Malaria

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Dr. Sachin Shelke
Internal Medicine

verified

According to the World Malaria Report 2019 from the World Health Organization (WHO), there were about 228 million cases worldwide of this disease in 2018. The report estimates that the global death burden of malaria was 4,05,000 in that year. It also reveals that 19 countries in sub-Saharan Africa and India carried almost 85% of the global malaria burden in 2018. There are four types of parasites that can cause this mosquito-borne disease. One of them, known as plasmodium falciparum, was highly prevalent in the WHO African region (99.7% cases) and South East Asian region (50% cases) in 2018. The prevalence of P. vivax, another malaria-causing parasite, was also high later (53% of the global burden) in the year. Out of the total number of P. vivax malaria cases in South East Asia, the majority were from India (47%) in 2018.
Malaria is a mosquito-borne parasitic disease characterised by high fever and chills. Transmitted through the bite of infected Anopheles mosquitoes, it can be caused by four parasites: Plasmodium (P) vivax, P. ovale, P. malariae and P. falciparum. However, there can be other modes of transmission too. You can catch malaria if you are exposed to infected blood during transfusion or while sharing needles used to inject drugs. A mother can also pass it on to the child at birth. The malaria parasites march to your liver after they sneak into your body. After maturing over there, they enter the bloodstream after a few days and attack your red blood cells. Once inside the red blood cells, these parasites take 48 to 72 hours to multiply. This makes your infected cells burst open. You start experiencing the symptoms of malaria as this process continues. P. falciparum leads to the most severe form of malaria called cerebral malaria. It can be fatal.

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Symptoms

It takes about 10 days to 4 weeks for malaria symptoms to manifest. In some cases, the parasite may even remain dormant for months. So, the manifestations also occur that late. The most common signs of malaria are fever, chills and shivers. This is followed by sweating and the lowering of the fever episode. But this classical triad of symptoms may sometimes be absent and patients may experience fever without chills too. If you suffer from this condition, you will experience the symptoms in cycles. Apart from these prominent signs, malaria can come with other associated manifestations too. Here are some of them:


  • Profuse sweating

  • Headache

  • Nausea

  • Vomiting

  • Abdominal pain

  • Diarrhoea

  • Anaemia

  • Muscle pain

  • Convulsions

  • Coma

  • Bloody stools

Causes And Risk Factors

Causes
As already mentioned, malaria is caused by Anopheles mosquitoes infected by parasites. You fall in the high-risk group for malaria if you live in or visit areas with a high prevalence rate of the disease. The incidence of malaria is very high in places with tropical and subtropical climates. African countries and South East Asian regions record the highest number of malaria cases. Coming in contact with someone from a malaria-infested part of the world can also increase your chance of getting the disease.
Malaria can also be passed on from an infected mother to the child before or during delivery.
Risk Factors
Risk factors for malaria include:


  • Travelling to countries with malaria transmission

  • Blood transfusion (very rare)


People who are at risk of severe conditions and complications from malaria include:

  • Pregnant women, young children and people with low immunity

  • People travelling from an area with no malaria to areas of malaria transmission

  • Poor people who live in rural areas with poor healthcare facilities

Prevention

With some simple yet effective precautionary measures, one can prevent malaria. Here are some of them:


  • Mosquitoes breed in stagnant water, be it an open drain near your house, a pond in the neighbourhood or a water puddle close by. Get them closed and cleaned up as soon as possible. Even plants in pots, bird baths, fountains, etc. should not hold stagnant water. The water in the swimming pools needs to be circulated and chlorinated. If you store water in the house due to its shortage, keep the container closed .

  • Use mosquito screens, nets, fibre glass meshes or magnetic insect repellent screens for your windows if you live in a mosquito-infested area.

  • If possible, avoid the time immediately after dusk to venture out. This is especially applicable to children. However, if you must be out, wear clothes that cover your body to a large extent. Cover the exposed parts with a mosquito repellent.

  • Indoor residual spraying with an insecticide is also recommended.

  • Insecticide treated bed nets should be used in areas where mosquitoes and malaria are rampant.

Diagnosis

If you experience the symptoms of malaria, consult a doctor immediately. After a detailed evaluation of your medical and travel history, the doctor will perform a physical examination and check for an enlarged spleen or liver. Your physician may advise a few blood tests for a confirmatory diagnosis. Here are some of them:


  • Thick and thin blood smears: This blood test confirms the presence of malaria parasites and reveals the type of parasite you are infected with. This is crucial for deciding treatment.

  • Antigen Testing: This is a quick option which only detects the presence malaria parasite but can’t tell your doctor about the type or severity of infection.

  • Molecular test: This is recommended if the results of your blood smear test don’t give a clear picture about the type and severity of your infection.

  • Drug resistance test: In some cases, malaria parasites can be resistant to drugs. Your physician can suggest a blood test to figure out which drugs can work against the parasite.
    Additionally, other blood tests can also be recommended for complications that are associated with malaria.

Treatment

The line of treatment varies depending on the type of parasite that has infected you and the severity of the condition. The intention is to control fever and seizures, and replenish fluids and electrolytes. The most commonly prescribed drug for malaria is chloroquine. However, it has been found that P. falciparum is resistant to this drug. The other anti-malarial drugs include Quinine, arterolane and piperaquine, Artemether and lumefantrine (Coartem), Atovaquone (Mepron), Proguanil (sold as a generic), Mefloquine, Clindamycin (Cleocin) and Doxycycline. The doctor will choose the medicine for the treatment depending on the following factors:


  • Age and medical history of the infected person

  • Type of parasite that caused the malaria

  • Drug resistance status of the parasite

  • Intended length of hospital stay


If not treated correctly, reinfection can occur if a few types of parasites responsible for malaria lie dormant in the liver or blood and reactivate months or years after the first attack. Hence, the doctor may prescribe more than one medicine to prevent relapse, such as primaquine.
Medicines used to treat malaria are associated with a few side-effects such as:

  • Headache

  • Insomnia

  • Ringing in the ears

  • Nausea

  • Diarrhoea

  • Seizures

  • Increased sensitivity to light

  • Vision problems

  • Psychological disorders


In addition to antimalarial drugs, the doctor may also give electrolytes, fluids and antiseizure medicines as per the requirements of each patient.

Lifestyle/management

There is no specific diet for this mosquito-borne disease. However, the right foods will help you battle malaria better by revving up your immune system. They will also ensure that your vital organs, kidney, liver or the digestive system function well as you heal. Have small, frequent meals through the day when suffering from malaria. Here are some dietary changes that will help you manage malaria better:
Load up on carbohydrates: You are likely to feel low on your energy levels when you are suffering from an infection including malaria. Carbohydrates boost your energy. Also, choose rice instead of wheat and millets because it will be easier on your stomach.
Have a lot of vitamins: A growing body of research suggests that fruits and vegetables rich in vitamins A and C are good for boosting the immunity of malaria patients. Fresh fruits and vegetables work wonders for malaria patients. Beetroot, carrot, papaya, grapes, berries, lemons, and oranges will be good options.
Take plenty of fluids: Loss of appetite is the common complaint among malaria patients. Fluids can be your saviour if you don’t like to have solid foods. They will also keep you hydrated. Glucose water, fresh fruit juices, coconut water, and electoral water among others can be your go-to options. They will also help in flushing out toxins from your body.
Include more proteins in your meals: A protein-rich diet will optimise the function of your immune cells and help you fight the malaria parasites. Include fish stew, chicken soup, eggs and pulses in your meals. Curd, buttermilk will also be helpful.
Avoid these foods: Avoid foods loaded with fats, especially dairy products. They won't be easy on your stomach. Deep fried and spicy foods should also be avoided when you are suffering from malaria. Stay away from chips, pastries, sauces, pickles and caffeinated beverage.

Prognosis And Complications

Prognosis
The treatment for malaria usually prove to be very effective when initiated in the early days. Hence, people who think they have malaria or those who have travelled to areas with malaria transmission should consult the doctor immediately and seek treatment. Early treatment can help to clear the parasite from the body and cure malaria. However, one can get re-infected with malaria if an infected mosquito bites again.
Complications
Generally, people with malaria who reach out for treatment on time recover and lead a normal, healthy life. However, if it is caused by P. falciparum, malaria can be fatal too. Severe malaria can come with several complications like brain damage and organ failure. Hence, people infected with P. falciparum are usually admitted to the intensive care unit during the early days of treatment to prevent such life-threatening complications.
Other complications that could manifest in people infected with P. falciparum include:


  • Jaundice

  • Blood coagulation disorders

  • Rupture of the spleen

  • Shock

  • Liver failure

  • Kidney failure

  • Pulmonary oedema

  • Cerebral malaria


Pregnant women should avoid travelling to places with malarial transmission as malaria during pregnancy can cause the following complications:

  • Miscarriage

  • Problems associated with the development of the baby

  • Transmission of malaria to the baby

References


  1. Frequently asked questions (FAQs). Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/malaria/about/faqs.html.

  2. Malaria. BetterHealth Channel. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/malaria.

  3. Malaria. familydoctor.org. Available at: https://familydoctor.org/condition/malaria/.

  4. Malaria. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/15014-malaria.

  5. Malaria. Harvard Health Publishing Harvard Medical School. Available at: https://www.health.harvard.edu/a_to_z/malaria-a-to-z.

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