Diagnosis Treatment Prevention of Malaria Infection Disease
Malaria is an arbo-borne infection caused by Plasmodium
infection through the bite of Anopheles mosquito or transfusion into the blood
of a person carrying Plasmodium. There are four types of Plasmodium parasites
in the human body, namely P. vivax, P. falciparum and P. ovale.
Plasmodium vivax and Plasmodium falciparum are the main species in China. The other two species are rare, and some cases imported from abroad have occasionally been seen in recent years. Different Plasmodium causes Plasmodium vivax, Plasmodium falciparum, Plasmodium falciparum, and Plasmodium ovale. The disease mainly manifests as periodic attacks, coldness, fever and sweating throughout the body. After repeated attacks for a long time, it can cause anemia and splenomegaly.
Plasmodium vivax and Plasmodium falciparum are the main species in China. The other two species are rare, and some cases imported from abroad have occasionally been seen in recent years. Different Plasmodium causes Plasmodium vivax, Plasmodium falciparum, Plasmodium falciparum, and Plasmodium ovale. The disease mainly manifests as periodic attacks, coldness, fever and sweating throughout the body. After repeated attacks for a long time, it can cause anemia and splenomegaly.
On October 27, 2017, the list of carcinogens published by the
International Agency for Research on Cancer of the World Health Organization
initially compiled a reference, and malaria (caused by Plasmodium falciparum
infection in highly endemic areas) was included in the category 2A carcinogen
list.
English name: Malaria
Visiting department: Infectious Diseases
Common causes: Infection by
Anopheles mosquito bite or transfusion into the blood of a person carrying
Plasmodium
Common symptoms: Periodic attacks,
chills, fever, sweating, anemia and splenomegaly
Contagious: Yes
Way for spreading: Transmitted by
infected anopheles bites
Basic Information
What are the Causes of Malaria?
Source of infection: patients with present malaria or
asymptomatic carriers who have gametophytes in their blood become the source of
infection. The higher the density of the protozoa in the blood, the higher the
density of the gametophyte and the greater the chance of transmission.
What is the Clinical Manifestation of Malaria?
1. Incubation period
From human infection to malaria parasites (oral temperature
exceeding 37.8 ° C), the incubation period is said.
The incubation period
includes the first reproductive cycle of the entire infrared period and the red
inner period.
Generally, malaria vivax and oval malaria are 14 days, malarial
malaria is 12 days, and malaria malaria is 30 days.
The amount of infected
protozoa varies, the number of strains, the difference in human immunity, and
the different ways of infection can cause different incubation periods.
In
temperate regions, there are so-called long-latency worm strains that can last
up to 8 to 14 months.
The incubation period of transfusion infection is 7-10
days.
Fetal malaria has a shorter incubation period. The incubation period can
be prolonged for people who have some immunity or who have taken preventive
medicine.
2. Cold period
The chills first caused coldness at the ends of the
extremities, and quickly felt cold in the back and body.
Goose bumps on the
skin, cyanosis on lips, nails, pale faces, and sore muscles and joints
throughout the body.
As a result, the whole body trembled, teeth trembled, and
some people couldn't stop covering a few quilts.
It lasts about 10 minutes, or
even an hour, and the chill stopped naturally and the temperature rose.
Patients often feel severely ill at this stage.
3. Fever period
After the cold sensation disappears, the complexion turns
red, the cyanosis disappears, and the body temperature rises rapidly.
Generally, the more pronounced the coldness, the higher the body temperature,
which can reach above 40 ° C.
Patients with high fever are intolerable.
Some
are restless and have more than purine; some are delirious, get empty, and even
twitch or unconscious.
Some have severe headaches and stubborn vomiting.
The
patient's face was red and short of breath.
There is conjunctival congestion.
The skin gets hot and dry.
Pulses get rapid.
Urine is short and dark.
Talk
about palpitations, thirst and cold drinks.
It lasts for 2 to 6 hours, and
sometimes reaches more than 10 hours.
Herpes is common on the lips and nose
after several episodes.
4. Sweating period
In the later period of high fever, the palms of the face
slightly sweated, and then spread throughout the body. The sweat was dripping,
the clothes were soaked, and the body temperature decreased in 2 to 3 hours,
often to 35.5 ° C.
The patient felt comfortable, but was very sleepy, and often
fell asleep.
When the patient wakes up, their spirit is light, the appetite is restored, and they can work as usual.
At this moment enters the rest period.
How to Test Malaria Virus?
1. Blood image
Red blood cells and hemoglobin decrease after multiple
episodes, especially in malaria.
The total number of white blood cells may
increase slightly at the beginning, and then normal or slightly lower.
The
number of monocytes classified by white blood cells often increases and
granulose granules are phagocytosed.
2. Plasmodium inspection
Blood smears (thin or thick) are stained for Plasmodium. And
can identify the species of Plasmodium.
Bone marrow smear staining showed a
positive rate for Plasmodium.
3. Serology
Antimalarial antibodies generally appear 2 to 3 weeks after
infection, peak at 4 to 8 weeks, and then gradually decline.
Indirect
immunofluorescence, indirect hemagglutination and enzyme-linked immunosorbent
assays have been applied, and the positive rate can reach 90%. Generally used
for epidemiological examination.
How to Diagnose Malaria fever?
Malaria Diagnosis:
1. Epidemiology
Fever patients with a history of living or traveling in
malaria-endemic areas, a history of malaria in recent years, or a recent blood
transfusion should be suspected.
2. Clinical Manifestations of Malarial Fever
Typical periodic chills, fever, and sweating can be diagnosed
initially. Irregular fever, accompanied by spleen, liver enlargement, and
anemia, should consider the possibility of malaria.
he most dangerous type
occurs in the epidemic period, and it is usually caused by anxiety, high fever,
chills, coma and convulsions. Suddenly high fever, chills, and coma in infants
and young children in endemic areas should also consider this disease.
3. Laboratory inspection
It is mainly the search for Plasmodium, which can usually be
confirmed. Blood tablets should be collected during the onset of a chill in order
to find the Plasmodium.
At this time, the number of protozoa is large and easy
to find. Repeat as many times as needed. And be sure to do a thick blood film
search.
If the clinical suspicion is high and the blood film is negative
several times, a bone marrow aspiration smear can be used to look for
Plasmodium.
4. Molecular biology technology diagnostics
(1) The sensitivity and specificity of polymerase chain
reaction (PCR) detection are high.
The PCR detection method has been developed
into a variety of methods based on the original, such as nested PCR, reverse
transcriptase PCR, PCR-ELISA and so on.
In addition to direct detection of
Plasmodium in blood samples, Plasmodium can also be detected on filter paper
dried blood drops.
It has progressed from detecting P. falciparum to detecting
P. vivax.
(2) DNA probe detection
DNA probe detection has good
specificity and stability.
5. Therapeutic diagnosis
The clinical manifestations are very similar to malaria, but
after repeated inspections no Plasmodium was found.
Try a drug that kills the
protozoa in the red stage (such as chloroquine), and for 48 hours, fever
control may be malaria. But pay attention to chloroquine-resistant strains.
Differential diagnosis
Malaria that is not symptomatic or other diseases suspected
of malaria should be identified.
Malaria has fever and liver and splenomegaly
symptoms and should be distinguished from other diseases with this
characteristic symptom.
1. Identification with common diseases
(1) In the past history of schistosomiasis, there has been
contact with epidemic water and a history of cercaria dermatitis in the
schistosomiasis endemic area.
Fever and liver, splenomegaly, gastrointestinal
symptoms include diarrhea, bloody stools, etc. Eosinophils are common.
Tests
for schistosomiasis kits shows positive antibodies and antigens.
(2) Amoebic liver abscess with irregular fever, markedly
enlarged liver and marked tenderness, increased white blood cell count, most of
which are neutrophils, and a mass on ultrasound examination.
(3) Septicemia chills or chills, high fever, enlarged liver
and spleen. Migratory abscesses can occur, with significant increases in white
blood cells and neutrophils.
Generally can be asked about the cause and process
of infection. Blood bacterial culture was positive.
(4) Typhoid fever is relaxation fever at the beginning,
followed by stagnant fever or relaxation fever, rose rash, gastrointestinal
symptoms and systemic poisoning symptoms are visible
Blood, bone marrow, feces
and urine were positive for bacterial culture, and Federer's response was
positive.
(5) Leptospirosis has a characteristic of relaxation fever or
persistent fever with gastrocnemius pain.
Hemorrhage of the skin and mucous
membranes, and enlarged liver and spleen may occur. Serum immunological test
was positive.
(6) Irregular fever with acute pyelonephritis, backache,
frequent urination or pain.
Red, white blood cells and protein appeared in
urine, and urine culture was positive.
(7) Brucellosis flaccid fever and orchitis are one of the characteristic
symptoms.
The spleen is enlarged and tender. Positive serum agglutination test
or ELISA test.
(8) Viral infections such as influenza, fever, and chills are
often accompanied by obvious symptoms of upper respiratory tract infection.
Another example is dengue fever, high fever with chills, liver, splenomegaly,
extremities and trunk rash.
Some virus infections have irregular fevers, and
the cause has not been found in various aspects.
Using molecular biology
techniques to test, a positive result of a virus has been detected.
2. Identification from coma other than cerebral malaria
Meningitis, encephalitis, epilepsy, brain abscess, brain
tumor, cerebrovascular accident, trypanosomiasis in the tropics, sickle cell
disease, etc. can cause coma.
If the clinical manifestations and laboratory
diagnosis results are comprehensively analyzed, it is difficult to
determine whether a coma caused by cerebral malaria.
However, at least at this
stage, cerebral malaria is the first disease to be considered for those who
have recently lived in malaria-endemic areas such as Africa and Southeast Asia
and have symptoms of coma.
How to Treat Malaria fever?
Treatment of Malarial Fever:
1. Basic treatment of Malarial Fever
(1) Bed rest should be taken during the onset and 24 hours
after fever.
(2) Pay attention to the supply of water, give a liquid or
semi-liquid diet to those with poor appetite, and give a high-protein diet to
the recovery period.
Those who can't eat due to diarrhea should be replenished
appropriately.
Those with anemia can be supplemented with iron.
(3) Pay attention to keep warm during the chills. When
sweating, you should dry it with a dry towel or warm and humid towels in time,
and change the sweaty clothes at any time to avoid cold. Use physical cooling
when the fever is high.
Dangerous fever should closely observe the condition,
timely detect changes in vital signs, record the amount of in and out, and do
basic care.
(4) Isolate according to arboreal infectious diseases. The
syringe used by the patient should be washed and disinfected.
2. Pathogen Treatment
The purpose is to kill both the Plasmodium in the red stage
to control the outbreak, to kill the Plasmodium in the infrared stage to
prevent recurrence, and to kill the gametophyte to prevent transmission.
(1) Treatment of P. vivax, P. vivax and O. malaria:
Including
current cases and relapsed cases of P. vivax, it is necessary to use blood
schizont killing drugs such as chloroquine to kill protozoa in the red stage
and quickly retreat.
Heat, and the use of tissue-stage schizont killing drugs also
known as radical medicine or anti-relapse medicine for radical cure or
anti-relapse therapy, killing the infrared-phase protozoa.
Commonly used in
combination with chloroquine and primary aminoquine.
(2) Treatment of falciparum malaria
In areas that have not
yet developed resistance to chloroquine, chloroquine can still be used to kill
protozoa in the red blood cell stage.
At the same time, gametophyte killers
must be added. Adults take chloroquine plus primary aminoquine.
3. Rescue principles for dangerous outbreaks
(1) Kill Plasmodium asexuals quickly
(2) Improve microcirculation and prevent capillary
endothelial cells from breaking down
(3) Maintaining hydropower balance
4. Fast and Efficient Anti-malarial Medication:
Malaria drugs Artemisinin and artesunate are available.
5. Other Treatments
(1) Those with circulatory dysfunction should be treated
according to septic shock, and given corticosteroids, tinctures, heparin, etc.,
with low scores of dextran
(2) Patients with high fever convulsions, given physical,
drug cooling and sedation
(3) Cerebral edema should be dehydrated; heart failure and
pulmonary edema should be used to strengthen the heart and diuresis.
Respiratory failure should use respiratory stimulants or artificial
respirators; severe renal failure can be used for hemodialysis.
(4) Black urine fever is the first to stop quinine and
primary quinine, followed by hormones, alkalized urine, diuresis and so on.
How to Prevent Malaria?
Prevention of Malaria:
Malaria prevention refers to the protection of susceptible
people. Including individual prevention and group prevention.
Individual
prevention is the protection measures taken by residents of the malaria area or
individuals who have entered the malaria area for a short period of time in
order to prevent mosquito bites, prevent morbidity or reduce clinical symptoms.
Mass prevention is to prevent high-malaria areas, outbreak-endemic areas, or
large numbers of people who have entered the malaria area for a longer period
of time.
In addition to the purpose of individual prevention, it must also
prevent transmission.
According to the weak links in the transmission channels,
it is necessary to choose protective measures that are economical, effective
and easily accepted by the masses.
What is Falciparum Malaria?
Falciparum malaria is rare in the People's Republic of China,
but it is highly common in tropical regions of Africa.
This infectious disease
caused by Plasmodium falciparum infection is often caused by chills, fever, and
headache, with many complications.
Treatment can be life threatening
What are the Clinical Symptoms of Falciparum Malaria?
The symptoms are Chills, fever,
headache
What is the Cause of Falciparum Malaria?
The cause is Plasmodium
falciparum infection
What is the Pathogenesis of Falciparum Malaria?
In the erythrocyte stage, Plasmodium schizont swells red
blood cells, schizont and Plasmodium metabolites, residual and degenerative
hemoglobin, and red blood cell fragments enter the bloodstream together.
A considerable part of them can be engulfed by polymorphonuclear leukocytes and
monocytes.
The swallowing of the cells of the cell system stimulates these cells
to produce endogenous pyrogens, which together with the malaria parasite
metabolites act on the hypothalamus's thermoregulatory center and cause fever.
What are the Pathological changes under Falciparum Malaria?
Anemia
After several episodes of malaria, symptoms of anemia may
appear. The more seizures, the longer the course of the disease, and the worse
the anemia.
Plasmodium within the red blood cells directly destroys red blood
cells, which is one of the causes of anemia in malaria patients.
Splenomegaly
The main reasons are spleen congestion and monocyte phagocytosis.
The phagocytic cells became dark due to the large amount of malarial pigment.
Splenomegaly can reach below the umbilicus, and its weight has increased from
150g to 500g, or even more than 1000g.
Epidemiology
Malaria is widely distributed in the world. It is one of the
parasitic diseases that seriously endanger human health.
It is an important
public health problem in a large area of Asia, Africa and Latin America.
According to statistics, there are still 120 million malaria patients and
nearly 300 million carriers in the world. There are still millions of children
dying of malaria every year in Africa.
Except for the genetic genes that
determine the innate immunity to some Plasmodium and the infants in high malaria
areas can obtain certain resistance from the mother, the population is
generally susceptible to Plasmodium.
In endemic areas, adults are more likely
to have repeated infections, and they can be infected with worms, while those
who are susceptible are mainly children.
Pregnant women have special
physiological functions, low immunity and susceptibility to malaria.
In
addition, non-immunized non-immunized populations who enter the malaria area
are also susceptible and can cause malaria outbreaks.
Author's Bio
 |
| Dr. Shawna Reason |
Education: MBBS, MD
Occupation: Medical Doctor / Virologist
Specialization: Medical Science, Micro Biology / Virology, Natural Treatment
Experience: 15 Years as a Medical Practitioner
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