What is Malaria?
Malaria
is a infectious disease transmitted
by female mosquito, it is responsible
for a good percentage of tropical febrile illnesses. Malaria as a disease has
been around for a long time, ancient scrolls from china and the Roman Empire describe
a disease with similar features as malaria. Malaria as a word originates from
medieval Italian words – mala aria “bad air” as the romans thought that breathing
in bad air transmitted malaria. This is
because people living in swamps and mashlands were afflicted more with the
disease. The romans were not right but were not exactly wrong.
How
is it transmitted?
As
stated earlier, malaria is transmitted by the bite of the female anopheles mosquito, which introduces the
malaria parasite into the blood stream of its victim. In the blood stream the
parasite (Plasmodium. sp) travels to
and infects various organs in the body. Once present in these organs the
parasites replicates and releases its progeny in a cyclical fashion that is
responsible for the fever, which characterizes this disease. There are about 5
different species of Plasmodium, which affect humans: P. vivax, P.malariae, P. ovale, P. faliciparum and P. knowlesi (a
zoonotic specie). These parasites have their different geographical
distributions, disease severity and/or presentation. In Africa and by extension
Nigeria there is a predominance of P.
falciparum infection. The vector (anopheles mosquito) breeds in stagnant
water, which provides a habitat for its eggs. Tropical countries with its increase
rainfalls and warm climates provide the ideal background for the vectors and as
such the parasite.
What
are the signs of malaria infections?
Following
infection by the parasite, it travels in the blood stream and infects several
organs depending on its tropism. Symptoms begin to appear 8-25 days following
infections and are dependent on the affected organ. Infection of the blood
(mostly the red blood cells) produces the cyclical fever, which results when
infected red cells rupture and release its components. Similarly the rupture of
the red cells will reduce their numbers and cause anemia (low red blood
volume). Infection of the gastro-intestinal tracts (stomach and intestines)
will cause either a diarrhea or constipation. Musculoskeletal infection causes
bone and joint pain, nervous system infections – convulsions and headaches.
Infections of the liver may lead to jaundice (yellow discolorations of the
eyes). Not all the described symptoms will be present in all infected people;
symptoms are dependent on the specie of the parasite and the competence of host
immune system.
How
to I confirm if I have malaria.
The
diagnosis of malaria could be clinical (from symptoms) and/or laboratory based.
For patents living in or recently visiting malaria endemic counties in the
tropics a febrile illness should immediately suggest malaria. In as much as
there are other causes of fever, the multi organ infection pattern of malaria
makes it difficult to clearly distinguish it from other fever causing illness.
There are several laboratory tests for the diagnosis of malaria, which ranges
from the simple to the complex. The availability of test is dependent on the
skill and resources available at the health institution. Simple tests like the
observation of malaria parasite (plasmodium) in the red blood cells could
quickly identify infected persons. Recently there has been an introduction of
rapid tests, which detects parasite proteins in the blood. Despite these tests
there are still some caveats, in the tropics a good percentage of individuals
will have a low level infection of the parasite without any clinical
manifestation. As such the detection of the parasite without a corresponding
clinical history may be seen. For these patients careful history taking and
examination often yields other sources of infection other than the malaria
parasite.
How
do I treat malaria?
Treatment
of malaria has generated a lot of interest due to the “resistance” of the
parasite to drugs over time. Presently, Artemisinin (also know as Qinghaosu- a Chinese herb extract) in combination with
other antimalarial have been suggested by the WHO as the standard treatment.
Treatment is also dependent on the severity and pregnancy. If you do suspect
you have malaria visit your nearest hospital for the treatment specific to you.
"I don’t want to ever get malaria"
It is difficult to completely eradicate
malaria in tropical regions not only due to economic reasons but also due to
physical factors present in the environment. Apart from moving to tropical regions
to prevent malaria infection there are other possible interventions, which may
reduce an individual’s susceptibility to malaria infection. These include
physical (sanitation, mosquito nets, insecticides), chemical (antimalarial
prophylactic medications), and biological (vector control). The WHO believes
that the use of insecticide treated nets is pivotal to the reduction of malaria
infection in tropics.
"I keep on treating my malaria every few weeks?"
Symptoms of malaria may re-appear after a
brief symptom free period depending on its timing it may be classified as a recrudescence,
relapse or a reinfection. A recrudescence occurs within a short
time following past infection and it is usually due to parasites surviving in
the blood as a result of inadequate or ineffective treatment.
Inadequate treatment may be due to short duration of treatment or the use of
mono therapy instead of the advised combination therapy. Also, the most common
cause of ineffective treatment is use of fake or substandard medications that
do not provide appropriate or optimal drug type or doses to infected
sites. Patients experiencing
recrudescence malaria should visit health facilities for appropriate treatment.
Also, it is pertinent we all contribute to reducing the scourge of fake and
adulterated medicine by providing information to appropriate government
agencies for investigation.
Certain strains of plasmodium (P. ovale
and P. vivax) could lay dormant in the liver and cause a relapse of
malaria 8 – 24 weeks after the index infection. The diagnosis of this is
clinical and affected individuals are provided with appropriate treatment when
this is discovered. Finally due to its endemic nature in the tropic,
susceptible individuals who to don take preventive strategies following index
infection can also are re-infected by the parasite. However, it is
pertinent to mention that recurrent febrile infection, which fails to respond
to appropriate anti-malaria may suggest, missed diagnosis of another febrile
infection. As such it is always important to consult with health practitioners
before onset of antimalarial treatment.
Conclusions
Malaria is an important disease with huge
economic impact on the lives of tropical people. Appropriate treatment and
preventions strategies will aid in the reduction of its prevalence. Recurrent
malaria should be investigated and managed depending on the findings.
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