Malaria is a group vector-borne diseases which are transmitted by the bite of a malarial mosquito. The disease is widespread in Africa and the Caucasus countries. Children under 5 years of age are most susceptible to the disease. More than 1 million deaths are recorded every year. But, with timely treatment, the disease proceeds without serious complications.
Etiology
There are three ways of contracting tropical malaria:
- transmission type(through the bite of a malarial mosquito);
- parenteral(through unprocessed medical supplies);
- transplacental(mixed type).
The first route of infection is the most common.
General symptoms
The first and most sure sign of infection with the disease is fever. It begins as soon as the malaria pathogen has entered and reached critical level. In general, the symptoms of malaria are:
- periodic fever;
- significant enlargement of the spleen;
- Possible liver hardening.
The general list may be supplemented with other signs, depending on the period of development and form of the disease.
Forms of malaria
IN modern medicine the disease is classified into four forms:
- three-day form;
- four-day;
- tropical infectious form;
- ovale malaria.
Each of these forms has its own characteristic, pronounced symptoms and requires an individual course of treatment.
Three-day form
Three-day malaria has a very favorable prognosis compared to other forms of the disease. Incubation period can last from 2 to 8 months from the moment of the mosquito bite.
The symptoms of malaria of this subform correspond to the list described above. In the absence of correct treatment or if the immune system is too weakened, complications in the form of nephritis or malarial hepatitis may occur. In the most difficult clinical cases Peripheral nephritis may develop. But in general, three-day malaria occurs without significant complications.
Quartan
Just like three-day malaria, with correct and timely treatment it proceeds without significant complications. General symptoms diseases can be supplemented by the following symptoms:
- daily fever;
- increase internal organs practically not observed.
It is worth noting that attacks of fever can be easily stopped if antimalarial drugs are used in a timely manner. However, relapse of the disease can occur even after 10–15 years.
In rare cases, a complication may develop in the form of renal failure.
Ovale malaria
In its symptoms and course, this form is similar to the three-day form of the disease. The incubation period can last on average up to 11 days.
Tropical malaria
Tropical malaria is the most common form of the disease. Harbingers of the development of the disease may be the following:
- sharp elevated temperature;
- chills;
- weakness, malaise;
- muscle pain.
Unlike three-day malaria, this form of pathology is characterized by a severe course. Without appropriate treatment, even death. The virus is transmitted from a sick person to a healthy person, or through a mosquito bite.
Periods of disease development
Since the disease is classified as a polycyclic infectious disease, its course is usually divided into four periods:
- latent (incubation period);
- primary acute period;
- secondary period;
- relapse of infection.
Clinical picture of periods
The initial period, that is, the incubation period, practically does not manifest itself at all. As the patient progresses to the acute stage, the following signs of the disease may appear:
- a sharp change from a period of chills to fever;
- increased sweating;
- partial cyanosis of the extremities;
- rapid pulse, heavy breathing.
At the end of the attack, the patient’s temperature can rise to 40 degrees, the skin becomes dry and red. In some cases there may be a violation mental state- a person is either in an excited state or falls into unconsciousness. Convulsions may occur.
During the transition to the secondary period of development of the pathology, the patient calms down, his condition improves somewhat, and he can sleep peacefully. This condition is observed until the next attack of fever. It is worth noting that each attack and the development of a new period of the disease is accompanied by profuse sweating.
Against the background of such attacks, an enlarged condition of the liver or spleen is observed. In general, the incubation period includes up to 10–12 such typical attacks. After this, the symptoms become less pronounced and the secondary period of the disease begins.
Without treatment, relapse almost always occurs and death cannot be ruled out.
Diagnostics
Diagnosis of this disease is not particularly difficult, due to its specific symptoms. To clarify the diagnosis and prescribe the correct course of treatment, laboratory analysis blood (allows you to identify the pathogen).
With timely treatment, malaria proceeds without significant complications. In this case, any traditional methods or dubious pills purchased independently from a pharmacy are unacceptable. Delay can result not only in relapse of the disease and complications in the form of other diseases, but also in death.
The most effective is drug treatment. In this case, the patient must be hospitalized, since treatment should be carried out only inpatiently and under the constant supervision of medical specialists.
At initial period, as a rule, they get by with just tablets. The most commonly used is Hingamin. The doctor calculates the dosage and frequency of administration individually based on general condition health, weight and age of the patient.
If you didn't bring the pills desired result, and the condition of the infected patient has not improved, drugs are prescribed that are administered intravenously.
Other tablets based on artemisinin can also be used to treat the disease. But drugs based on this substance are very expensive, so clinical practice they did not find a cure for malaria infection wide application. However, such tablets are most effective for treating even late stages development of the pathological process.
Possible complications
Unfortunately, malaria in any form can affect the condition of any organ or system in the human body. The disease most often affects the liver, spleen and cardiovascular system. Also, against the background of malaria, diseases of the nervous system, genitourinary and vascular systems can occur.
As shown medical practice, the disease is most difficult and fatal in southern countries where there is no access to good drugs. Cheap pills can only temporarily stop attacks, but the infectious agent does not die from this. As a consequence of this, the transition to the last period of development of the disease begins and death occurs.
Prevention
Prevention of malaria requires taking special tablets. You should start taking them 2 weeks before your intended departure to the risk zone. An infectious disease doctor can prescribe them. It is worth continuing to take the prescribed pills after arrival (for 1–2 weeks).
In addition, to prevent the spread of infection in countries where the disease is not uncommon, measures are being taken to destroy malaria mosquitoes. The windows of the buildings are protected by special nets.
If you are planning to go to such a dangerous zone, you should get special protective clothing and do not forget to take preventive pills.
Such preventive measures almost completely eliminate infection of this dangerous disease. If you experience at least a few of the symptoms described above, you should immediately contact an infectious disease specialist. Timely treatment will allow you to almost completely get rid of the disease and prevent the development of complications.
Called infection resulting from a mosquito bite. Signs of malaria in adults manifest themselves in the form of prolonged fever, and the disease is often accompanied by relapses.
This disease has spread throughout the world, but places with a humid climate are most often susceptible to infection. Such conditions are favorable for malaria mosquitoes; here they can reproduce much faster.
Residents of African countries especially often suffer from this disease. According to world statistics, the disease annually claimed the lives of more than 200 million people.
However, through intensified control starting in 2000, rates have now improved and deaths have been halved.
How to identify the disease? It is necessary to know how Plasmodium falciparum manifests itself in an adult.
The causative agents of the disease are the protozoa Plasmodium. They get to a person after being bitten by a mosquito, the female of which injects them into the blood. The incubation period varies, until the first manifestations. A person may not feel any discomfort, therefore, do not consult a doctor.
Depending on the type of sporozoites, the length of the incubation period varies:
- From 10 to 21 days, with slow development, for 1 year. This type is called three-day malaria;
- 11-16 days, with a slow course of the disease, more than 1 year, this variety is called malaria ovale;
- 25-42 days, development of four-day malaria occurs;
- Tropical malaria develops within 10-20 days.
The first symptoms of malaria after a mosquito bite are observed: headaches, joint pain, chills. Most often, this condition lasts more than 3 days.
Features of the course of the disease:
- At tertian malaria short-term attacks occur, mainly during the day or morning;
- With malaria oval, attacks are observed in the afternoon. The disease proceeds without visible complications;
- With four-day malaria, relapses rarely occur;
- With tropical malaria, a strong fever occurs, the patient feels weak, and in the absence of timely help, leads to death. Seizures occur frequently.
Typically, malaria mosquitoes are active at night. In areas prone to this disease, the epidemic begins during periods of prolonged rain.
At-risk groups
There are several factors that influence infection:
- insect lifespan;
- external environment;
- human immunity.
People living locally at high risk develop immunity to the disease over the years. That is why children under 5 years of age are most often susceptible to infection.
People who move from another region are also more likely to contract malaria. Then the risk increases fatal outcome diseases.
Patients infected with malaria can pose a danger to others, so they must be isolated from society during treatment. Humans also run the risk of becoming a source of infection for mosquitoes.
Thus, having become infected while traveling in one region, a patient can easily spread the disease to another region upon returning.
How to diagnose the disease
The main reasons for diagnosis are attacks that recur every 48 or 72 hours. The liver enlarges, jaundice and sclerosis appear.
Sometimes these signs are not enough to make a diagnosis because the symptoms are similar to other infectious diseases.
Signs of tropical malaria can be confused with diseases of the central nervous system.
To do this, it is necessary to find out whether the patient has had similar problems before.
General blood test of the patient:
- hemoglobin is below normal;
- red blood cells are below normal;
- leukocytes are exceeded;
- platelets are higher than normal.
Analyzing data on diagnoses made at the first symptoms of malaria, doctors most often diagnosed ARVI, influenza, and meningitis. This simplifies the procedure, and is sometimes done to hide the fact that the patient was in the area of the disease epidemic.
Taking tests
Of fundamental importance laboratory diagnostics. The main method is to test the patient's blood. For analysis it is necessary blood from finger.
The core of plasmodium acquires a dark red color. For any form of the disease, except tropical malaria, a blood test can detect all stages of the development of plasmodium.
In addition, a general Analysis of urine. For detection hidden blood and urobilin, which increases with disease.
Based on the results of all studies, it is possible to determine what type of symptoms are observed, which will help select treatment.
Symptoms
Each of the 4 forms of the disease has its own characteristics, but the symptoms are common: febrile attacks; anemia, enlarged spleen.
During the course of the disease, several periods are observed:
- primary, hidden;
- primary manifestations of symptoms;
- hidden secondary period;
- period of complications.
Towards the end of the incubation period, the first symptoms begin to appear in the form of chills and pain.
Periods of the disease
The acute period is the most difficult. Now the patient has an increase in body temperature, but at the same time he is freezing, arterial pressure exceeds the norm, the pulse rate increases. Depending on the form of the disease, this condition can last up to 3 hours.
This is followed by a febrile period when the body temperature reaches 40 °C. The face becomes red, the patient feels hot. In this state, patients experience anxiety and their consciousness becomes confused. Headaches intensify, and in some cases, seizures occur.
At the end of this period it appears copious discharge sweat, body temperature decreases, the person begins to fall asleep. The attacks will be repeated in accordance with the frequency corresponding to the type of disease.
It is necessary to carefully monitor emerging symptoms, because malarial plasmodium has a destructive effect on all body systems, but most negatively on nervous system, genitourinary, cardiovascular.
Consequences
At improper treatment The disease may relapse after some time.
The following complications are observed:
- coma;
- severe swelling;
- profuse hemorrhage;
- neurological disorders;
- liver and kidney pathologies;
- rupture of the spleen.
During attacks, some patients experience a decrease in the amount of urine produced, leading to kidney failure and death.
Treatment and prevention for adults
The latest treatment methods help fight the disease even in its most advanced forms.
IMPORTANT! Drug treatment should be carried out immediately after diagnosis of the disease, in a hospital setting.
Treatment has the following goals:
Depending on the form of malaria, symptoms and treatment will differ. Medicines used in therapy:
- quinine;
- tetracycline antibiotics;
- biguanides;
- lincosamides.
Patients need daily care and a special diet. It is necessary to include boiled vegetables and fresh fruits in the diet.
Summary
The risk of getting this disease exists not only in Africa, but also in some countries in Asia and Latin America.
Susceptible to infection:
- Women during pregnancy. If infected, there is a risk of miscarriage, as well as death of the mother and fetus;
- HIV – infected and sick with AIDS;
- People who are not immune to the disease.
The most effective measures to combat the disease is the destruction of malaria mosquitoes. Indoors must be sprayed special means, and also install a mosquito net on the windows.
In addition, before going outside, it is advisable to lubricate the skin with a protective cream. If possible, avoid wearing revealing clothing.
In contact with
Unlike the so-called "benign" clinical forms malaria caused by Pl. vivax, Pl. ovale and Pl. malaria, tropical malaria(the causative agent is Pl. falciparum) is considered a potentially fatal infection and therefore almost always requires emergency medical care, especially with complications, that is, malignant variants.
The causative agent of malaria
The causative agent of malaria is Plasmodium falciparum are the simplest microorganisms studied by protozoology.
Pathogenesis
Clinically, the symptoms of tropical malaria in non-immune people are characterized by a combination of fever, hemolytic anemia, enlarged spleen and liver, severe intoxication and symptoms of damage to other organs.
The incubation period for primary tropical malaria usually lasts 10-14 days. In the initial period of the disease, symptoms of intoxication are expressed in the form of chills, significant headache, myalgia and arthralgia. A sudden fever becomes permanent or remitting in nature and only after 2-5 days in some patients it becomes typical intermittent with periods of apyrexia and low-grade fever on the same day. In some patients, classic malarial paroxysms can occur daily, and in some patients they do not develop at all and the fever remains remitting or subcontinuous.
Malarial paroxysms in tropical malaria are characterized by the triad of “chills-fever-sweats”, but the severity of each component may be different, unlike other etiological forms. During an attack, the symptoms of general intoxication are most pronounced. Patients are restless, excited, sometimes with confused consciousness. Herpetic rash, pain in the right hypochondrium, lower back pain and anemia appear early and often. The spleen and later the liver enlarge. Jaundice and toxic kidney syndrome appear.
Some patients with tropical malaria have a cough with signs of bronchitis and even bronchopneumonia or.
There may be abdominal syndrome:
- anorexia,
- abdominal pain,
- nausea,
- vomit,
Complications
In the absence of adequate therapy at various times from the onset of the disease (even on days 2-3), tropical malaria in non-immune people acquires a malignant course and complications develop, life-threatening sick.
At the core possible complications There may be the following pathophysiological syndromes:
- swelling of the brain and lungs,
- acute renal failure,
- acute intravascular hemolysis,
- hemorrhagic syndrome,
- acute adrenal insufficiency,
- overhydration,
- toxic effects of specific drugs...
Clinically, in patients with tropical malaria, a malignant attack can manifest itself:
- malarial coma (cerebral malaria);
- acute intravascular hemolysis;
- acute renal failure(acute tubular necrosis, immune complex nephritis),
- hypoglycemia;
- pulmonary edema (excessive fluid administration);
- hemoglobinuric fever.
Laboratory diagnosis of the disease consists of detecting plasmodia in the patient’s blood by microscopy.
Treatment: injections and tablets for malaria
The drug of choice for the treatment of patients with malarial coma and severe forms of tropical malaria is dihydrochloride tablets and its analogues, as well as forms of the drug in the form of solutions.
Also, if it is not possible to give the patient anti-malaria tablets, an alternative drug, chloroquine, is used for parenteral administration. The drugs are administered parenterally until vomiting stops and the patient exits the unconsciousness taking into account the duration of the drug, one-time and daily dose. The drugs are administered in a 5% glucose solution. Infusions are repeated every 4-6 hours. The volume of injected fluid should not exceed 2-3 liters per day and strictly correspond to the amount of injected fluid. When treating patients with malarial coma, it is necessary to provide oxygen therapy, combat toxicosis, cerebral hypertension, cerebral edema and possible renal failure. A study of it is mandatory if a malarial coma is suspected.
Anemia, hepatomegaly and splenomegaly.
Malaria is transmitted through the bites of female malaria mosquitoes (Anopheles).
Other names of the disease- swamp fever, intermittent fever.
Malarial plasmodium (most often Plasmodium falciparum), when it enters the body, attaches to red blood cells and tissue macrophages (protective immune cells), then, spreading throughout the body, causing a number of pathologies in various organs. The end result of malaria can be death for the infected person.
The largest number of registered cases of malaria infection are located in the countries of Africa (closer to the equator, i.e. below the Sahara), Southeast Asia, Central and South America, and Oceania.
The peak incidence of malaria occurs during the most active period of mosquitoes - summer-autumn.
Pathogenesis (disease development)
The pathogenesis of malaria largely depends on the method of infection.
Thus, with a direct bite of a malarial mosquito, plasmodium sporozoites with its saliva, through the bloodstream, enter the liver cells, where they settle, develop, turning into tissue schizonts, then grow and divide many times (the process of reproduction, or schizogony). Next, the cytoplasm is distributed around the new nuclei and an “army” of tissue merozoites (motile spores of Plasmodium) is formed. The entire development cycle of plasmodium in liver cells is called tissue schizogony. Afterwards, the malaria pathogen partially remains in the liver, and partially penetrates into red blood cells, spreading through the bloodstream to other organs and systems, where the process of development and reproduction also begins.
With direct infection with malarial plasmodium - through injections, blood transfusions, etc., the pathogen immediately penetrates into red blood cells and spreads throughout the body (erythrocyte phase of schizogony).
With tissue schizogony, there are practically no clinical manifestations, while with erythrocyte schizogony, the patient almost immediately shows signs of blood damage - fever and others.
Fever in malaria develops as a result of the reaction of the immune system and the heat-regulating center to the appearance in the body of substances, the appearance of which is caused by the disintegration of merozoite morulae. These are malarial pigment, hemoglobin, remnants of red blood cells, etc. The severity of fever depends on the degree of infection and the reactivity of the body's defenses.
The frequency of fever attacks is determined by periods of erythrocyte schizogony (the cycle of development and division of malarial plasmodia).
The presence of foreign substances circulating in the blood causes irritation reticular cells liver, spleen, kidneys and other organs, which leads to hyperplasia of these organs, resulting in the growth connective tissue, an increase in the size of the affected organs and their pain.
Anemia in malaria is caused by the breakdown of red blood cells against the background of erythrocyte schizogony, hemolysis during the formation of autoantibodies, as well as increased phagocytosis of red blood cells of the reticuloendothelial system of the spleen.
Relapses of malaria are caused by a decrease in the reactivity of the immune system in the presence of remnants of erythrocyte schizonts, which is why the pathogen begins to multiply again. Relapses may be present even 6-14 months after completion clinical manifestations malaria.
An interesting point that scientists came to during experiments on mice is that when the body is infected with malarial plasmodium, the body odor of the “victim” mosquito changes, which in turn attracts even more mosquitoes.
Statistics
According to WHO statistics, as of 2016, 216,000,000 cases of malaria were registered in the world, and this figure is 5,000,000 more than in 2015. The number of deaths from of this disease in 2016 it was 445,000. However, the mortality rate since the beginning of the 21st century has decreased by 47-54%, depending on the region.
If we talk about regions, then 90% of all cases of malaria occur in African countries, especially below the Sahara Desert.
Children under 5 years of age are most affected.
Malaria - ICD
ICD-10: B50 - B54;
ICD-9: 084.
The symptoms of malaria depend on the method of infection, the reactivity of the body's defenses and the degree of damage.
Other types of malaria infection are transplacental (during pregnancy - from mother to baby), parenteral (during transfusions of donor infected blood) and contact-household (during injections, cuts - an extremely rare occurrence).
In total, about 400 species of Anopheles mosquitoes are known, of which only about 30 are carriers of malaria infection.
Malaria mosquitoes live almost all over the globe, with the exception of cold or arid zones. A particularly large number of them live in areas with a warm and humid climate - Central and Southern Africa (about 90% of all malaria cases), Central and South America, Southeast Asia, Oceania.
On the territory of Russia, malaria zones include: European part countries – South-Eastern regions.
Types of malaria
Malaria is classified as follows:
Depending on the pathogen:
Ovale malaria– characterized by a paroxysmal cyclic course with an increase and decrease in the clinical manifestations of the disease, the period of the full cycle of which is 2 days. The causative agent is Plasmodium ovale.
Three-day malaria– characterized by a paroxysmal cyclic course with an increase and decrease in the clinical manifestations of the disease, the period of the full cycle of which is 3 days. The causative agent is Plasmodium vivax.
Quartan– characterized by a paroxysmal cyclic course with an increase and decrease in the clinical manifestations of the disease, the period of the full cycle of which is 4 days. The causative agent is Plasmodium malariae.
Tropical malaria– the most severe form of malaria caused by Plasmodium falciparum. A similar course of malaria can be provoked by another plasmodium pathogenic for humans - Plasmodium knowlesi. Characterized by the absence of tissue schizogony, i.e. accumulation and reproduction of plasmodium in the liver - development occurs in the blood (erythrocyte schizogony).
By method of infection:
Schizont malaria– infection of the body occurs when the blood is infected with ready-made (formed) schizonts. Characterized by early clinical manifestations of malaria.
Diagnosis of malaria
Diagnosis of malaria includes following methods examinations:
Treatment of malaria
How to treat malaria? Treatment of malaria is aimed at stopping the infection, maintaining the body and minimizing the clinical manifestations of the disease. The main method of therapy is medication, using antimicrobial agents. medicines.
1. Antimicrobial therapy (essential drugs for malaria)
Basic medicines for the relief of malaria, they are produced on the basis of quinine (an alkaloid found in the bark of the cinchona tree), chloroquinone (a derivative of 4-aminoquinoline), artemisinin (an extract of the wormwood plant - Artemisia annua) and its synthetic analogues.
The difficulty in treatment lies in the ability of malarial plasmodium to mutate and acquire resistance to one or another antimalarial drug, therefore the choice of drug is made on the basis of diagnosis, and in case of mutation, the drug is changed. It is also worth noting that many antimalarial drugs are not registered in the Russian Federation.
Essential medicines for malaria– quinine (“Quinine hydrochloride”, “Quinine sulfate”), chloroquine (“Delagil”), cotrifazide, mefloquine (“Mefloquine”, “Lariam”), proguanil (“Savarin”), doxycycline (“Doxycycline”, “Doxilan” ), and combination drugs- atovaquone/proguanil (“Malaron”, “Malanil”), artemether/lumefantrine (“Coartem”, “Riamet”), sulfadoxine/pyrimethamine (“Fansidar”).
Separation of antimalarial drugs depending on the phase of the disease (localization of plasmodium):
Histoschizotropic - affect mainly tissue forms of infection (in the presence of plasmodium in liver cells, active ingredients): quinopide, primaquine.
Hematoschizotropic - act mainly on erythrocyte forms of infection (active ingredients): quinine, chloroquine, amodiaquine, halofantrine, pyrimethamine, mefloquine, lumefantrine, sulfadoxine, clindamycin, doxycycline, artemisinin.
Gametotropic - act mainly on gametes: quinocide, quinine, hydroxychloroquine, primaquine, pyrimethamine. This group drugs are used mainly for tropical malaria.
2. Symptomatic therapy
If the patient is in a coma, he is turned on his side to avoid suffocation when vomiting vomit.
With persistent high temperature At 38.5 °C and above, compresses and – “ ”, “ ”, “ ” are used. Acetylsalicylic acid contraindicated.
In case of water balance disturbances, rehydration therapy is carried out with caution.
If the hematocrit decreases below 20%, blood transfusions are prescribed.
To maintain liver health, including due to the use of antimicrobial drugs, the doctor may prescribe hepatoprotectors - “Phosphogliv”, “”, “Liv 52”.
The choice of other drugs depends on the complications and syndromes associated with malaria.
Treatment of malaria with folk remedies
Treatment of malaria at home is not recommended, which is associated with the high mortality rate from this disease in the absence of timely antimicrobial therapy.
Prevention of malaria includes:
- Destruction of mosquitoes in places of residence, use of insecticides (for example DDT -ethane).
- Installation of anti-mosquito protective equipment in homes - nets, mosquito traps and others, the effectiveness especially increases if the mosquito net is treated with an insecticide.
- Application of mosquito repellents.
- Refusal to travel to malaria-endemic countries - Central and Southern Africa, Central and South America, South-West Asia, Oceania.
- The use of certain antimicrobial drugs that may be included in the course of treatment for infection with Plasmodium falciparum - primaquine, quinacrine, mefloquine (Lariam), artesunate/amodiaquine. However, if a person still gets malaria, the drug used for prevention can no longer be used. In addition, these drugs have a number of side effects. The prophylactic drug should be taken 1 week before traveling to an endemic area and up to 1 month after the trip.
- Experimental (as of 2017) vaccinations are PfSPZ (which applies to Plasmodium falciparum), as well as Mosquirix™, “RTS,S/AS01”.
- Some scientists are now developing genetic modifications of mosquitoes that are resistant to malaria.
- Immunity against malaria infection develops slowly and, according to doctors, practically does not protect against re-infection with malaria.
Which doctor should I contact?
- Immunologist
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