-linked immunosorbent sera, as well as using monoclonal antibodies.
Enzyme-linked immunosorbent assay using soluble antigens of Plasmodium malaria (REMA or ELISA), like RNIF, is mainly used for epidemiological studies.
Malaria Treatment:
Quinine is still the most commonly used drug for treating malaria. It was replaced for a while by chloroquine, but more recently quinine has regained popularity. The reason for this was the appearance in Asia and then spread to Africa and other parts of the world, Plasmodium falciparum with a mutation of resistance to chloroquine.
Extracts of the plant Artemisia annua (Artemisia annua), which contain the substance artemisinin and its synthetic analogues, are highly effective, but their production is expensive. Currently (2006), clinical effects and the possibility of producing new drugs based on artemisinin are being studied. Another work by a team of French and South African researchers has developed a group of new drugs known as G25 and TE3 that have been successfully tested in primates.
Although antimalarial drugs are on the market, the disease poses a threat to people who live in endemic areas where there is no adequate access to effective drugs. According to Médecins Sans Frontières, the average cost of treating a person infected with malaria in some African countries is as low as US$0.25 to US$2.40.
Malaria Prevention:
Methods that are used to prevent the spread of the disease or for protection in areas endemic for malaria include preventive medicines, mosquito extermination, and mosquito bite prevention products. At the moment there is no vaccine against malaria, but active research is underway to create one.
Preventive medicines
A number of drugs used to treat malaria can also be used for prevention. Usually, these drugs are taken daily or weekly at a lower dose than for treatment. Preventive medicines are commonly used by people visiting areas at risk of contracting malaria and are hardly used by the local population due to the high cost and side effects of these medicines.
Since the beginning of the 17th century, quinine has been used for prevention. The 20th century synthesis of more effective alternatives such as quinacrine (Acriquine), chloroquine, and primaquine reduced the use of quinine. With the advent of the chloroquine-resistant strain of Plasmodium falciparum, quinine has returned as a treatment, but not a preventive.
Mosquito extermination
Efforts to control malaria by killing mosquitoes have been successful in some areas. Malaria was once common in the United States and Southern Europe, but the draining of swamps and improved sanitation, along with the control and treatment of infected people, have made these areas unsafe. For example, in 2002, there were 1,059 cases of malaria in the United States, including 8 deaths. On the other hand, malaria has not been eradicated in many parts of the world, especially in developing countries - the problem is most prevalent in Africa.
DDT has proven to be an effective chemical against mosquitoes. It was developed during World War II as the first modern insecticide. At first it was used to fight against malaria, and then it spread to agriculture. Over time, pest control, rather than mosquito eradication, has come to dominate the use of DDT, especially in developing countries. Throughout the 1960s, evidence of the negative effects of its misuse increased, eventually leading to the banning of DDT in many countries in the 1970s. Until that time, its widespread use had already led to the emergence of DDT-resistant mosquito populations in many areas. But now there is the prospect of a possible return of DDT. The World Health Organization (WHO) today recommends the use of DDT against malaria in endemic areas. Along with this, it is proposed to apply alternative insecticides in areas where mosquitoes are resistant to DDT in order to control the evolution of resistance.
Mosquito nets and repellents
Mosquito nets help keep people away from mosquitoes and thereby significantly reduce infections and transmission of malaria. Nets are not a perfect barrier, so they are often used in conjunction with an insecticide that is sprayed to kill mosquitoes before they can find their way through the net. Therefore, nets impregnated with insecticides are much more effective.
For personal protection, closed clothing and repellents are also effective. Repellents fall into two categories: natural and synthetic. Common natural repellents are the essential oils of certain plants.
Examples of synthetic repellents:
DEET (active substance - diethyltoluamide) (eng. DEET, N, N-diethyl-m-toluamine)
IR3535®
Bayrepel®
Permethrin
transgenic mosquitoes
Several variants of possible genetic modifications of the mosquito genome are considered. One potential mosquito control method is the rearing of sterile mosquitoes. Significant progress has now been made towards the development of a transgenic or genetically modified malaria-resistant mosquito. In 2002, two groups of researchers have already announced the development of the first samples of such mosquitoes.
Which doctors should you contact if you have Malaria:
Are you worried about something? Do you want to know more detailed information about Malaria, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study the external signs and help identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.
How to contact the clinic:
Phone of our clinic in Kyiv: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.
(+38 044) 206-20-00
If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.
You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.
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Almost 100 states of the world with a tropical and subtropical climate consider malaria to be the most serious health problem. The disease is dangerous both for residents of endemic risk zones and for tourists who come to rest in hot countries.
What is this disease
The most frequently recorded cases of infection are in Africa, Southeast Asia, and the Eastern Mediterranean. Any of these regions is dangerous for people with immunodeficiency, the elderly, pregnant women, and young children. All of them have a severe form of the disease, because of malaria they face an increased risk of death, miscarriage, stillbirth.
The causative agent of the disease is the simplest unicellular organism of the genus Plasmodium. It comes in 4 types. In this regard, experts distinguish 4 forms of the disease:
- Oval-malaria. This is a relatively rare condition. It is found in West Africa. Oval-malaria accounts for about 1% of cases. The causative agent is Plasmodium ovale.
- four day form. It is considered rare (up to 7% of cases). It is caused by Plasmodium malariae.
- three day form. It is caused by Plasmodium vivax. The disease arising from this pathogen is widespread in the world (up to 43% of cases).
- tropical malaria. This form is the most common (up to 50% of cases). Its causative agent is Plasmodium falciparum.
How is malaria transmitted?
The disease can occur in almost anyone who lives or has been in areas of endemic risk. There are only a few features:
- Native West Africans have inherent immunity to Plasmodium vivax;
- people with sickle cell anemia easily tolerate the tropical form of the disease, which is considered the most dangerous, rapidly progressing if left untreated.
Malaria is caused by female mosquitoes of the genus Anopheles. They act as carriers of Plasmodium. Insects transmit pathogens from sick people to healthy people through bites. In the past, several isolated cases of human infection with zoonotic species of Plasmodium (Plasmodium knowlesi and Plasmodium cynomolgi) have been recorded. These pathogens were transmitted to people from mosquitoes after the bites of sick monkeys.
With malaria, the incubation period depends on the type of plasmodium that has entered the body. The most rapid development of the disease is observed in the tropical form. The first symptoms appear after 8-16 days. The incubation period for the four-day form ranges from 3 to 6 weeks. Pathogens such as Plasmodium vivax and Plasmodium ovale tend to retain dormant hypnozoites in the liver. The period from infection to the moment of activation can be from 6-8 months to 3 years.
First signs and main symptoms
Fever, chills, headache, muscle pain, muscle weakness, cough, vomiting, abdominal pain, and diarrhea are possible clinical signs. In the absence of treatment, negative progression of malaria is observed, the disease leads to manifestations of insufficiency of individual organs (acute renal failure, pulmonary edema). Perhaps the onset of coma and death.
Of all the symptoms, fever deserves special attention. If it arose for unknown reasons 7 days or more after the first possible contact with the pathogen, then you should immediately consult a doctor. It is advisable to make a visit to a specialist no later than 24 hours after the onset of symptoms indicating malaria, because treatment, started in a timely manner, will reduce or eliminate the likelihood of a fatal outcome.
An important feature of the disease is its paroxysmal course. In the first days, the fever is of the wrong type (temperature fluctuations are observed during the day without patterns). It lasts 1-3 days for three-day and oval malaria and 5-6 days for tropical malaria. After this period, the clinical picture takes the form of typical paroxysms (attacks). They clearly expressed 3 phases - chills, fever, sweating. The duration of the attacks varies from 1-2 hours to 12 hours.
Paroxysms recur either after 48 hours (with tropical, three-day and oval malaria), or after 72 hours (with a four-day form of the disease). Between attacks, the condition of sick people is satisfactory. After 2-3 temperature paroxysms, the liver and spleen increase in size. Anemia develops from the second week of illness.
Diagnosis and treatment
The medicine for malaria is prescribed after confirmation of the presence of the disease. Diagnosis includes taking anamnesis, clinical examination. Laboratory methods are an obligatory part of it. One of them is microscopic. In the course of its application, blood preparations prepared by the method of "thin smear" and "thick drop" and stained according to Romanovsky-Giemsa are examined. The microscopic method allows you to confirm or exclude the disease, determine the type of pathogen, the severity of the infectious process.
After confirming the diagnosis, the doctor thinks about how to rid the patient of malaria. Treatment begins in a hospital setting. It includes:
- the use of etiotropic drugs (Daraprim, Delagil, etc.);
- conducting pathogenetic therapy (prescribed drugs - Prednisolone, Korglikon, ascorbic acid, multivitamins).
Forecast and prevention
A favorable prognosis is with timely diagnosis and treatment of uncomplicated malaria. Full recovery comes quickly. The most dangerous malignant forms of the disease. The lethality due to them is 1%. For example, in the cerebral (coma) form, multiple hemorrhages are observed in the brain tissue, meninges. The disease is manifested by intense headache, nausea, repeated or repeated vomiting, disturbances and loss of consciousness. Death occurs due to increasing heart and respiratory failure.
It is possible to avoid the disease and its negative consequences, because the prevention of malaria has been developed. One of the effective measures is the use of drugs prescribed for treatment. It is recommended that you first consult with your doctor about such prevention. Medicines are prescribed for those people who are going to travel to endemic areas. When drawing up a prevention scheme, the specialist takes into account:
- malaria situation in the region, malarial season, period of disease transmission (part of the year during which pathogens can be transferred from mosquito to humans);
- planned duration of stay in the endemic area;
- the presence of individual intolerance to drugs.
In order to reduce the likelihood of developing malaria, prevention also includes the use of personal protective equipment (mosquito nets, repellents). An important role is played by chemical, physical, biological and hydrotechnical measures carried out by countries at the state level (bringing water sources into proper sanitary and technical condition, leveling banks, clearing vegetation, etc.). A vaccine is also being developed that could 100% protect against infection.
