Malaria

Know Everything about Malaria

Malaria is a life-threatening disease. It’s typically transmitted through the bite of an infected Anopheles mosquito. Infected mosquitoes carry the Plasmodium parasite. When this mosquito bites you, the parasite is released into your bloodstream. The initial symptoms of malaria is fever.

Fever is a very common problem from which almost all of us suffer whenever there is a change of season. Fever is not an illness; it’s a defense mechanism of the body to fight the infections. It’s the sign that our body is working against the infection which is caused by the viruses or bacteria. In fever the temperature of the body rises above the normal, the normal temperature of the body is 98.6 degree Fahrenheit. If the body will have fever then the temperature will rise higher than this. As soon as our body get in contact with the toxins the white blood cells of the body raises the temperature. These toxins do not have a very good tolerance to the heat so fever helps to fight these infections and whenever we sweat we are eliminating the toxins from the body.

What is Malaria?

Malaria is an infectious disease caused by a parasite, Plasmodium, which infects red blood cells. Malaria is characterized by cycles of chills, fever, pain, and sweating. Historical records suggest malaria has infected humans since the beginning of mankind. The name “mal aria” (meaning “bad air” in Italian) was first used in English in 1740 by H. Walpole when describing the disease. The term was shortened to “malaria” in the 20th century.

C. Laveran in 1880 was the first to identify the parasites in human blood. In 1889, R. Ross discovered that mosquitoes transmitted malaria. Of the four common species that cause malaria, the most serious type is Plasmodium falciparum malaria. It can be life-threatening. However, another relatively new species, Plasmodium knowlesi, is also a dangerous species that is typically found only in long-tailed and pigtail macaque monkeys. Like P. falciparum, P. knowlesi may be deadly to anyone infected. The other three common species of malaria (P. vivax, P. malariae, and P. ovale) are generally less serious and are usually not life-threatening. It is possible to be infected with more than one species of Plasmodium at the same time.

Currently, about 2 million deaths per year worldwide are due to Plasmodium infections. The majority occur in children under 5 years of age in sub-Saharan African countries. There are about 400 million new cases per year worldwide. Most people diagnosed in the U.S. obtained their infection outside of the country, usually while living or traveling through an area where malaria is endemic.

What are malaria symptoms and signs?

The symptoms characteristic of malaria include flulike illness with fever, chills, muscle aches, and headache. Some patients develop nausea, vomiting, cough, and diarrhea. Cycles of chills, fever, and sweating that repeat every one, two, or three days are typical. There can sometimes be vomiting, diarrhea, coughing, and yellowing (jaundice) of the skin and whites of the eyes due to destruction of red blood cells and liver cells.

People with severe P. falciparum malaria can develop bleeding problems, shock, liver or kidney failure, central nervous system problems, coma, and can die from the infection or its complications. Cerebral malaria (coma, or altered mental status or seizures) can occur with severe P. falciparum infection. It is lethal if not treated quickly; even with treatment, about 15%-20% die.

What is the incubation period for malaria?

The period between the mosquito bite and the onset of the malarial illness is usually one to three weeks (seven to 21 days). This initial time period is highly variable as reports suggest that the range of incubation periods may range from four days to one year. The usual incubation period may be increased when a person has taken an inadequate course of malaria prevention medications. Certain types of malaria (P. vivax and P. ovale) parasites can also take much longer, as long as eight to 10 months, to cause symptoms. These parasites remain dormant (inactive or hibernating) in the liver cells during this time. Unfortunately, some of these dormant parasites can remain even after a patient recovers from malaria, so the patient can get sick again. This situation is termed relapsing malaria.

How is malaria transmitted?

The life cycle of the malaria parasite (Plasmodium) is complicated and involves two hosts, humans and Anopheles mosquitoes. The disease is transmitted to humans when an infected Anopheles mosquito bites a person and injects the malaria parasites (sporozoites) into the blood.

Sporozoites travel through the bloodstream to the liver, mature, and eventually infect the human red blood cells. While in red blood cells, the parasites again develop until a mosquito takes a blood meal from an infected human and ingests human red blood cells containing the parasites. Then the parasites reach the Anopheles mosquito’s stomach and eventually invade the mosquito salivary glands. When an Anopheles mosquito bites a human, these sporozoites complete and repeat the complex Plasmodium life cycle. P. ovale and P. vivax can further complicate the cycle by producing dormant stages (hypnozoites) that may not develop for weeks to years.

How is malaria diagnosed?

Clinical symptoms associated with travel to countries that have identified malarial risk (listed above) suggest malaria as a diagnosis. Malaria tests are not routinely ordered by most physicians so recognition of travel history is essential. Unfortunately, many diseases can mimic symptoms of malaria (for example, yellow fever, dengue fever, typhoid fever, cholera, filariasis, and even measles and tuberculosis). Consequently, physicians need to order the correct special tests to diagnose malaria, especially in industrialized countries where malaria is seldom seen. Without the travel history, it is likely that other tests will be ordered initially. In addition, the long incubation periods may tend to allow people to forget the initial exposure to infected mosquitoes.

The classic and most used diagnostic test for malaria is the blood smear on a microscope slide that is stained (Giemsa stain) to show the parasites inside red blood cells .

Although this test is easily done, correct results are dependent on the technical skill of the lab technician who prepares and examines the slides with a microscope. Other tests based on immunologic principles exist; including RDTs (rapid diagnostic tests) approved for use in the U.S. in 2007 and polymerase chain reaction (PCR) tests. These are not yet widely available and are more expensive than the traditional Giemsa blood smear. Some investigators suggest such immunologic based tests be confirmed with a Giemsa blood smear.

What is the treatment for malaria?

Three main factors determine treatments: the infecting species of Plasmodium parasite, the clinical situation of the patient (for example, adult, child, or pregnant female with either mild or severe malaria), and the drug susceptibility of the infecting parasites. Drug susceptibility is determined by the geographic area where the infection was acquired. Different areas of the world have malaria types that are resistant to certain medications. The correct drugs for each type of malaria must be prescribed by a doctor who is familiar with malaria treatment protocols. Since people infected with P. falciparum malaria can die (often because of delayed treatment), immediate treatment for P. falciparum malaria is necessary.

Mild malaria can be treated with oral medication; severe malaria (one or more symptoms of either impaired consciousness/coma, severe anemia, renal failure, pulmonary edema, acute respiratory distress syndrome, shock, disseminated intravascular coagulation, spontaneous bleeding, acidosis, hemoglobinuria [hemoglobin in the urine], jaundice, repeated generalized convulsions, and/or parasitemia [parasites in the blood] of > 5%) requires intravenous (IV) drug treatment and fluids in the hospital.

Drug treatment of malaria is not always easy. Chloroquine phosphate (Aralen) is the drug of choice for all malarial parasites except for chloroquine-resistant Plasmodium strains. Although almost all strains of P. malariae are susceptible to chloroquine, P. falciparum, P. vivax, and even some P. ovale strains have been reported as resistant tochloroquine. Unfortunately, resistance is usually noted by drug-treatment failure in the individual patient. There are, however, multiple drug-treatment protocols for treatment of drug-resistant Plasmodium strains (for example, quinine sulfate plus doxycycline [Vibramycin, Oracea, Adoxa, Atridox] or tetracycline [Achromycin], or clindamycin [Cleocin], or atovaquone-proguanil [Malarone]). There are specialized labs that can test the patient’s parasites for resistance, but this is not done frequently. Consequently, treatment is usually based on the majority of Plasmodium species diagnosed and its general drug-resistance pattern for the country or world region where the patient became infested. For example, P. falciparum acquired in the Middle East countries is usually susceptible to chloroquine, but if it’s acquired in sub-Sahara African countries, it’s usually resistant to chloroquine. The WHO’s treatment policy, recently established in 2006, is to treat all cases of uncomplicated P. falciparum malaria with artemisinin-derived combination therapy (ACTs). ACTs are drug combinations (for example, artesunate-amodiaquine, artesunate-mefloquine, artesunate-pyronaridine, dihydroartemisinin-piperaquine, and chlorproguanil-dapsoneartesunate) used to treat drug-resistant P. falciparum. Unfortunately, as of 2009, a number of P. falciparum-infected individuals have parasites resistant to ACT drugs.

New drug treatments of malaria are currently under study because Plasmodium species continue to produce resistant strains that frequently spread to other areas. One promising drug class under investigation is the spiroindolones, which have been effective in stopping P. falciparum experimental infections.

Is malaria a particular problem for children?

Yes. All children, including young infants, living in or traveling to malaria risk areas should take antimalarial drugs (for example, chloroquine and mefloquine [Lariam]). Although the recommendations for most antimalarial drugs are the same as for adults, it is crucial to use the correct dosage for the child. The dosage of drug depends on the age and weight of the child. A specialist in pediatric infectious diseases is recommended for consultation in prophylaxis(prevention) and treatment of children. Since an overdose of an antimalarial drug can be fatal, all antimalarial (and all other) drugs should be stored in childproof containers well out of the child’s reach.

Is malaria a particular problem during pregnancy?

Yes. Malaria may pose a serious threat to a pregnant woman and her fetus. Malaria infection in pregnant women may be more severe than in women who are not pregnant. Malaria may also increase the risk of problems with the pregnancy, including prematurity, abortion, and stillbirth. Statistics indicate that in sub-Saharan Africa, between 75,000-200,000 infants die from malaria per year; worldwide estimates indicate about 2 million children die from malaria each year. Therefore, all pregnant women who are living in or traveling to a malaria risk area should consult a doctor and take prescription drugs (for example, sulfadoxine-pyrimethamine) to avoid contracting malaria. Treatment of malaria in the pregnant female is similar to the usual treatment described above; however, drugs such as primaquine (Primaquine), tetracycline (Achromycin, Sumycin), doxycycline, and halofantrine (Halfan) are not recommended as they may harm the fetus. In addition to monitoring the patient for anemia, an OB/GYN specialist often is consulted for further management.

How to prevent Malaria?

Apply insect repellent to your skin. The US Center for Disease Control recommends the following repellents:

  • DEET
    • Picaridin
    • Oil of Lemon Eucalyptus or PMD
    • IR3535

Use bed-nets when sleeping in areas infested with mosquitoes.

Use insecticides and flying insect sprays to reduce the number of mosquitoes in areas where you will be spending a significant amount of time.

When possible, avoid camping or spending prolonged amounts of time in areas where standing water is present. Keep pots and pans emptied of water. Open vessels for drinking water should be covered. Mosquitoes use areas of standing water to lay their eggs.

If you know you will be traveling in areas where malaria is prevalent, ask your doctor for antimalarial drugs. The CDC recommended malaria drugs include:

  • atovaquone/proguanil
    • chloroquine
    • doxycycline
    • mefloquine
    • primaquine

Wear long-sleeved clothing.

If possible, stay in screened quarters or quarters with air conditioning.

Malaria At A Glance

  • Malaria is a disease caused by Plasmodium spp. parasites that infects about 400 million people per year with about 2 million deaths.
  • Symptoms include recurrent cycles (every one to three days) of fever, chills, muscle aches, headaches; nausea, vomiting, and jaundice also may occur.
  • Anopheles mosquitoes transmit the parasites to humans when they bite. The parasites undergo a complicated life cycle in both mosquitoes and humans; the cycle begins again when the mosquitoes take a blood meal from a human that is contaminated with mature parasites.
  • Africa, Asia, and Central and South America are the areas with high numbers of malarial infections.
  • The incubation period for malaria symptoms is about one to three weeks but may be extended to eight to 10 months after the initial infected mosquito bites occur. Some people may have dormant parasites that may get reactivated years after the initial infection.
  • Malaria is diagnosed by the patient’s history of recurrent symptoms and the identification of the parasites in the patient’s blood, usually by a Giemsa blood smear.
  • Malaria is usually treated by using combinations of two or more anti-parasite drugs incorporated into pills that are taken before exposure (prophylactic or preventative therapy) or during infection. More serious infections are treated by IV anti-parasitic drugs in the hospital.
  • Infants, children, and pregnant females, along with immunodepressed patients are at higher risk for worse outcomes when infected with malaria parasites.
  • To reduce the chance of getting malaria, people should avoid malaria-endemic areas of the world, use mosquito repellents, cover exposed skin, and use mosquito netting covered areas when sleeping.
  • The prognosis for the majority of malaria patients is good; most recover with no problems, unless infected with P. falciparum or P. knowlesi, which may have fair to poor outcomes unless treated immediately. Infants, children under 5 years of age, pregnant females, and those with depressed immune systems frequently have a fair to poor prognosis unless effectively treated early in the infection.

Precautions

The first step in handling Mosquito malaise is prevention. You and your family can prevent malaria / dengue by a few simple precautionary steps:

  • Try to keep mosquitoes from biting you, especially at night – so close your doors and windows at dusk. You can alsohave net screens to cover windows and doors.
  • Wearing long-sleeved clothing if out of doors after sunset.
  • Maintaining hygiene around your house and eliminating places around your home where mosquitoes breed.
  • Mosquito nets help keep mosquitoes away from people and greatly reduce the transmission of mosquito related diseases. Mosquito nets are often an affordable medium and hence can help reduce the chances of a mosquitoattack.
  • Indoor residual spraying (IRS) is the practice of spraying insecticides on the walls of homes in malaria affected areas. So if the walls have been coated with insecticides, the resting mosquitoes will be killed before they can bite another person, transferring the malaria parasite. Surprisingly mosquitoes have developed a resistance against these withtime.


Diet also plays a very important role in management of fevers.

FOOD FOR FEVER   :-

There is no specific recommendation regarding diet during dengue/malaria fever and after dengue/malaria fever.However there are plenty of hints and tips for diets that may be easier for the condition to handle.

  • Firstly, and pretty obviously, it is important to try and eat healthily to boost your immune system and help to fight off the illness.

Eating a nutritionally balanced diet. Take regular and frequent meals as they are very important for a quick and early recovery from the fevers. During the fever the metabolism of the body gets very high so don’t cut your calories as they are required to maintain the functioning of the body and they also boost the body’s ability to fight the infections.

  • Like with any other febrile illness, eat foods which can be easily digested. Take the foods which are easy to digest and rich in nutrients. Homemade soups and porridge can be a very good option in fevers. These foods contain essential vitamins and nutrients and are required for recovering from the condition.
  • Take the adequate amounts of proteins as they required for the tissue repair and regeneration. Adequate proteins are also required for the production of white blood cells and antibodies. One should take the proteins of high biological values to avoid the muscle depletion. Eggs, lean meat, fish, milk and milk products are good examples of this. The requirement of the proteins during the fever should be 1.2 to 1.5 gm per kg body weight.
  • Avoid the saturated fats and take the unsaturated or monounsaturated fats as they contain essential oils which are required for the healthy immune system and well being of the person. Avoid fried foods and foods with oil, spices and salt. You can use lemon juice or certain herbs to enhance the flavour of your food.

 Nuts like almonds, walnuts, pistachios, pine nuts and oilseeds such as flaxseeds, pumpkin seeds and sunflower seeds are good to take during the fevers.

  • Fluids are usually lost during the fevers by sweating. So adequate fluids intake should be there with the electrolyte balance. Coconut water is very good option during the fevers as this natural drink contains balanced amounts of electrolytes also. Herbal teas or green teas are also a very good option during the fevers. These teas also help in the early recovery from the fever. Some of the effective teas can be tulsi green tea, chamomile tea and peppermint tea. According to some experts of Ayurveda, tea made with fever reducing herbs such as ginger and cardamom is helpful. So drink plenty of fluids such as oral rehydration solution, fresh juice, soups, coconut water etc. This will help to prevent dehydration due to vomiting and high fever.
  • Take plenty of fresh fruit and vegetables during the fevers. green leafy vegetables and Fruits can provided the essential vitamins and minerals that can ward off the infection. Chewing two cloves of garlic or drinking hot garlic vegetable soup can decrease the multiplication of viruses Orange juice, amla or amla juice, and grapefruit can promote antibody production. Vitamin C present in these fruits can aid in improving cellular immunity and preventing dengue hemorrhagic fever .

On the other hand, some people recommend a liquid diet for severe cases. This is more than likely because the illness is a fever in its simplest form and patients of fever usually do not feel like eating that much. Liquid diet foods can include smoothies, fruit juices, thin porridge,soup etc. Try adding oats to the smoothie to make it more filling if you find that it does not keep you satisfied for long.

There are also certain foods, which can exacerbate the condition. Caffeine and alcohol, known for their diuretic properties, are best avoided to prevent dehydration. Avoiding junk food with empty calories, sugary products, and fried foods is a must, as they accentuate the symptoms of the disease and fail to provide the necessary nutrition for bettering health. If you have any doubt regarding your diet during dengue fever, consult your dietitian to avoid any complications.

Shoot your thoughts in the comments below.

You can consult with us. Book an Appointment with our expert dietitians.

For more details you can follow us on Facebook, Twitter, Instagram & Youtube.

Support and share
0 0 votes
Article Rating
Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments
0
Would love your thoughts, please comment.x
()
x