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What is Malaria Diagnosis Treatment and Prevention of Infection?


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.

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.
    Malaria Parasite Infection Details in Chart

    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.
    Diagnosing Malaria Virus and fever

    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 of malaria fever and virus

    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.
    Identification of Malaria and Tests

     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. 

    Treatment of Malaria

    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.


    Prevention of Malaria Disease

    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

    Doctor Shawna Reason, Virologist
    Dr. Shawna Reason
    Name: Shawna Reason

    Education: MBBS, MD

    Occupation: Medical Doctor / Virologist 

    Specialization: Medical Science, Micro Biology / Virology, Natural Treatment

    Experience: 15 Years as a Medical Practitioner

    About Me | Linkedin | Quora Profile | Medium Profile | Twitter



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