Malaria

Malaria is a severe mosquito-borne disease that poses a significant global health threat, mainly in tropical & subtropical regions. Malaria has an impact on individuals, families, and communities, causing symptoms ranging from mild fever to life-threatening complications. Understanding what malaria is, its symptoms, and how to prevent it is crucial for everyone, especially those living in or travelling to high-risk areas.

What is Malaria?

Malaria is a life-threatening infectious disease. It is caused by parasites transmitted to human bodies through the bites of infected female Anopheles mosquitoes. This serious illness affects millions worldwide, particularly in tropical and subtropical regions.

Malaria symptoms appear 10-15 days after the infective bite, starting with fever, headache, and chills. If left untreated, P. falciparum malaria can progress to severe illness within 24 hours, leading to complications such as severe anaemia, respiratory distress, and cerebral malaria.

Types of Malaria

Five species of Plasmodium parasite cause malaria in humans, with P. falciparum and P. vivax posing the most significant danger. P. falciparum is the deadliest form and is most prevalent in Africa, while P. vivax dominates in most countries outside sub-Saharan Africa.

Plasmodium ovale and Plasmodium malariae have a wider distribution but cause less frequent infections. Plasmodium knowlesi is a recently identified human pathogen and is found in Southeast Asia.

Each species has unique characteristics, such as geographical distribution, severity of symptoms, and ability to remain dormant in the liver. Understanding these types of malaria is crucial for effective diagnosis, treatment, and prevention strategies worldwide.

Symptoms of Malaria

Malaria typically manifests with flu-like symptoms, usually 10-15 days after an infected mosquito bite. Some people may experience cycles of malaria symptoms with periods of no symptoms. The most common early signs and symptoms are: 

• Fever
• Headache
• Chills
• Sweating
• Fatigue
• Chest pain
• Breathing problems
• Cough
• Diarrhoea
• Nausea and vomiting

As the disease progresses, it can result in anaemia and jaundice. The most severe form, cerebral malaria, may lead to coma and has an impact on mortality rates in both children and adults.

Causes of Malaria Disease

Malaria impacts millions of people worldwide and is caused by parasites of the Plasmodium genus. These parasites are transmitted to humans through the infected female Anopheles mosquito bites. The malaria parasite's life cycle involves two hosts: humans and mosquitoes. When an infected mosquito bites an individual, it injects sporozoites into the blood circulation. These sporozoites go to the liver, where they mature and multiply. The parasites then enter the bloodstream, infecting red blood cells (RBCs) and causing the symptoms of malaria. Some parasites develop into gametocytes, which mosquitoes can ingest during a blood meal, perpetuating the cycle. Understanding this complex life cycle is crucial to developing effective prevention and control of malaria strategies.

Risk Factors

Several factors have an impact on the likelihood of contracting malaria, such as:

• Living in or visiting tropical and subtropical regions, particularly South and Southeast Asia, sub-Saharan Africa, and Central and South America, poses the most significant risk. The degree of risk depends on local malaria control efforts, seasonal changes in malaria rates, and personal precautions taken to prevent mosquito bites. 
• Young children, infants, older adults, travellers from non-malaria areas, and pregnant women face an increased risk of serious disease. 
• A pregnant woman can transfer malaria to her unborn child (congenital malaria).
• Environmental factors such as rainfall, humidity, temperature, and altitude influence malaria transmission. 
• Rarely, a blood transfusion infected with malaria directly releases parasites into the recipient's bloodstream, causing high-risk malaria complications.

Complications

Malaria has an impact on various organs, leading to severe complications, including:

• Cerebral malaria, the most common and deadly form, can cause seizures, coma, and brain damage.
• Breathing problems may arise due to pulmonary oedema, making breathing difficult.
• Organ failure, commonly affecting the kidneys and liver, poses a life-threatening risk.
• Severe anaemia often occurs, especially in children in highly endemic areas.
• Hypoglycaemia is a frequent complication, sometimes exacerbated by quinine treatment.
• Malaria in pregnancy can result in low birth weight and premature labour.
• There are a few malaria parasite varieties that can persist for years and relapse, which typically cause milder forms of malaria.
• Other complications include jaundice, acute respiratory distress syndrome, and disseminated intravascular coagulation. These complications can develop rapidly and may even lead to death within hours or days if left untreated.

Diagnosis of Malaria

Prompt diagnosis of malaria is crucial for effective management and strong surveillance.

• Blood Tests: Doctors typically use blood tests to check for signs of malaria parasites. The gold standard for diagnosis is a microscopic examination of blood films. This method involves spreading a blood sample on a slide, staining it, and examining it under a microscope. Thick blood smears help detect the presence of parasites, while thin smears aid in identifying the specific malaria species.
• Rapid Diagnostic Tests (RDTs): RDTs offer a quick alternative, providing results within 15-30 minutes. These tests detect specific malaria antigens in the blood. However, RDTs may not detect low-density infections, so microscopy remains essential for confirmation and determining parasite density.

Treatment of Malaria

The treatment of malaria disease mainly depends on the severity of the illness, the infecting species, and drug resistance patterns. Prompt treatment is essential, with hospitalisation often recommended for severe cases.

• Artemisinin-based Combination Therapies (ACTs): ACTs are the preferred treatment for uncomplicated falciparum malaria, combining an artemisinin derivative with a partner drug. These treatments have an impact on reducing parasite biomass quickly and ensuring high cure rates.
• Chloroquine Phosphate: For chloroquine-sensitive infections, chloroquine phosphate or hydroxychloroquine remains effective.

In cases of severe malaria, intravenous artesunate has become the recommended treatment, showing lower mortality rates compared to quinine.

Treatment should be tailored to the specific Plasmodium species and the patient's clinical status to ensure the most effective outcome.

When to See a Doctor

Seeking timely treatment from your doctor is crucial when dealing with malaria. If you experience fever after visiting or living in a high-risk malaria region, consult your doctor immediately. Malaria has an impact on health rapidly, potentially leading to severe complications within hours or days of initial symptoms. For those with severe symptoms, emergency medical care is essential.

Pregnant women should avoid travelling to malaria-prone areas due to increased risks. Even if you've returned from an endemic area and develop unexplained fever months later, consider malaria as a possibility. Remember, early diagnosis and treatment are vital to prevent the malaria infection from progressing to a life-threatening stage. Don't delay seeking help, as prompt action can make a significant difference in recovery.

Prevention

Preventing malaria has an impact on reducing its global burden.

Using insecticide-treated bed nets (ITNs) is highly effective, especially in endemic regions. These nets create a physical and chemical barrier against mosquitoes, reducing malaria illness and death rates. Long-lasting insecticidal nets (LLINs) have significantly decreased malaria cases. Other preventive measures include:

• Applying insect repellent containing DEET to exposed skin
• Wear long-sleeved clothing
• Use screens on windows and doors 
• Doctors generally recommend antimalarial drugs for travellers to malaria-prone areas. It's crucial to consult a doctor well before travel to determine the most suitable prevention strategy.

Conclusion

Malaria poses a significant threat to global health, affecting millions worldwide, particularly in tropical and subtropical regions. Understanding the different types of malaria, recognising its symptoms, and knowing the risk factors impact our ability to combat this serious disease effectively. Early diagnosis with prompt and correct treatment is crucial to prevent complications and reduce mortality rates.

Prevention remains a crucial focus in the fight against malaria. Using insecticide-treated bed nets, applying insect repellents, and taking appropriate antimalarial drugs when travelling to high-risk areas are essential to protect oneself. Public health initiatives and ongoing research continue to play an elementary role in reducing the global burden of malaria. By staying informed & taking necessary precautions, we can contribute to the worldwide effort to control and eventually eliminate this life-threatening disease.

FAQ's

1. Can malaria be cured?

Yes, malaria can be cured with proper treatment. Prompt diagnosis and appropriate medication are crucial for adequate recovery. Antimalarial drugs, such as artemisinin-based combination therapies, can eliminate the parasites from the body.

2. Is malaria a virus?

No, malaria is not a virus. The causative agent is protozoa of the genus Plasmodium, transmitted through the bites of infected female Anopheles mosquitoes.

3. What is the blood test for malaria?

The gold standard for diagnosing malaria is a microscopic examination of Giemsa-stained thick and thin blood smears. Rapid diagnostic tests (RDTs) can also detect malaria antigens quickly.

4. Can malaria recover by itself?

While some individuals may experience mild symptoms, malaria typically requires proper treatment to recover fully and prevent complications. Seeking medical attention is essential for effective management.

5. How many days does malaria last?

The duration of malaria varies and depends on the parasite species and treatment. With appropriate medication, symptoms can improve within a few days, but complete recovery may take up to two weeks.

6. What food to avoid in malaria?

During malaria treatment, it's advisable to avoid sugary and processed foods, high-fat and fried items, alcohol, and excessive caffeine. These can impact recovery and overall health.

Dr. Gandham Sneha

MBBS, DNB (Internal Medicine)
CARE Hospitals Outpatient Centre, Banjara Hills, Hyderabad

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