Malaria. Tropical malaria (causative agent, symptoms, treatment) Consequences of malaria in women

In a patient with malaria, the body temperature rises, he is very chilly. Sweating is very intense.

In developed countries with a temperate climate, this disease is rare. Cases of infection are recorded in the tropics and subtropics. And often the disease becomes the cause of death. Not only residents of these climatic zones can become infected, but also tourists. The leadership of states at risk directs efforts to combat the disease, but it is not possible to completely get rid of it. Malaria kills about 660,000 people every year. That is why it is so important to know the symptoms of malaria. This will allow you to start treatment on time and save a person's life.

Translated from Italian, malaria (mala aria) means "bad air". Previously, this disease was called swamp fever.

There are three possible routes of infection with tropical malaria:

Transmission type. Infection occurs during the bite of an Anopheles mosquito.

parenteral. The infection is transmitted through blood, during its transfusion or during transplantation of donor organs. There is also a risk of contracting malaria during surgery if the instruments used by the surgeon are infected.

Transplacental. The disease is transmitted to the child from the mother.

Malaria is a seasonal infection. Its outbreaks are recorded during the hot and humid season. People living in high-risk areas are regularly tested for malaria. When cases of the disease are detected, treatment is prescribed.

Although scientists know more than 4,000 species of protozoa of the order Coccidiida and the genus Plasmodium, it has been established that only five of them can become a spreader of malaria:

Depending on the period of malaria, there are:

primary infection.

Malaria in the period of early relapse (recurrence of symptoms occurs less than six months after the first case).

Distant relapses of malaria, which may be several.

Period of latent malaria.

Depending on the severity of the course of the disease, there are:

Mild malaria.

Malaria of moderate course.

Severe malaria.

Malaria of a malignant course.

Sometimes "malaria on the lips" is called the manifestation of a herpes infection (when infected). In fact, this name is incorrect, since it has nothing to do with malaria.

Plasmodium falciparum is detected faster than others, it makes itself felt on the 6-8th day. Longer than others does not cause symptoms of Plasmodium malariae disease. The incubation period stretches to 14-16 days.

When the prodromal period begins, the patient feels the first signs of infection. At this time, his general well-being worsens, chills may occur,. The average duration of the prodromal phase is 5 days.

Then malaria makes itself felt in full force. There is an acute stage of the disease. At this time, the body temperature rises greatly, a series of febrile attacks occur. Each of them can last from 3 to 10 hours. After that, the person becomes easier. The symptoms of the disease are on the decline.

Malaria is a common infection. The disease occurs in the West Indies, Mexico, Central America. The inhabitants of the northern regions of South America suffer from the infection, especially the population that lives in the Amazon Valley. For Africans, illness is also a problem. Cases of malaria are recorded among the inhabitants of the Red and Mediterranean Seas, in Ukraine and in the Balkans. Every year, data comes in about infected residents of Southeast Asia, India and northern Australia.

Distribution of malaria in the world, taking into account its resistance to drugs:

brown the map shows common strains.

Areas in which malaria strains are resistant to Chloroquine are marked in red.

light brown designated areas in which mosquitoes that spread non-lethal types of infection live.

Areas where malaria is not present at all are marked in gray.

Until 1950, mass outbreaks of malaria were recorded in the USSR. Moreover, not only the inhabitants of the Caucasus suffered from the infection, but also the population of Central Asia, Transcaucasia, and central Europe. The peak of malaria was observed in 1934-1935. At this time, 9 million cases of the disease were recorded. However, by 1960, malaria was completely eliminated.

Every year, 350-500 million people worldwide suffer from malaria. About 1.3-3 million people die from the disease. Approximately 90% of cases are residents of Africa, located south of the Sahara. Moreover, mainly children under 5 years of age are infected there.

After a person is bitten by a malaria mosquito, it takes about 2 days for the person to develop symptoms of the disease. If the immune system is active and strong, then this period can stretch up to 7 days.

According to the first symptoms, it is impossible to understand that a person develops malaria. They can characterize various diseases.

Early signs of infection include:

Fatigue and weakness.

Lack of desire to eat.

Headache. This symptom occurs only when infected with Plasmodium falciparum.

Violation of the digestive tract:, abdominal pain.

Sometimes blood impurities appear in the feces. This symptom also characterizes Plasmodium falciparum infection.

Muscle pain.

The typical symptoms of malaria occur later:

Cyclic fever. Periods last 3 or 4 days, or permanently.

Tremor of the limbs. It also occurs from time to time.

Joint pain. This feature characterizes Plasmodium falciparum.

Coma. The patient is unconscious, there are no reflexes.

To diagnose malaria, the following blood tests are performed:

Examination of a thick drop of blood.

Thin smear of blood. If the doctor detects changes characteristic of malaria in a thick drop, he prescribes this study. It allows you to clarify the type of pathogen and the stage of its development.

The methods of immunological research include:

Determination of proteins to Plasmodium falciparum. This method allows you to diagnose tropical malaria. It is often resorted to in those countries where the tropical form of the disease is widespread. A person can perform such a test even on their own. For its implementation, blood from a finger is required.

PCR or polymer chain reaction to malaria. For the study, blood is taken from a vein, or a thick drop of blood is taken from a finger. This method allows you to detect the causative agent of the disease. They resort to PCR to detect difficult-to-diagnose forms of malaria.

When the disease has just begun to develop, it can be confused with pneumonia, food poisoning, influenza, meningitis, etc. As the pathology progresses, the symptoms become more specific. However, differential diagnosis is carried out with diseases such as: yellow fever, viral hepatitis, leptospirosis, leukemia.

The main goals to be achieved in the course of malaria treatment are:

Getting rid of the complications of pathology.

Prevention of recurrence of the disease and relief of pathological symptoms.

Immunity boost.

Immediately after the diagnosis is made, the patient is hospitalized. Treatment is carried out only in the hospital.

Types of treatment:

Carrying out specific therapy. The patient is prescribed drugs that can destroy the causative agent of the disease.

Carrying out symptomatic therapy. It is necessary to stop the symptoms of the disease in the case when they have a vivid manifestation.

Compliance with patient care.

Antimalarial drugs

To cope with the infection, it is increasingly necessary to resort to combination therapy with the inclusion of artemisinin in the treatment regimen.

Artemether / lumefantrine (Artemether / lumefantrine). Trade name of the drug Coartem. In a number of countries it can be found under the brand name Riamet. The drug is used to treat an infection.

Artesunate / amodiaquine (Artesunate / amodiaquine)- used for prophylactic purposes.

Malaron - both for treatment and for prevention. Its other name is Malanil. The main active ingredient in this drug is Atovaquone/proguanil.

Quinine (Quinine). Used to treat sickness

Chloroquine (Chloroquine). Trade name of the drug Delagil. It is used for both therapeutic and prophylactic purposes.

Cotrifazid (Cotrifazid)- used to prevent and treat malaria.

Doxycycline (Doxycycline). Appoint with the preventive and therapeutic purpose.

Lariam containing mefloquine (Mefloquine) is used for prophylactic purposes, as well as for the treatment of malaria.

Savarin containing proguanil (Proguanil) is used only for treatment.

Primaquine (Primaquine) is used exclusively for prevention.

Fansidar containing the substances sulfadoxine / pyrimethamine (Sulfadoxine / pyrimethamine) is used both for the treatment of the disease and for prophylactic purposes.

In Russia, not all listed medicines are allowed for use.

If a case of malaria was registered on the territory of the Russian Federation, then the patient may be prescribed drugs such as:

• Plaquenil based on hydroxychloroquine.

  Lariam with mefloquine.

  Fansidar. It is a combination drug with pyrimethamine and sulfadoxine.

  Doxycycline, which is a broad spectrum antibiotic.

Such a causative agent of malaria as Plasmodium falciparum practically does not respond to drugs with chloroquine.

To prevent recurrence of the disease, all adult patients (with the exception of pregnant women and children with glucose-6-phosphate dehydrogenase deficiency), in addition to therapy with chloroquine or artemisinin, are additionally prescribed primaquine. The course should last 2 weeks.

Therapy of malaria in Russia is quite difficult. Not every medical institution has a specialist who can make a correct diagnosis. Even after malaria is confirmed, there may simply not be drugs to treat it in the country.

If, after treating malaria, after a while the condition begins to worsen again, you should consult a doctor.

A person who has had malaria cannot donate blood for 3 years. After this period, donation is possible, but medical personnel must be warned that such an infection was transferred 3 years ago.

Malaria during pregnancy

Pregnant women are seriously ill with malaria. This infection can cause miscarriage or early labor. If a woman in a position went on a trip to countries with a high risk of infection, or lives there, then efforts should be directed to the prevention of the disease.

If a pregnant woman has contracted malaria, she should seek medical attention as soon as possible. Most of the drugs designed to combat this infection do not harm the health of the child and do not affect his development.

Malaria for children is dangerous, as it has an aggressive course. If the child does not receive therapy, then he remains at a high risk of developing complications.

In children under 5 years of age, the disease does not lead to an increase in body temperature. Therefore, the body cannot cope with plasmodium on its own. This explains the high mortality rate among children.

Treatment of malaria in childhood is carried out according to the same scheme as in adults, but the dose of drugs is reduced.

Prevention of malaria

If a person goes on a trip to a country where malaria is “raging”, or lives in such states, you need to take care of preventive measures. Preparation should be taken seriously. It is not recommended to go to malaria pandemic countries for people with HIV, as well as children under 4 years old.

Before starting a trip, you need to find out from the country's embassy how things are with malaria in a specific period of time. This will allow you to take the necessary action.

Mosquito bite protection

The most reliable way to prevent the disease is to prevent mosquito bites.

It is impossible to protect yourself from insects by 100%, but recommendations such as:

Use of mosquito nets. They are installed in windows and doorways.

Use of network curtains. They need to be tucked into the mattress. In such a bed you can sleep without fear.

The use of repellents. These substances repel insects, but they cannot destroy them. Repellents are applied to clothing or skin. They are available in the form of sprays, aerosols, gels, creams, etc. You need to use such products in accordance with the available instructions.

The use of insecticides. These drugs allow you to destroy insects. They are available in the form of an aerosol. To kill mosquitoes, you need to spray them indoors, apply them to thresholds and mosquito nets. Half an hour after treatment, the room is ventilated.

Medical prevention of malaria

To prevent infection, you can take drugs that are used to treat the disease. However, when infected, an integrated approach is required. For prophylactic purposes, you can take Lariam, Quinine, Primakhin, Malarone, etc.

It must be remembered that these drugs are harmful to human health and have multiple side effects. They are taken 2 times a week, 14 days before the trip and 14 days after it.

Every person who arrives from a dangerous country in terms of infection must be examined. If an infection occurs, then within 3 years the patient will be registered with an infectious disease specialist.

It is impossible to find a malaria vaccine commercially. Scientists are making efforts to create it, but research has not yet been completed.

In 2017, it was announced that the drug had been developed. In the journal Nature, information appeared that the created vaccine is 100% effective. 67 volunteers took part in the tests. They received Sanaria PsfPZ-cv. Those who received the high dose developed immunity from malaria. He continued to act for 10 weeks after its introduction. The subjects did not develop any side effects. Experiments are being conducted in the African country of Gabon. Now the second stage of testing is underway. Doctors are studying how the vaccine will perform for several years after it is given.

Sanaria PsfPZ-cv is not the only effective vaccine against the disease. In 2018, WHO announced that it had started an experiment using the licensed Mosquirix vaccine. It is being researched in 3 African countries. The effectiveness of the drug is 50%, but its improvements continue.

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

Depending on the type of malaria, the presence or absence of complications of the disease, the stage of the development cycle of malarial plasmodium, the presence of resistance (resistance) to antimalarial drugs, individual etiotropic therapy regimens are developed from the presented antimalarial drugs.

A person with malaria needs constant and careful care, which will reduce suffering during attacks of fever. During the period of chills, it is necessary to cover the patient, you can put heating pads to your feet. During the heat, it is necessary to open the patient, remove the heating pads, but prevent hypothermia and drafts. With a headache, you can put a cold on the head. After profuse sweating, change underwear, give rest to the patient.

In the room where the patient is located, it is necessary to prevent mosquitoes from entering (using nets, insecticides) in order to prevent the spread of malaria.

When complications of malaria appear, the patient is transferred to a ward or intensive care unit.

Diet for malaria

• Interictal period- the diet is not prescribed, the common table number 15 with plenty of drink.
• During a fever – table number 13 with plenty of drink. Table number 13 provides for an increase in the body's defenses, nutrition should be frequent and fractional.

• low-fat varieties of fish and meat, low-fat broths,
• boiled eggs,
• dairy products,
• mashed rice, buckwheat and semolina porridge,
• boiled vegetables,
• stale wheat bread, croutons,
• grated soft fruits and berries,
• juices, fruit drinks, decoctions,
• honey, sugar.

Prevention of malaria

Mosquito bite protection

• Mosquito nets on windows and doorways, you can sleep under a curtain of mesh, tucking it under the mattress.
• Repellents- chemical compounds that repel mosquitoes, but do not kill them, which are applied to the skin or clothing of a person. There are various forms: creams, sprays, aerosols, gels, etc. They are used according to the instructions.
• Insecticides- Mosquito killers. It is recommended to treat rooms, nets, thresholds with an insecticide aerosol. Half an hour after treatment, it is necessary to ventilate the room.

Medical prevention of malaria

Drugs used to prevent malaria(Must start 1 week before travel and continue 4-6 weeks after arrival home) :

• Chloroquine (delagil) 0.5 g for adults and 5 mg / kg / day. children once a week.
• Hydroxychloroquine (plaquenil) 0.4 g for adults and 6.5 mg/kg for children once a week.
• Mefloquine (Lariam) 0.25 g for adults and 0.05 - 0.25 mg for children 1 time per week.
• Primakhin 30 mg for adults and 0.3 mg/kg for children 1 time in 48 hours.
• Proguanil (bigumal) 0.2g/day adults and 0.05-0.2 g for children.
• Primetamine (chloridine) 0.0125 g for adults and 0.0025 - 0.0125 g for children in combination with the drug dapsone 0.1 g for adults 1 time per week.

Identification and effective treatment of patients with malaria

Malaria vaccine

What is malaria on the lips and how does it manifest itself?

The stages of manifestation of herpes on the lips are:

• tingling;
• bubble formation;
• the formation of ulcers;
• scab formation;
• healing.

Bubble formation
At this stage, the inflammatory process begins to develop. The areas in which tingling was felt swell and small transparent bubbles form on their surface. Vesicles are located close to each other, forming small clusters. These formations are filled with a clear liquid, which, as they increase, becomes more cloudy. The pressure in the blisters increases and they become very painful. The place of localization of the bubbles is the upper or lower lip, as well as the area under the nose.

Ulcer formation
After 2 - 3 days, the bubbles with liquid begin to burst. During this period, the patient is most contagious, since the liquid contains a large number of viruses. An ulcer forms at the site of the burst vesicle.

Scab formation
At this stage, the ulcers begin to become covered with a brown crust. All affected areas are involved in the process, and within one day, dried scabs form at the site of the blisters. Bleeding wounds, itching or burning sensations may occur when the crust is removed.

Healing
Within 4 - 5 days, wounds heal and the skin is restored. In the process of falling off the scab of the patient, mild peeling and itching may disturb, which often provokes patients to peel off the crust of ulcers on their own. This leads to the fact that the healing process is delayed. Such interference can lead to the addition of a bacterial infection.

Common manifestations of herpes on the lips
Along with rashes in the area of ​​the lips, herpes simplex type 1 can be manifested by a deterioration in the general condition, weakness, and headache. Often, patients have enlarged lymph nodes located in the lower jaw. Body temperature may also rise, muscle pain develops, and salivation increases.

What are the types of malaria?

The types of malaria are:

• tropical malaria;
• three-day malaria;
• malaria oval;
• quartan.

The disease begins with the onset of fever, diffuse headache and myalgia ( severe muscle pain). After a couple of days, symptoms of a toxic syndrome appear - nausea, vomiting, low blood pressure. Tropical malaria is characterized by the appearance of a rash on the body ( allergic exanthema), coughing, feeling of suffocation. During the first week, hemolytic anemia develops, which is accompanied by the development of jaundice. Anemia develops due to increased destruction ( hemolysis - hence the name of anemia) erythrocytes. Enlargement of the liver and spleen is noted only in the second week, which greatly complicates the early diagnosis of malaria.

Many immunocompromised people may develop toxic shock, malarial coma, or acute renal failure as early as the first or second week of illness. Patients who develop malarial coma become lethargic, sleepy, and apathetic. After a few hours, consciousness becomes confused, inhibited, and convulsions may also appear. This condition is characterized by an unfavorable outcome.

Due to the massive destruction of red blood cells, acute renal failure most often develops. So, from the destroyed erythrocytes, hemoglobin enters first into the blood, and then into the urine. As a result, the processes of urination are disturbed in the kidneys and diuresis decreases ( daily urine). Due to oliguria, metabolic products that are normally excreted in the urine remain in the body. A condition called uremia develops.

Three day malaria
Three-day malaria refers to benign types of malarial invasion. As a rule, it is not accompanied by severe complications and does not lead to death.

Its beginning is preceded by a short prodromal period, which is absent in the tropical species. It manifests itself as weakness and pain in the muscles, after which a fever appears sharply. The difference between three-day malaria is that temperature rises occur every 48 hours, that is, every third day. Hence the name of this type of malaria. During the rise in temperature, patients are excited, breathing heavily, their skin is hot and dry. The heart rate is drastically increased ( up to 100 - 120 beats per minute), blood pressure falls, urinary retention develops. The phases of "chill", "heat" and "sweat" become more distinct. The average duration of an attack varies from 6 to 12 hours. After two or three episodes ( respectively on the 7th - 10th day) appears enlarged liver, spleen, develops jaundice.

However, it can also happen that bouts of fever occur every day. This phenomenon is due to the ingestion of several generations of malarial plasmodium into the blood at once. A few months after the disease, the patient may have periodic rises in temperature.

Malaria oval
This type of malaria is in many ways similar to three-day malaria, but it has a milder course. The difference between malaria oval is that fever attacks occur every other day. The temperature rises mainly in the evening hours, which is not typical for previous types of malaria.

Quartan
This type of malaria, like the previous one, refers to benign forms of malarial invasion. It develops acutely, without any prodromal phenomena. Fever attacks develop every 72 hours. The temperature rises to 39 - 40 degrees. During the attacks, the patient is also in a serious condition - the consciousness is confused, the skin is dry, the tongue is lined, blood pressure drops sharply.

In addition to the classic types of malaria, there is also a schizont type. It develops as a result of ready-made schizonts entering the human blood ( Plasmodium that have gone through an asexual developmental cycle). Schizontal malaria mainly develops as a result of blood transfusions or by the transplacental route. Therefore, this species is also called syringe or graft. Its difference is the absence of a phase of development of plasmodium in the liver, and the clinical picture depends entirely on the volume of injected blood.

Mixed malaria is also found, which develops as a result of infection at the same time by several types of malarial plasmodia.

What are the features of tropical malaria?

The onset of the disease
Malaria is characterized by a prodromal period ( mild disease interval), which is characterized by general malaise, mild headaches. Feverish states typical of this disease, followed by periods of calm ( paroxysms), occur after 2-3 days. With tropical malaria, the onset of the disease is more acute. From the first days, patients begin to be disturbed by nausea, vomiting, indigestion in the form of diarrhea. Headaches differ in their intensity. These symptoms are accompanied by a febrile state of a permanent nature, which can last for several days. In the future, the fever acquires an intermittent course with other phases of paroxysms.

Features of tropical malaria from other forms

Complications of tropical malaria are:

• malarial coma- the unconscious state of the patient in the complete absence of reaction to any stimuli;
• algid- toxic-infectious shock, in which the patient remains conscious, but is in prostration ( severely depressed state of indifference);
• hemoglobinuric fever- development of acute renal and hepatic failure.

What are the signs of malaria in adults?

The phases of a malaria attack are:

• chills;

Heat
This phase is accompanied by a sharp increase in temperature, which can reach above 40 degrees. The patient's condition is deteriorating markedly. The face becomes red, the skin is dry and hot to the touch. The patient begins to experience severe headaches, heaviness in the muscles, rapid painful heartbeat. The tongue is covered with a grayish coating and is not moist enough. Often the stage of heat is accompanied by vomiting and diarrhea. The patient is in a state of excitement, convulsions and loss of consciousness may be noted. The heat provokes an insatiable thirst. This state can continue from 5 - 6 to 12 hours.

Sweat
The stage of heat is replaced by the final phase, which is manifested by profuse sweating. The temperature drops sharply to normal values, sometimes it can reach 35 degrees. The patient at the same time feels relief, calms down and falls asleep.

Other signs of malaria
Along with attacks, one of the most characteristic features of malaria is anemia ( anemia), splenomegaly ( enlargement of the spleen) and hepatomegaly ( liver enlargement). Also, this disease has a number of symptoms that manifest themselves both on the physical and mental levels.

The signs of malaria include:

• anemia;
• splenomegaly;
• hepatomegaly;
• urination disorders;
• dysfunction of the cardiovascular system;
• icteric staining of the skin and mucous membranes;
• skin hemorrhages;
• herpetic eruptions ( manifestations of herpes);
• nervous disorders.

Splenomegaly
Enlargement of the spleen is noted after 3-4 attacks of fever and persists for a long time. In tropical malaria, the spleen may enlarge immediately after the first paroxysm. Along with the increase, soreness of this organ is observed. The spleen becomes more dense, which is determined by palpation. In the absence of adequate treatment, the spleen enlarges so much that it begins to occupy the entire left side of the abdomen.

Hepatomegaly
The enlargement of the liver occurs faster than the change of the spleen. In this case, the edge of the liver falls below the costal arch, becomes more dense and painful. The patient complains of painful discomfort in the area of ​​the right hypochondrium.

urinary disorders
Against the background of ongoing processes in the body, with attacks during chills, patients experience frequent urination. At the same time, urine has an almost transparent color. With the onset of heat, the volume of urine becomes more scarce, and the color becomes darker.

Dysfunction of the cardiovascular system
Most sharply violations of the cardiovascular system are expressed in malarial paroxysms. Characteristic signs of this disease are an increase in blood pressure during chills and its fall during fever.

Icteric coloration of the skin and mucous membranes
It is an early sign of malaria in adults. When red blood cells are destroyed, not only hemoglobin, but also bilirubin is released from them ( bile pigment). It gives yellow color to the skin and mucous membranes. In people with dark skin color, it is sometimes difficult to detect icteric staining. Their jaundice is determined by the color of the visible mucous membranes, namely the sclera ( outer shell of the eye). The yellowish color of the sclera or their icterus may appear long before the icteric staining of the skin, therefore it is an important diagnostic sign.

Skin hemorrhages
Due to vasospasm, a hemorrhagic rash forms on the patient's body ( subcutaneous hemorrhages). The rash does not have a specific localization and spreads unevenly throughout the body. Outwardly, this sign looks like star-shaped spots of blue, red or purple.

Herpetic eruptions
If a patient with malaria is a carrier of the herpes virus, it is exacerbated during a feverish state. Vesicles with a clear liquid characteristic of the virus appear on the lips, wings of the nose, and less often on other areas of the face.

Nervous disorders
The most obvious disorders of the nervous system are manifested in three-day and tropical malaria. Patients experience persistent headaches, insomnia, lethargy in the morning and throughout the day. The psyche of patients undergoes negative changes during attacks. They are in a depressed state, poorly oriented, confusedly answer the questions asked. Often, during the heat, patients rave, experience hallucinations. Tropical malaria is characterized by a violent state of the patient, which can continue even after an attack.

What are the signs of malaria in children?

Signs of malaria in children include:

• fever;
• anemia;
• rash;
• disorders of the gastrointestinal tract;
• nervous system disorders;
• convulsions;
• enlargement of the spleen and liver.

Anemia
As a rule, malaria in children occurs with severe anemia. It appears already from the first days of the disease and is often an early diagnostic sign. It develops due to the massive destruction of red blood cells. The number of red blood cells is sometimes reduced to 30 - 40 percent of the norm.

A hallmark of malarial invasion in children are changes in the blood not only in erythrocytes and hemoglobin, but also in other blood elements. So, very often there is a general decrease in leukocytes ( leukopenia), platelets. At the same time, the erythrocyte sedimentation rate increases. Despite severe anemia, jaundice in children with malaria occurs in only 15 to 20 percent of cases.

Rash
The rash is especially common in young children. It first appears on the abdomen, then spreads to the chest and other parts of the body. The nature of the rash can be very diverse - petechial, spotty, hemorrhagic. The development of a rash is due to a decrease in the number of platelets and increased permeability of the vascular wall.

Gastrointestinal disorders
Disorders from the digestive system are almost always noted. The younger the child, the more diverse these disorders are. They manifest themselves in the form of diarrhea, repeated vomiting, nausea. Loose stools with an admixture of mucus are often noted, which is accompanied by bloating, soreness. In infants, this may be the first sign of a malaria infection. There is also repeated vomiting, which does not bring relief.

Disorders from the nervous system
They can appear both at the height of febrile attacks, and in the temperatureless period. These disorders manifest themselves in the form of meningeal symptoms, which are characteristic of all types of malaria. There is photophobia, stiff neck, vomiting. Similar symptoms disappear simultaneously with a drop in temperature. There may also be motor excitation, delirium, clouding of consciousness. Such a variety of disorders of the nervous system is due to the action of malarial toxin on nerve cells.

convulsions
Seizures or convulsions are also very common in children with malaria. Basically, convulsions appear at the height of fever. They may be clonic or tonic. Their appearance is due to high temperature, and not the presence of any disease. These seizures are categorized as febrile seizures, which are common in childhood. The younger the child, the more likely it is to have seizures.

Enlargement of the spleen and liver
It is a common but inconsistent symptom. The spleen and liver enlarge only after a few repeated attacks of fever.

A separate type of malaria infection in children is congenital malaria. In this case, the malarial plasmodium enters the child's body in utero through the placenta. This malaria is extremely difficult, often fatal. Children with congenital malaria are born prematurely, with insufficient weight and abnormalities of the internal organs. The skin of such children is pale, with a waxy or icteric tint, and a hemorrhagic rash is often observed. The spleen and liver are sharply enlarged. When born, children do not emit the first cry, usually lethargic, with reduced muscle tone.

Why is malaria dangerous during pregnancy?

The consequences of malaria for women
The infection poses the greatest danger when it is infected in the early stages of bearing a child. The most common consequence is spontaneous abortion. Termination of pregnancy occurs due to irreversible changes that have occurred in the body of a woman under the influence of malarial plasmodia. When pregnancy persists, children are often born prematurely, among which 15 percent die during childbirth and 42 percent die in the first days after birth. Among full-term children born to women infected with malaria, the percentage of stillbirths is an order of magnitude higher than that of other women in labor. Often the children of patients with malaria are born underweight and often get sick during the first years of life.

Complications of malaria during pregnancy are:

• anemia (anemia among the people);
• nephropathy (a form of late toxicosis caused by kidney dysfunction);
• eclampsia (critical complications due to brain damage);
• hypoglycemia (decrease in blood sugar).

Other consequences of malaria due to anemia are:

• abruption of the placenta ahead of time;
• the birth of a dead child;
• weakness of labor activity.

Eclampsia
This disorder develops against the background of damage to brain cells that provokes a malaria infection. Eclampsia is manifested by convulsive seizures, after which the patient falls into a coma. After some time, the patient returns to consciousness. In some cases, it is possible to develop a prolonged coma from which a woman cannot get out. Spasms of blood vessels that occur during convulsions can lead to asphyxia ( suffocation) or hypoxia ( oxygen starvation) embryo. Often, eclampsia causes intrauterine fetal death. In a pregnant woman, this complication of malaria can cause stroke, heart or lung failure, liver or kidney dysfunction. Often, against the background of this disorder, premature detachment of the placenta occurs. All these pathologies can lead to the death of both the fetus and the woman herself.

hypoglycemia
This syndrome can develop in pregnant women infected with tropical malaria. Hypoglycemia is manifested by attacks, the repeated repetition of which can harm both the fetus and the expectant mother. The lack of the required amount of glucose can provoke heart failure or lag in physical and mental development in the embryo. For women, this condition is fraught with depression of cognitive functions, a depressed state, and a disorder of attention.

Also, the consequences of congenital malaria include:

• jaundice;
• epileptic seizures;
• anemia ( often severe);
• enlarged liver and/or spleen;
• increased susceptibility to infections.

What drugs are available for malaria?

There are the following main groups of drugs against malaria:

• drugs that act on malarial plasmodia in the liver and which prevent their further penetration into red blood cells - proguanil, primaquine;
• drugs that act on erythrocyte forms of plasmodium, that is, those that are already in erythrocytes - quinine, mefloquine, atovaquone;
• drugs that act on the sexual forms of malarial plasmodium - chloroquine;
• drugs to prevent recurrence of malaria - primaquine;
• drugs used to prevent malaria - plasmocid, bigumal.
• drugs that are used both to treat and prevent malaria are antifolates.

Main drugs used in the treatment and prevention of malaria

• antihistamines - clemastine, loratadine;
• diuretics - furosemide, diacarb, mannitol;
• colloidal and crystalloid solutions - refortan, 20 and 40% glucose solution;
• cardiotonic drugs - dopamine, dobutamine;
• glucocorticoids - avamys, beclazone;

What are the malaria pills?

The name of the tablets	Characteristic
Quinine sulfate	Taken at 1 - 2 grams per day, lasting 4 - 7 days. They can be found in the form of tablets of 0.25 grams and 0.5 grams. The daily dose is divided into 2 - 3 doses. Tablets should be washed down with acidified water. It is best to use water with lemon juice. The dose and duration of taking the tablets depends on the type of malaria. Children's doses depend on age. At the age of ten years, the daily dose is 10 milligrams per year of life. Children over ten years of age are prescribed 1 gram per day.
Chloroquine	Adults are prescribed 0.5 grams per day. On the first day, the daily dose was increased to 1.5 grams in two doses - 1.0 and 0.5 grams each. Children's doses are 5 - 7.5 milligrams per kilogram. Treatment with chloroquine lasts 3 days.
Hydroxychloroquine	Adults are prescribed 0.4 grams per day. On the first day, the daily dose was increased to 1.2 grams in two doses - 0.8 and 0.4 grams each. Children's doses are 6.5 milligrams per kilogram. Treatment with hydroxychloroquine tablets lasts 3 days.
Primakhin	Available in 3 and 9 milligrams. They are taken at 27 milligrams per day for two weeks. The daily dose is divided into 2 - 3 doses. Proguanil is prescribed not only for therapy, but also for the prevention of malaria. The dosage depends on the type of malaria. On average, the daily therapeutic dose is 0.4 grams, and the prophylactic dose is 0.2 grams. Treatment lasts 3 days, and prevention - the entire period of stay in an area with a high risk of infection, plus another 4 weeks. Children's doses do not exceed 0.3 grams per day. Diaminopyrimidine group of drugs Pyrimethamine tablets are prescribed in the complex treatment and prevention of tropical malaria. Usually they are used together with drugs of the sulfanilamide group. Adults are prescribed 50 - 75 milligrams at one time. Children's dose varies from 12.5 to 50 milligrams, depending on age. As a preventive measure, pyrimethamine tablets are taken at 25 milligrams per week in one dose during the period of stay in the "dangerous" zone. Sulfanilamide group of drugs The sulfanilamide group of drugs for malaria is effective in the fight against erythrocyte forms of plasmodium only in combination with biguanides. Sulfadoxine tablets are given as a single dose of 1.0-1.5 grams, according to the severity of malaria. The children's dose is 0.25 - 1.0 grams, taking into account the age of the child. Sulfones Sulfones are the drugs of the reserve group in the treatment of malaria. They are prescribed for tropical malaria resistant to conventional treatment. Dapsone tablets are used in combination with drugs of the diaminopyrimidine group ( pyrimethamine). The adult dose is 100 - 200 milligrams per day. The duration of taking the tablets depends on the severity of the malaria. Children's doses correspond to the weight of the child - up to 2 milligrams per kilogram. Tetracycline group of drugs and lincosamides The tetracycline group of drugs and lincosamides are prescribed for malaria only if other drugs are ineffective. They have a weak effect against plasmodia, so the course of treatment is long. The name of the tablets Characteristic Tetracycline Available in 100 milligrams. For malaria, they are taken 3-5 tablets 4 times a day. The terms of therapy can vary from 2 to 2.5 weeks. Children's doses are calculated according to the weight of the child. The daily dose is up to 50 milligrams per kilogram. Clindamycin Assign 2-3 tablets 4 times a day. In one tablet - 150 milligrams of the active substance. Children are shown 10 - 25 milligrams per kilogram per day. Treatment with clindamycin tablets for malaria can last 1.5 to 2 weeks. What tests for malaria should be taken? For malaria, it is necessary to pass a general urine test, as well as general and specific blood tests that will help diagnose this disease. General urine analysis If malaria is suspected, a urinalysis should be done. The results of the analysis may indicate the appearance of blood in the urine of the patient. Hemoleukogram All blood tests begin with a hemoleukogram. In malaria, erythrocytes are destroyed in large numbers, which leads to shifts in the overall ratio of cellular elements in the blood. The main abnormalities in the hemoleukogram in malaria are: decrease in erythrocyte count ( less than 3.5 - 4 trillion cells per liter of blood); decrease in hemoglobin ( less than 110 - 120 grams per liter of blood); decrease in mean erythrocyte volume ( less than 86 cubic micrometers); an increase in the platelet count ( more than 320 billion cells per liter of blood); increase in leukocyte count ( more than 9 billion cells per liter of blood). Blood chemistry With malaria, it is also necessary to pass a biochemical blood test, which confirms the active destruction of red blood cells in the vascular bed. Immunological blood test For the detection of malaria antigens ( special proteins) it is necessary to donate blood for immunological analysis. There are several rapid tests for various types of Plasmodium, which allow you to diagnose the disease right at the patient's bed. Immunological tests take 10-15 minutes to complete. This assay is widely used for epidemiological studies in countries at high risk of malaria. Blood drop polymerase chain reaction PCR for malaria should be taken only if previous tests have not confirmed the disease. PCR is performed on the basis of a drop of peripheral blood of a sick person. This type of analysis is highly specific. It gives a positive result and detects the pathogen in more than 95 percent of cases. What are the stages of malaria? There are several stages in the clinical picture of malaria. The stages of malaria are: stage of incubation; stage of primary manifestations; stage of early and late relapses; recovery stage. Incubation stage The incubation period is the length of time from the moment the malarial plasmodium enters the body until the first symptoms appear. The duration of this period depends on the type of malarial plasmodium. The duration of the incubation period depending on the type of malaria The duration of the incubation period may change if inadequate prophylaxis has been previously undertaken. Stage of primary manifestations This stage is characterized by the appearance of classic febrile seizures. These attacks begin with a tremendous chill, penetrating the whole body. It is followed by the hot phase maximum temperature rise). In this phase, patients are excited, rush about within the bed, or, conversely, are inhibited. The temperature in the heat phase reaches 40 degrees and even more. Patients' skin becomes dry, red and hot. The heart rate increases sharply and reaches 100 - 120 beats per minute. Blood pressure is reduced to less than 90 millimeters of mercury. After 6 - 8 hours, the temperature drops sharply, and it is replaced by pouring sweat. The state of health of patients during this period improves and they fall asleep. Further, the development of primary manifestations depends on the type of malarial invasion. With a three-day malaria, febrile attacks occur every third day, with a four-day one - every fourth. The difference between tropical malaria is the absence of such paroxysms. The liver and spleen also enlarge during this stage. During periods of absence of temperature, symptoms such as muscle and headaches, weakness, and nausea persist. If malaria develops in children, then during this period the symptoms of the disorder of the gastrointestinal tract predominate. These symptoms are vomiting, diarrhea, bloating. As the liver enlarges, a dull pain in the right hypochondrium increases and jaundice develops, as a result of which the skin of patients acquires an icteric hue. One of the most formidable symptoms of this period is rapidly developing anemia ( decrease in the number of red blood cells and hemoglobin in the blood). Its development is due to the destruction of erythrocytes by malarial plasmodium. Erythrocytes are destroyed, and hemoglobin is released from them ( which subsequently appears in the urine) and bilirubin, which gives the skin its yellow color. Anemia, in turn, leads to other complications. This is, firstly, oxygen deficiency experienced by the body. Secondly, hemoglobin released from red blood cells enters the kidneys, disrupting their functionality. Therefore, a frequent complication of this period is acute renal failure. It is also the main cause of death from malaria. This stage characterizes the main clinical picture of malaria. In case of untimely diagnosis and treatment, such conditions as malarial coma, toxic shock, hemorrhagic syndrome develop. The toxic syndrome in this stage is expressed moderately, complications are rare. As in the stage of early manifestations, anemia develops, the liver and spleen moderately enlarge. For three-day and four-day malaria, late relapses are also characteristic. They occur 8 to 10 months after the early relapses have ended. Late relapses are also characterized by periodic rises in temperature up to 39 - 40 degrees. Phase changes are also well expressed. recovery stage It occurs when the stage of late relapses passes. Thus, the total duration of the disease is determined by the type of invasion. The total duration for three-day and four-day malaria is from two to four years, for oval malaria - from one and a half to three years, for tropical - up to a year. Occasionally, a latent stage may occur between periods of early and late relapses ( complete absence of symptoms). It can last from two to ten months and is mainly characteristic of three-day malaria and oval malaria. What are the consequences of malaria? There are multiple consequences of malaria. They can occur both in the acute period of the disease ( that is, in the stage of early manifestations) and after. The consequences of malaria are: malarial coma; toxic shock; acute renal failure; acute massive hemolysis; hemorrhagic syndrome. malarial coma As a rule, it is a complication of tropical malaria, but it can also be a consequence of other forms of malarial invasion. This complication is characterized by a staged, but, at the same time, rapid course. Initially, patients complain of severe headache, recurrent vomiting, dizziness. They have lethargy, apathy and severe drowsiness. Within a few hours, drowsiness worsens, a soporous condition develops. During this period, convulsions, meningeal symptoms ( photophobia and muscle stiffness), consciousness becomes confused. If there is no treatment, then a deep coma develops, during which blood pressure drops, reflexes disappear, breathing becomes arrhythmic. During coma, there is no reaction to external stimuli, vascular tone changes, and temperature regulation is disturbed. This condition is critical and requires resuscitation. toxic shock Toxic shock is also a consequence that is life threatening. In this case, damage to vital organs, such as the liver, kidneys, and lungs, is noted. In shock, blood pressure falls first, sometimes reaching 50 to 40 millimeters of mercury ( at a rate of 90 to 120). The development of hypotension is associated both with impaired vascular tone ( blood vessels dilate and blood pressure drops) and cardiac dysfunction. In shock, breathing in patients becomes shallow and unstable. The main cause of mortality during this period is developing renal failure. Due to a sharp decrease in blood pressure, hypoperfusion occurs ( insufficient blood supply) of renal tissue, resulting in renal ischemia. Since the kidneys remove all toxins from the body, when they lose their function, all metabolic products remain in the body. The phenomenon of autointoxication occurs, which means that the body is poisoned by its own metabolic products ( urea, creatinine). Also, with toxic shock, damage to the nervous system occurs, which is manifested by confusion, psychomotor agitation, fever ( due to temperature regulation). Acute renal failure This consequence is due to the massive destruction of red blood cells and the release of hemoglobin from them. Hemoglobin begins to appear in the urine ( this phenomenon is called hemoglobinuria), giving it a dark color. The condition is aggravated by low blood pressure. Renal failure in malaria is manifested by oliguria and anuria. In the first case, the daily amount of urine is reduced to 400 milliliters, and in the second - up to 50 - 100 milliliters. Symptoms of acute renal failure are rapid deterioration, decreased diuresis, dark urine. In the blood, there is a violation of the water-electrolyte balance, a shift in alkaline balance, an increase in the number of leukocytes. Acute massive hemolysis Hemolysis is the premature destruction of red blood cells. The normal life cycle of an erythrocyte is about 120 days. However, with malaria, due to the fact that they develop malarial plasmodium, the destruction of red blood cells occurs much earlier. Hemolysis is the main pathogenetic link in malaria. It causes anemia and many other symptoms. Hemorrhagic syndrome With hemorrhagic syndrome, due to numerous violations of hemostasis, an increased tendency to bleeding develops. More often, a hemorrhagic rash develops, which is manifested by multiple hemorrhages in the skin and mucous membranes. Rarely, cerebral hemorrhage develops ( found in malarial coma) and other organs. Hemorrhagic syndrome can be combined with disseminated intravascular coagulation syndrome ( DIC). It, in turn, is characterized by the formation of numerous blood clots. Thrombi are blood clots that fill the lumen of blood vessels and prevent further blood circulation. So, in the brain, blood clots form the formation of Durk's granulomas, which are specific for malarial coma. These granulomas are capillaries filled with blood clots, around which edema and hemorrhages form. These thrombi are formed due to increased thrombocytopoiesis, which, in turn, is activated due to the destruction of red blood cells. Thus, a vicious circle is formed. As a result of hemolysis of erythrocytes, numerous decay products are formed, which enhance the formation of blood clots. The more intense the hemolysis, the stronger the hemorrhagic and DIC syndrome. Is there a malaria vaccine? There is a vaccine against malaria, but it is not currently universal. Its planned use is not approved in the European countries of the world. The first malaria vaccine was created in 2014 in the UK by pharmaceutical company GlaxoSmithKline. British scientists have created the drug mosquirix ( mosquirix), which is designed to vaccinate populations most at risk of contracting malaria. Since 2015, this vaccine has been used to vaccinate children in many countries in Africa, where malaria is most common. Mosquirix vaccination is given to children from one and a half months to two years. It is at this age that African children are most susceptible to contracting malaria. According to scientists, as a result of vaccination, not all children developed immunity against malaria. In children aged 5 to 17 months, the disease was prevented in 56 percent of cases, and in children under 3 months only in 31 percent of cases. Thus, the currently created malaria vaccine has a number of negative qualities, which stops its large-scale use. New developments are underway to create a more universal malaria vaccine. According to scientists' forecasts, the first mass vaccinations should appear by 2017.

Malaria: features of the disease

Russia is a malaria-free region, although occasionally there are rare cases of morbidity among the population.

In adults, the central symptom of malaria is fever, which proceeds cyclically and has several phases of its course. Patients are also worried about headache, aching joints, fever, urination disorders, dysfunction of the heart and blood vessels. Rashes, insomnia may appear on the background of a nervous breakdown.

Malaria in children

Malaria in its symptoms in children can be different, and the clinical picture will depend on the level of immune protection of the child, and on his age. Among the main signs of malaria are fever, disorders of the stomach and intestines, rashes on the body, convulsions and anemia.

If malaria is congenital, then the child is born mainly prematurely, with an underestimated body weight, sometimes with obvious anomalies in the development of organs and reduced muscle tone.

causative agent of malaria

To date, there are more than 4,000 species of protozoa of the order Coccidiidae and the genus Plasmodium, but it has been proven that only 5 of them are the causative agents of malaria.

Plasmodium malaria is:

• Falciparum (a tropical type of disease develops);
• Vivax (three-day type of disease);
• Malariae (four-day type of disease);
• Oval.

Doctors also isolate the Plasmodium malaria Knowlesi, but this option has been studied very little.

How is malaria transmitted?

A person becomes infected with malaria mainly through the bite of an infected mosquito of the genus Anopheles. But malaria is not always spread this way. Allocate doctors and ways of infection during blood transfusions, as well as the transplacental method.

Stages of development and manifestations of malaria

In the prodromal period, the so-called precursors of the disease appear. The general condition of the infected person worsens, pain in the head, chills may appear. It lasts up to 5 days on average.

Then there are specific signs of malaria - a special acute period, which is characterized by serial febrile attacks. The duration of these can be different, usually from 3-4 to 10 hours. After relief comes, the symptoms of malaria subside.

This disease can be different. Types of malaria have significant differences, which should definitely be considered in detail. Each type of malaria has its own specific course and appears against the background of the negative impact of the corresponding type of plasmodium.

tropical malaria

This disease, otherwise called coma, is characterized by the most severe clinical picture. This type of malaria accounts for more than 90% of the total number of deaths. Clinically, the disease is manifested primarily by a pronounced toxic syndrome. At the same time, the alternations of such phases as chills, fever, sweating, characteristic of other forms of the disease, are very weakly expressed here.

The onset of the disease is accompanied by fever, severe headache and muscle pain. After about 2 days, symptoms of toxicosis appear: the patient begins to feel sick, vomiting and a feeling of suffocation occur, pressure drops, coughing begins. In addition, tropical malaria has one characteristic symptom - an allergic rash that appears on the body.

During the first 7 days of the disease, hemolytic anemia develops, accompanied by. The occurrence of anemia is associated with the rapid destruction of red blood cells, that is, their hemolysis (hence the name of anemia). From the 2nd week, the picture changes: the spleen and liver increase, which creates significant difficulties in the early diagnosis of the disease.

In people whose immunity is weakened, tropical malaria can develop more rapidly: already on the 2nd, and sometimes on the 1st week of the disease, either toxic shock, or coma, or acute kidney dysfunction begins to progress. Patients with malarial coma become weak, indifferent, lethargic, apathetic, constantly experiencing drowsiness. Literally in a matter of hours, consciousness becomes confused, becomes inhibited, convulsions may begin. This is a very dangerous condition, because it often has an unfavorable outcome.

The massive destruction of red blood cells usually leads to acute renal failure. The mechanism of this process is as follows: hemoglobin, which is released as a result of hemolysis, first enters the bloodstream and then into the urine. As a result, a violation of urinary processes occurs in the kidneys and diuresis (the volume of urine per day) decreases. The products of natural metabolism, which should normally leave the body in the urine, are not excreted, as a result of which a serious condition called uremia begins to develop.

This type of disease is considered a mild form. In most cases, complications do not appear, the disease does not lead to the death of the patient, despite the fact that it often proceeds quite hard.

The onset of three-day malaria is preceded by a short prodromal phase. There is no such period in a tropical species. It is characterized by symptoms such as weakness and muscle pain, after which fever immediately begins.

Three-day malaria is characterized by a cyclical increase in temperature, which occurs every two days, that is, every 3rd day. This was the reason to call this type of disease three-day. In the phase of the temperature rise, the patient is excited, his breathing quickens, the skin becomes hot and very dry. The heart begins to contract with a frequency of up to one hundred beats per minute, blood pressure drops, urinary retention appears. The phases of chills, heat and sweating are more pronounced. On average, an attack lasts 5-10 hours. After repeated attacks, that is, approximately on the 10th day, an increase in the liver and spleen is determined, the development of jaundice begins.

However, in some patients, bouts of fever occur daily. This phenomenon in three-day malaria is due to the fact that several generations of plasmodium penetrate into the bloodstream at the same time. In such cases, the patient's body temperature may periodically rise even several months after the illness.

Malaria oval

This type of malaria is very similar to the three-day form of the disease. The difference is that the disease is much easier. Another characteristic feature of the oval is the frequency of fever attacks that appear every other day. An increase in temperature usually occurs in the evening, which is not inherent in other types of malaria.

Quartan

This disease, like the two previous species, is classified as a mild malarial form of invasion. Such a disease begins to develop sharply and brightly, without any prodromal symptoms. Every three days there are bouts of fever, during which the temperature rises to high levels. While the attack lasts, the patient's condition is severe: consciousness is confused, the skin becomes dry, the tongue is lined, and blood pressure is significantly reduced.

It should be noted that in addition to the listed traditional types of malaria, there is another one - schizont. This form develops after already formed schizonts, that is, malarial plasmodia that have passed the asexual phase of development, penetrate into the bloodstream. As a rule, schizont disease occurs as a result of infection during blood transfusion. For this reason, this type of malaria is called syringe or vaccination. A distinctive feature of the schizont type of malaria is the absence of a period in which plasmodium develops in the liver. The clinical manifestation of the disease in such cases depends entirely on the volume of blood that was administered to the person.

Sometimes there is mixed malaria, which occurs due to the fact that a person simultaneously becomes infected with two or more types of malarial plasmodia. Such a disease proceeds quite severely, with symptoms characteristic of those forms that begin to develop as a result of infection.

Signs of malaria are especially pronounced in infected preschool children and women who are in the period of gestation.

Fever most often worries cyclically. The initial chill is replaced by fever. The skin becomes dry and acquires a reddish tint. Further, the heat passes into the stage of increased sweating. The patient feels slight relief. Anemia may not be visible, although hemoglobin levels are low on laboratory tests. Further, the skin becomes yellow due to an increase in the level of bilirubin in the blood. Relieve joint pain. A person infected with malaria complains of nausea, vomiting, headaches, drowsiness, loss of strength.

Malaria: symptoms with complications

On the lips has several stages of its manifestation. Here it is worth highlighting the initial tingling, then the appearance of vesicles, sores, the formation of scabs and the healing stage. Such "malaria on the lips" can be accompanied by headaches, an increase in body temperature, pain symptoms in the muscles. Often, with the so-called malaria, increased salivation can be traced on the lips.

Diagnosis of malaria

Diagnosis of malaria is carried out according to a number of criteria, including:

• Clinical, expressed by characteristic symptoms, including the appearance of fever.
• Epidemic, when the patient has traveled to a malaria-endemic country in the last 3 years.
• Anamnestic, involving the study of the patient's life history. This checks for factors such as a previous form of malaria and blood transfusions.

In addition, for the diagnosis of malaria, the specialist should familiarize himself with the results of the following basic tests:

• general blood test for malaria;
• urine test;
• biochemical analysis.

It should be noted that it is the results of a laboratory study that are the main criterion for the diagnosis of malaria.

For diagnosis in this case, the following laboratory tests are used:

1. Blood microscopy - examination of a thick drop.

It is used if a disease is suspected: there are epidemiological indications and the following signs are observed: the temperature rises paroxysmal, the spleen and liver increase, anemia develops. This is the cheapest and easiest research method that allows you to detect the presence of malaria, determine the type of plasmodia and determine at what stage of development they are.

2. Examination of a thin (stained) blood smear.

It is carried out if, after examining a drop of blood, it is required to confirm and clarify the type of pathogen, as well as the phase of its development. This analysis is not as revealing as the first one.

3. Immunological research methods:

Detection of specificity of proteins in the analysis of peripheral blood is a method for the rapid diagnosis of the disease, used in those regions where malaria is widespread. A person can resort to this method himself.

Serological tests - detection of the presence in the venous blood of specific antibodies to malaria. It is used mainly in non-endemic regions when the disease is suspected. When antibodies are detected, this may indicate both a current illness and the fact that a person has had malaria in the past. The absence of antibodies is a sign of the complete absence of malaria.

4. Study of the blood polymerase chain reaction to the disease.

5. Autopsy of carriers - mosquitoes.

This procedure allows epidemic control of malaria.

How to donate blood for malaria

It is best to draw blood from a patient for malaria when he has an attack, but this can also be done in the period between attacks. If the concentration of malarial plasmodia is low, blood for malaria is taken for analysis within 24 hours, with a frequency of 4-5 hours.

In order to diagnose malaria, the blood taken is subjected to a study. For this, both the drop method and the colored (thin) smear method can be used. Sometimes both methods are used. They allow you to accurately determine the type of disease. If during the tests it is found that more than 2 percent of red blood cells are affected, the doctor makes a diagnosis of tropical malaria.

Treatment for malaria is selected strictly on an individual basis, taking into account the type of disease and the presence or absence of complications. Quinolylmethanols can be recommended - these are Quinine, Chloroquine, Mefloquine, etc. Biguanides, diaminopyrimidines, terpene lactones, sulfonamides, tetracyclines, sulfones and other groups of drugs are prescribed. Each drug used in the treatment of malaria has its own mechanism of action, the level of effectiveness in relation to a particular pathogen and the regimen of administration. Only a qualified doctor can prescribe a cure for malaria. Self-medication is unacceptable.

Caring for a sick person

A person suffering from malaria needs constant and most thorough, proper care. Only in this way can the patient's condition be alleviated, the intensity of pain that an infected person experiences during each attack of fever can be reduced.

When the chills begin, the patient must be wrapped up, a heating pad should be applied to the legs. During the period of heat, the patient should be opened, the heating pads should be taken away, however, make sure that there are no drafts. It is important to prevent hypothermia. For headaches, it is allowed to put something cold on the head. When the period of sweating passes, you should immediately change your underwear and bed linen, and then let the person rest in peace.

It is important to carry out preventive measures in the room in which the patient stays. These include not only ventilation, but also preventing the entry of mosquitoes so that malaria cannot spread to other people. To do this, use insecticides and mosquito nets installed on window openings.

In the case when there is a complex form of malaria, the patient should not be at home: he is observed in a hospital facility - either in a ward or in an intensive care unit, depending on the severity of the course of the disease.

In addition to the above rules for caring for a sick person, it is necessary to provide him with proper nutrition (diet) and plenty of fluids. Moreover, the dietary table is prescribed only during attacks, and between them a person can eat in the usual way and do not forget to drink plenty of fluids.

Preventive measures against malaria are important for those people who live permanently or temporarily stay in endemic countries for the disease. Therefore, before you go to a malaria-prone region, you should prepare in advance and take this issue very seriously. Small children under four years of age, pregnant women and HIV-infected countries are strongly discouraged from traveling to countries that are dangerous in terms of the incidence of malaria.

Before traveling, it is advisable to visit the embassy of the country of destination in order to obtain comprehensive information about the current epidemic situation and consult on ways to prevent malaria that are effective and relevant for a particular region.

The main way to prevent the disease is effective protection against malaria mosquito bites. Of course, it is impossible to provide such protection one hundred percent, but such prevention of malaria will significantly reduce the likelihood of getting sick. The means of protection are:

• Mosquito nets installed in window and door openings.
• Net curtains, carefully tucked under the mattress, under which you can sleep safely.
• Repellents are special compounds of chemicals that repel mosquitoes, but cannot kill them. The agent should be applied either to the skin or to clothing. Repellents can be presented in the form of aerosols and sprays, creams, gels, and so on. Use the drug should be in accordance with the instructions attached to it.
• Insecticides are chemicals used to kill insects. Presented in the form of aerosols. To kill mosquitoes, rooms, thresholds and mosquito nets should be treated with insecticide. After 30 minutes after completion of the treatment, the room should be ventilated. Instructions for use are also included with insecticides.

Medical prevention

There is also a drug prevention of malaria, involving the use of antimalarial drugs. Before using this or that medication, it is necessary to clarify the degree of resistance to it of the disease in a particular country.

It should be noted that drug prevention of malaria cannot fully protect against infection, however, with the right choice of medicines, it significantly reduces the likelihood of getting sick. It is also important to understand that this is not about the malaria vaccine. Taking medications for the prevention of illness should be started one week before departure and, without interrupting it throughout the trip, continue for another 1-1.5 months after returning home. These medicines include:

Chloroquine or Delagil. In order to prevent malaria, it is taken every 7 days at a dosage of 0.5 g for adults and 5 mg per 1 kg of body weight for children.

Hydroxychloroquine or Plaquenil. It is taken every 7 days at a dosage of 0.4 g for adults and 6.5 mg per 1 kg of body weight for children.

Mefloquine, or Lariam. It is taken every 7 days at a dosage of 0.25 g for adults and from 0.05 to 0.25 mg for children.

Primakhin. It is used every 2 days at a dosage of 30 mg for adults and 0.3 mg per 1 kg of body weight for children.

Proguanil, or Bigumal. It is used once a day at a dosage of 0.2 g for adults and from 0.05 to 0.2 g for children.

Pyrimethamine or Chloridine. It is used every 7 days at a dosage of 0.0125 g for adults and from 0.0025 to 0.0125 g for children. Children should be given the drug in combination with Dapsone.

Thus, malaria prevention should be started early and not put off until the last day. Before taking certain medications, you should consult with a specialist to clarify the dosage.

If infection nevertheless occurred or there is even the slightest suspicion of it, it is important to pay attention to the symptoms in a timely manner and examine the patient in time. This will allow you to quickly prescribe adequate treatment that will be effective. In addition, it is mandatory to conduct a survey of patients with any hyperthermic syndrome who arrived from regions endemic in terms of malaria, and do this for 3 years. Timely and effective therapy will prevent the further spread of the pathogen.

Malaria vaccination would certainly be an effective tool to prevent the disease. However, there is currently no official vaccine for malaria. As a result of ongoing clinical studies, an experimental specimen was created, which is not intended for widespread use. In fact, it cannot yet be called a vaccine in the truest sense of the word, and it still has a long way to go before mass production.

When a real vaccine is developed and people can protect themselves by vaccinating themselves against malaria, this will be a significant event, as vaccination will help to cope with the disease throughout the world. It is to be hoped that an effective malaria vaccine will soon become a reality.

Malaria, formerly called swamp fever, is a group of infectious diseases caused by malarial plasmodia, which are transmitted to humans by the bite of malarial mosquitoes (mosquitoes of the genus Anopheles). 85-90% of cases of the disease and death from it are registered in the southern regions of Africa, in the European territory, cases of malaria are mainly imported. More than 1 million cases of the disease are recorded annually, ending in death.

Symptoms of malaria

There are 4 forms of malaria caused by different types of pathogens: three-day, four-day, tropical and the so-called oval malaria. Each form of the disease has its own characteristics, but all are characterized by common symptoms: bouts of fever, enlarged spleen and anemia.

Malaria refers to polycyclic infections, in its course there are 4 periods:

• incubation (primary latent);
• the period of primary acute manifestations;
• latent secondary;
• relapse period.

The duration of the incubation period directly depends on the type of pathogen. At the end of it, the so-called symptoms appear - the precursors of the disease: headache, chills, muscle pain.

The acute period is characterized by recurrent bouts of fever. During an attack, there is a clear change in the stages of chills, fever and sweating. During the chill, which can last from half an hour to 3 hours, the body temperature rises, but the patient cannot warm up in any way, cyanosis of the extremities is observed. The pulse quickens, blood pressure rises, and breathing becomes shallow.

The chill period ends and a febrile period sets in, the patient warms up, while the body temperature can rise to 40-41C. The patient's face turns red, the code becomes dry and hot, psycho-emotional arousal, anxiety, confusion are noted. Patients complain of headache, sometimes there are convulsions.

Towards the end of the fever period, the body temperature drops very quickly, accompanied by profuse (very profuse) sweating. The patient quickly calms down and falls asleep. This is followed by a period of apyrexia, during which a patient with malaria will maintain a normal body temperature and a satisfactory state of health. But the attacks will be repeated with a certain cyclicity, which depends on the type of pathogen.

Against the background of attacks in patients, an increase in the spleen, liver, and the development of anemia are observed. Malaria affects almost every system in the body. The most severe lesions are observed in the cardiovascular (cardiodystrophy), nervous (neuritis, migraine), genitourinary (nephritis) and hematopoietic systems.

Usually, each patient has 10–12 acute attacks, after which the infection subsides and a secondary latent period of malaria sets in.

With ineffective or incorrect treatment, relapses of the disease occur after a few weeks or months.

Features of malaria species depending on the type of pathogen:

1. Three day malaria. The incubation period can last from 10 days to 12 months. The prodromal period usually has general symptoms. The disease begins acutely. During the first week, the fever is irregular, and then a fever sets in, in which the attacks are repeated every other day. Attacks usually occur in the first half of the day, there is a clear change in the stages of chills, fever and sweating. After 2–3 attacks, the spleen noticeably enlarges, and anemia develops at the 2nd week of the disease.
2. Oval-malaria in its manifestations is very similar to three-day malaria, but the disease is milder. The minimum incubation period is 11 days. Fever attacks most often occur in the evening.
3. Four-day malaria is classified as a benign form of malaria infection. The duration of the incubation period usually does not exceed 42 days (at least 25 days), and fever attacks clearly alternate after 2 days. Enlargement of the spleen and anemia are rare.
4. Tropical malaria is characterized by a short incubation period (7 days on average) and a typical prodromal period. Patients with this form of malaria often lack the typical symptoms of an attack. The chill period may be mild or absent, the febrile period may be prolonged (up to 30–40 hours), the temperature drops without pronounced sweating. Patients have confusion, convulsions, insomnia. Often they complain of abdominal pain, nausea, vomiting and diarrhea.

Malaria treatment

There are few remedies for the treatment of this serious disease. Quinine has been the most reliable and proven drug for the treatment of malaria for decades. Physicians repeatedly tried to replace it with another remedy, but invariably returned to this drug.

Highly effective in the treatment of malaria is the extract of the annual wormwood (Artemisia annua), which contains the substance artemisinin. Unfortunately, the drug is not widely used due to its high price.

Prevention of malaria

1. Taking prophylactic medicines is justified in cases where it is necessary to visit areas where there is an increased risk of contracting malaria. To prescribe the drug, you must consult a doctor. It should be noted that it is necessary to start taking prophylactic drugs in advance (1–2 weeks before leaving for a dangerous area) and continue taking them for some time after returning from a dangerous area.
2. Destruction of mosquitoes - carriers of infection.
3. Use of protective mosquito nets and repellents.

Which doctor to contact

If you are planning to travel to areas where malaria is common, talk to an infectious disease specialist or tropical disease specialist for advice on preventing the disease. If, upon returning home, you begin to have bouts of fever, you also need the help of an infectious disease specialist. With the development of complications, appropriate specialists will provide assistance - a cardiologist, a neurologist, a hematologist, a nephrologist.

Elena Malysheva in the program "Life is great!" talks about malaria (see from 36:30 min.):

The story about malaria in the program "Morning with the Province":

Ancient times

18th and 19th centuries: first scientific research

XX century: the search for methods of treatment

Malaria therapy and scientific discoveries

Antimalarial drugs

DDT

The insecticidal properties of DDT (dichloro-diphenyl trichloroethane) were established in 1939 by Paul Hermann Müller of Geigy Pharmaceutical, Basel, Switzerland, using powdered pyrethrum from ash-leaf chamomile (a plant from the chrysanthemum family). The use of DDT is a standard insect control method. However, due to the environmental impact of DDT and the fact that mosquitoes have developed resistance to the substance, DDT is being used less and less, especially in areas where malaria is not endemic. In 1948, Paul Müller received the Nobel Prize in Medicine.

Malaria in humans and monkeys

In the 1920s, American researchers injected people with the blood of various monkey species to determine the potential for monkey-to-human transmission of malaria. In 1932-33, Sinton and Mulligan identified the presence of Plasmodium gonderi among monkeys from the marmoset family. Until the 1960s, natural infection of monkeys in India was rare, however, animals were already being used for research purposes. However, it has been known since 1932 that P. knowlesi can be transmitted to humans through contaminated monkey blood. The issue of human infection with simian malaria, especially important in the context of the malaria eradication program, came to the fore in 1960, when, by chance, the possibility of transmission (via mosquitoes) of malaria from monkeys to humans was discovered. In 1969, the Chesson Plasmodium vivax strain was first adapted to a non-human primate. Since 2004, P. knowlesi, which is known to be associated with simian malaria, has also been associated with malaria infections in humans.

Research and perspectives

Pharmacology

Vaccines

P. falciparum circumsporozoite protein (RTS);

Antigen from the cell surface of the hepatitis B virus (S);

Adjuvant consisting of 250 μm water-oil emulsion, 50 μg QS21 saponin and 50 μg lipid monophosphoric immunostimulant A (AS02A).

This vaccine is the most advanced second-generation vaccine. Provided that all research and trials continue as normal, the vaccine may be placed on the market in early 2012, in accordance with Article 58 of the European Medicines Agency, and enter phase IV clinical trials. Other research related to the search for a vaccine:

Genetics

Epidemiology

The prevalence of malaria in the world

Europe

Until the nineteenth century, malaria epidemics could occur even in Northern Europe. The regression of malaria in Europe is mainly due to the draining of swamps. The disappearance of malaria in France so surprised researchers that it was referred to as a "spontaneous" or even "mysterious" disappearance. It appears that this disappearance had several causes. In regions such as Sologne, for example, various agronomic innovations, including those related to land cultivation, could have played an important role in eradicating the disease. The disease began to decline, as elsewhere in Europe, before quinine was used, which was misused at first, given to the sick too late or in too small doses. The use of quinine, however, hastened the disappearance of the disease in those regions where it was already beginning to disappear.

In France

In the capital of France, malaria has disappeared relatively recently. In 1931 it was still present in the Marais poitevin, in Brenne, in the plains of Alsace, in Flanders, in the Landes, in the Sologne, in the Puisaye region, in the Gulf of Morbihan, in the Camargue... In the Middle Ages and until the 15th-16th centuries, malaria was mainly common in villages; the situation did not change even when the rivers in many cities began to be used as transport hubs, even though these rivers periodically flooded in many places. The times of the Renaissance are associated with the revival of fever, religious wars, forcing the inhabitants of cities to lock themselves in walls surrounded by ditches with stagnant water. In addition, rebuilding was taking place in Paris at the end of the nineteenth century, and the work was largely associated with excavations. Water in puddles, ponds and other springs stagnated, which contributed to an increase in the mosquito population and outbreaks of malaria. In addition, a large number of workers carried Plasmodium from infected areas. An unusually severe epidemic in Pitivia in 1802 led to the visit of a commission from the Faculty of Medicine; it was associated with a very large flood, during which the surrounding meadows were covered with water for several weeks. The disease was eradicated from Corsica in 1973. Malaria appeared in these places after the vandal raids. The last epidemic in Corsica, caused by an unimported infection of Plasmodium vivax, was observed in 1970-1973. Notably, in 2006, one local case of Plasmodium vivax infection was observed on the island. Since then, nearly all cases of malaria seen in France have been imported.

Risk zones

After a series of ferocious epidemics that have affected almost the entire inhabited world, malaria affects 90 countries of the world (99 countries according to a 2011 WHO report), mainly the poorest countries in Africa, Asia and Latin America. In 1950, malaria was eradicated from most of Europe and much of Central and South America by spraying DDT and draining swamps. The degeneration of the forests may also have contributed to this; "a 2006 study in Peru shows that mosquito bites are 278 times lower in intact forests than elsewhere". Imported malaria cases were common in Europe in 2006, mainly in France (5267 cases), Great Britain (1758 cases) and Germany (566 cases). In France, 558 cases have been linked to the military, but the disease also affects tourists, out of a hundred thousand tourists who visited malarial areas, three thousand returned home infected with one of the known forms of Plasmodium, the remaining cases are associated with the importation of the disease by immigrants.

The African continent is particularly prone to malaria; 95% of imported cases of malaria in France are associated with African migrants. In North Africa, the risk of infection is close to zero, but in East Africa, sub-Saharan Africa and Equatorial Africa (in both rural and urban areas), the risk is quite high.

In Asia, malaria is absent from major cities and rarely seen in coastal plains. The danger is high in the agricultural areas of Cambodia, Indonesia, Laos, Malaysia, the Philippines, Thailand, Burma (Myanmar), Vietnam and China (in the provinces of Yunnan and Hainan).

In the Caribbean, malaria is common near Haiti and on the border of the Dominican Republic.

In Central America, there are micro-zones of infection, but the risk is relatively low.

In South America, the risk of infection is low in large cities, but it increases in rural Bolivia, Colombia, Ecuador, Peru and Venezuela, as well as in the Amazonian regions.

Important factors in the spread of malaria infection are altitude and ambient temperature.

Some species of mosquitoes (such as Anopheles gambiae) cannot survive above 1000 meters above sea level, but others (such as Anopheles funestus) are perfectly adapted to life at altitudes up to 2000 meters.

Plasmodium maturation inside the mosquito can only be ensured in the ambient temperature range of 16 to 35°C.

WHO fight against malaria

The global program to eradicate WHO was preceded by projects by the International Health Council and then by the Rockefeller Foundation from 1915, but especially after the 1920s. These two organizations, created by John D. Rockefeller, already had experience in campaigning to eradicate hookworm and yellow fever. The Rockefeller strategy of 1924 was based on a break with the tradition of mass introduction of quinine and the regulation of mosquito populations - in particular through drainage works, and was associated only with the eradication of mosquitoes. Then Paris Green was made, a substance that is highly toxic to mosquitoes but not effective on adult mosquitoes. Major programs since the late 1920s have been carried out in Italy and other countries of the Foundation in the Mediterranean region and the Balkans. Despite mixed results, the same policy was carried out in India from 1936 to 1942. Here, in combination with other similar measures, it was possible to achieve impressive, but temporary, results: in 1941, a situation was observed similar to the situation before the start of the program. World War II brought some programs to a halt, but encouraged the expansion of several others: in 1942, the Rockefeller Foundation Health Commission was established to support the efforts of the armed forces and protect soldiers in the frontline areas. The development of DDT, in which the Rockefeller team took part, and the spraying of this insecticide from aircraft in the flooded area west of Rome, helped launch the campaign to eradicate malaria in Italy in 1946. The most famous of the programs carried out was carried out in Sardinia from 1946 to 1951. The program was based on the massive use of DDT, and, despite the controversial environmental consequences, contributed to the elimination of mosquitoes and, as a result, malaria. The Rockefeller Foundation ended its public health and antimalarial program in 1952. The WHO was established in 1948. The Global Malaria Eradication Program was launched in 1955 (at that time the program covered South Africa and Madagascar). After initial notable successes (Spain became the first country officially declared free of malaria by WHO in 1964), the program met with difficulties. In 1969, the XXII World Assembly confirmed its failures, but reaffirmed the Global Goals for the eradication of malaria. In 1972, the Brazzaville faction decided to abandon the goal of eradication and instead take up the mission of disease control. At the 31st World Health Assembly in 1978, WHO agreed to this change: it abandoned the global elimination and eradication of malaria, concentrating only on its control. In 1992, the Amsterdam Ministerial Conference adopted a global strategy for revisiting malaria control. In 2001, this strategy was adopted by WHO. WHO abandoned malaria eradication certification procedures in the 1980s and reintroduced them in 2004. In 1998, the RBM (Roll Back Malaria) partnership was created, bringing together WHO, UNICEF, the United Nations Development Program (UNDP) and the World Bank. Since its founding in 1955, the United States has sought to guard against the importation of malaria through South America and has been a major player in the global eradication program; in addition, they were also motivated by political considerations - the fight against communism. The global effort to control and eradicate malaria is believed to have saved 3.3 million lives since 2000 by reducing deaths due to the disease by 45% worldwide and by 49% in Africa.

Socio-economic impact

Malaria is not only commonly associated with poverty, but is also a major cause of poverty and a major impediment to economic and social development. The disease has negative economic consequences for those regions where it is widespread. A comparison of GDP per capita in 1995, adjusted for the ratio of purchasing power between malaria-affected and non-malaria-affected countries, showed deviations from 1 to 5 (USD 1,526 vs. USD 8,268). In addition, in countries where malaria is endemic, the country's per capita GDP growth was 0.4% per year on average from 1965 to 1990, compared to 2.4% for other countries. This correlation does not mean, however, that the causal relationship and prevalence of malaria in these countries is also partly due to a decline in economic capacity to control the disease. The cost of malaria is estimated at US$12 billion per year for Africa alone. A good illustration is Zambia. If the budget that the country spent on the fight against this disease in 1985 was 25,000 US dollars, then since 2008, thanks to international assistance and PATH (Optimal Technology in Health Program), the budget has become 33 million over nine years. The main goal of budgetary support is to provide mosquito nets to the entire population of the country. At the individual level, the economic consequences include health care and hospitalization costs, lost work days, lost days of attendance at school, reduced productivity due to brain damage caused by the disease. For states, additional consequences are a decrease in investment, including from the tourism industry. In some countries, especially those affected by malaria, malaria costs can reach 40% of total health care costs, 30-50% of patients are admitted to hospitals, and up to 50% attend medical consultations.

Causes of malaria

Anophele, malaria vector

Interactions between Anophele and plasmodium

Transfer phase

The bubbles are released in the sinusoids of the liver (liver capillaries at the junction between the liver and the bloodstream), and then reach the bloodstream and spread there a stream of young "pre-erythrocytic" merozoites, ready to infect red blood cells. Each infected liver cell contains about 100,000 merozoites (each schizont is capable of producing 20,000 merozoites). A true Trojan horse technique is used here to transfer liver cells into the blood. In vivo imaging from 2005-2006 showed that in rodents, merozoites can produce dead cells, allowing them to leave the liver and enter the bloodstream, thus avoiding the immune system). They appear to be in charge of this process, which allows them to hide the biochemical signals that macrophages normally help alert them to. Perhaps in the future there will be new active drugs or vaccines against the exoerythrocyte stage to the stage of invasion into red blood cells.

blood phase

Other modes of transmission

Diagnostics

Symptoms

General fatigue

Loss of appetite

Dizziness

Headache

Digestive problems (indigestion), nausea, vomiting, stomach pain

muscle pain

Clinical signs

Fever

Periodic tremor

Joint pain

Signs of anemia caused by hemolysis

Hemoglobinuria

convulsions

The skin may experience a tingling sensation, especially if P. falciparum is the cause of malaria. The most classic symptom of malaria is the cycling of a sudden sensation of cold and heat, chills and hyperhidrosis for four to six hours, every 48 hours, with P. malariae infection (however, P. falciparum can cause fever every 36 to 48 hours or continuous fever , which will be less pronounced). Severe malaria is caused almost exclusively by P. falciparum infection and typically begins 6 to 14 days after infection. This type of malaria can lead to coma and death if left untreated, especially in young children and pregnant women. Severe headache associated with cerebral ischemia is another non-specific symptom of malaria. Other clinical signs include an enlarged spleen, hepatomegaly, hypoglycemia, and impaired renal function. If the kidneys are functioning, a disease can develop in which hemoglobin from red blood cells leaks into the urine. Severe malaria can progress extremely rapidly and can lead to death within days or even hours, so prompt diagnosis is especially important. In the most severe cases, mortality can exceed 20% even with good medical care. For reasons still poorly understood, but possibly related to intracranial pressure, children with malaria may have postural abnormalities suggestive of cerebral malaria. This type of malaria may be associated with developmental delay because it usually causes anemia during a period of rapid brain development, which may be associated with neurological damage and long-term developmental problems.

Anamnesis

In many cases, even a simple laboratory diagnosis is not possible, and the presence or absence of fever is used as an indicator of the need for further treatment of malaria. However, this method is not the most effective: in Malawi, the use of Romanowsky-Giemsa blood smears showed that unnecessary use of antimalarial treatments was reduced when data from clinical indicators (rectal temperature, nail pallor, splenomegaly) were used instead of a history of fever ( sensitivity increased by 21-41%). Malaria in children is too often misdiagnosed (poor history, poor interpretation of field trials) by local paramedics (members of the community who have received basic training to enable them to provide basic care in the absence of professional medical staff).

Clinical examination

Clinical manifestations of malaria are observed only during asexual reproduction of plasmodia in malaria erythrocytes, which leads to:

severe and recurring fevers;

massive death of red blood cells (direct and indirect), which causes hemolytic anemia and SRH reaction (progressive splenomegaly);

pigmented bile and, consequently, jaundice (hepatomegaly);

worsening of the general condition, which can lead to cachexia.

Additional tests

Microscopic blood tests

Field trials

Others, such as ICT Malaria or ParaHIT, focus on the HRP2164 antigen.

Molecular laboratory method

Different types of malaria

uncomplicated malaria

The diagnosis of malaria may be suspected upon return from endemic areas, characterized by fever, temperature above 40°C, chills, followed by a drop in temperature followed by sweating and a feeling of coldness. Plasmodium vivax and Plasmodium ovale (benign three-day malaria) and Plasmodium falciparum (malignant three-day malaria) and four-day malaria (i.e., an attack occurs every 3 days) are usually distinguished account of Plasmodium malariae (the term "malaria" refers specifically to the four-day fever). Attacks of malaria may recur for months or years with P. ovale, P. vivax, and P. malariae, but not with P. falciparum, if the disease is properly treated and in the absence of reinfection.

Visceral progressive malaria

Malarial cachexia was previously called moderate intermittent fever, anemia and cytopenia, moderate splenomegaly in children from 2 to 5 years. In visceral progressive malaria, the body is noticeably overwhelmed and must be protected at all costs, as the virus consistently affects the blood and tissues of the body:

Chloroquine (Nivaquin) 600 mg (2 tablets of 0.30 g) per day for the first 2 days, then 300 mg (1 tablet of 0.30 g) per day for the next 3 days,

Primaquine 15 mg (3 tablets of 0.5 mg) daily for 15 days, from days 6 to 20 inclusive.

Signs of intolerance to 8-amino-quinolines (dizziness, nausea, diarrhea, cyanosis, hemoglobinuria, agranulocytosis) should be monitored, although this is rarely observed at this dosage.

Severe attacks of Plasmodium falciparum malaria

cerebral malaria

continuous horizontal nystagmus,

sometimes - neck stiffness and impaired reflexes,

in approximately 15% of cases, retinal hemorrhages,

• opisthotonus

  black urine,

  hematemesis, probably due to stomach ulcers due to stress.

Laboratory tests will show:

pulmonary edema, mortality from which exceeds 80%,

impaired renal function (rarely observed in children, but also accompanied by high mortality). Its mechanism is not exactly known.

anemia, which is the result of the destruction and elimination of red blood cells by the spleen, associated with a deficiency in the production of these cells in the bone marrow (bone marrow aplasia). Anemia usually requires a transfusion. Anemia is very dangerous in childhood and is associated with the presence of hemoglobin in the blood, black urine and kidney surgery.

Malarial hemoglobinuria

Another complication associated with malaria is malarial hemolobinuria. This is a rare complication seen in some individuals previously infected with Plasmodium falciparum in highly endemic countries (where a large proportion of the population is affected) and is associated with the ingestion of quinine or other synthetic molecules such as Halofantrine (a derivative of phenanthrene-methanol) (Halfan). The disease is associated with the rupture of red blood cells inside blood vessels (intravascular hemolysis). The clinical examination is characterized by:

high temperature,

shock with prostration,

jaundice

urine samples contain darker hyaline casts (vitreous).

Laboratory examination will show:

• hemoglobinuria (the presence of hemoglobin in the urine, which gives it the color of port wine),

and most often

fatal kidney failure due to destruction of the renal tubules, called acute tubular necrosis.

The disease requires urgent medical attention, because it is associated with a malarial coma. Treatment is aimed at 3 goals:

master oligoanuria (reduction or disappearance of urine output by the kidneys)

deworming the patient

treatment of hemolytic anemia.

Malaria in pregnant women

Transfusion malaria

Transfusion malaria is transmitted through blood transfusions or needle exchanges among drug addicts. In France, there has been an increase in the risk of transfusion malaria in the 20 years leading up to 2005. In 2004, a reduced risk of contracting malaria through blood transfusion was recorded in France. In endemic areas, transfusion malaria is quite common, but this malaria is considered benign due to the semi-immunity of the recipients. Transfusion malaria is most commonly associated with P. malariae and P. falciparum. In this case, the incubation period is very short due to the lack of a preerythrocyte cycle (before the invasion of red blood cells). Transfusion malaria presents with the same symptoms as Plasmodium. However, severe P. falciparum infection is most commonly seen among drug addicts. Treatment with primaquine for P. ovale or P. vivax is not useful due to the difference in transmission cycle of transfusion malaria.

Tropical malaria in children

This type of malaria was originally associated with approximately 1 to 3 million deaths per year. The disease affects mainly Africans and is accompanied by:

neurological disorders with seizures, including coma,

hypoglycemia,

increased blood acidity (metabolic acidosis)

severe anemia.

Unlike other forms of malaria, childhood malaria rarely or almost never causes kidney disease (renal failure) or fluid buildup in the lungs (pulmonary edema). Treatment for this type of malaria is usually effective and fast.

Tropical splenomegaly

The disease is now called hyperimmune malarial splenomegaly and occurs in some individuals living in regions where malaria is endemic. These people show an abnormal immune response to malaria infection, which is reflected, in addition to splenomegaly, by hepatomegaly, an increase in a certain type of immunoglobulin in the blood (IgM, antibodies against malaria), and the number of lymphocytes in the sinusoids of the liver. Liver biopsies and examination under an optical microscope will allow a correct diagnosis. Symptoms:

pain in the stomach,

the presence of a palpable tumor-like formation in the abdominal cavity,

severe abdominal pain (perisplenitis: inflammation of the tissues surrounding the spleen),

Recurrent infections: Complications: high mortality, proliferation of lymphocytes with the appearance of malignant lymphoproliferative disease, which can develop in people with resistance to malaria treatment.

Host protection

Immunity

Genetic factors

Genetic factors may also act as a defense against malaria. Most of the described factors are associated with erythrocytes. Examples:

Thalassemia or hereditary anemia: A subject carrying the SS gene, as a result of a change in the rate of synthesis of globin chains, has poor blood circulation and constantly feels tired.

A genetic deficiency in G6PD (glucose dehydrogenase-6-phosphate), an antioxidant enzyme that protects against the effects of oxidative stress in red blood cells, provides increased protection against severe malaria.

The human leukocyte antigen is associated with a low risk of developing severe malaria. The major histocompatibility complex class I molecule is present in the liver and is a T-cell antigen (because it is located in the thymus) against the sporozoite stage. Encoded by IL-4 (interleukin-4) and produced by T cells (thymus), this antigen promotes the proliferation and differentiation of B antibody-producing cells. antibodies than neighboring ethnic groups showed that the IL4-524 T allele was associated with increased levels of anti-malaria antibodies and resistance to malaria.

Treatment

In endemic areas, treatments are often inadequate and the overall mortality rate for all cases of malaria averages one in ten. Massive use of outdated treatments, drug counterfeiting, and poor medical history are the main reasons for poor clinical evaluation.

Outdated treatments

AKP

Artemisinin-based combination therapy (ACT) is a treatment and tertiary prophylaxis for uncomplicated malaria. A combination of two molecules is used: one molecule is a semi-synthetic derivative of artemisinin, and the second is a synthetic molecule that serves to enhance the effect of the first molecule and to delay the onset of resistance, which leads to an improvement in the outcome of the disease. Since 2001, after conducting phase III clinical trials for the first time in the history of APC, it has become the only WHO-recommended treatment for this disease. AKP drugs are produced in fairly small quantities and are more expensive than chloroquine. Treatment with chloroquine or SP currently costs between $0.2 and $0.5, while APC treatment costs between $1.2 and $2.4, five to six times more expensive. For many patients, this difference is equivalent to the cost of survival. The AKP is only able to afford a few people in Africa. Production on a larger scale and financial assistance from rich countries can significantly reduce the production costs of creating an ACP.

Research directions

Currently, new methods of treating malaria using peptides and new chemical compounds are being studied. Spiroindolones are a new class of investigational malaria drugs. Cipargamine (NITD609) is an experimental oral drug in this class.

Fake drugs

Counterfeit antimalarial drugs are believed to be circulating in Thailand, Vietnam, China and Cambodia; they are one of the leading causes of death that is considered preventable. In August 2007, the Chinese pharmaceutical company Holley-Cotec Pharmaceutical Company was forced to recall twenty thousand doses of artemisinin drug DUO-COTECXIN in Kenya due to counterfeiting of this drug in Asia, containing very few active ingredients and circulating on the market at a price five times less other drugs. There is no easy way to distinguish a fake from a real drug without the use of laboratory analysis. Pharmaceutical companies are trying to fight drug counterfeiting with new technologies to protect their product.

Prevention

Measures for mosquito control or protection against mosquitoes

There are several ways to control the vector of malaria (the female Anopheles malaria mosquito) that can be effective if implemented correctly. The real problem with malaria prevention is the very high cost of treatment. Prevention can be effective for travelers, but the main victims of this disease are people in developing countries. An example is the island of Reunion, where, like other islands in the region (Madagascar and Mauritius), malaria was rampant. Reunion Island was a French colony, so the problem of high cost did not exist, because of which malaria could be eradicated from the island without much difficulty. In countries where malaria is prevalent, two methods of prevention are used. They are aimed, firstly, at protecting people from mosquito bites and, secondly, at eliminating mosquitoes using various means. The main goal of prevention is to limit the number of disease-carrying mosquitoes. In the 1960s, the main method used to eradicate the female malaria mosquito was the massive use of insecticides. The most commonly used DDT (dichloro-diphenyl-trichloroethane). This approach has been effective in many regions, and malaria has been completely eliminated in some areas. The intensive use of DDT favored the selection of resistant mosquitoes. In addition, DDT can cause poisoning and disease in humans, as happened in India, where the substance was misused in agriculture. Despite the fact that this product has been completely banned for use in Europe since 1972, and that since 1992 it has been classified as a POPs (Persistent Organic Pollutant) by WHO, it seems that WHO itself is ready to reconsider its position and start recommending the use of this pesticide again (especially for indoor malaria control). However, without a doubt, DDT:

persistent substance: its half-life is fifteen years, that is, when spraying 10 kg of DDT in the field, fifteen years later there will be 5 kg, after 30 years - 2.5 kg, and so on;

dispersion agent: found in Arctic snows;

accumulates in the environment: animals that absorb it do not die, but do not eliminate it either. The substance is stored in the fatty tissues of the animal, and in particularly high concentrations in animals at the top of the food chain. In addition, its toxicity is a controversial issue, because ingestion of 35 g of DDT can be fatal for a 70 kg person.

In order to replace DDT, which is considered dangerous and less effective, new ways to control the malaria vector are being created:

draining swamps (without disturbing the ecological system), draining stagnant waters in which Anopheles larvae develop;

larval control associated with the distribution of gasoline or vegetable oil; and the widespread use of soluble insecticides on standing water surfaces to try to limit or prevent Anopheles larval births. These measures are quite dubious because they damage the environment;

dispersion in the water of predators that eat Anopheles larvae, such as some mollusks and fish (tilapia, guppies, mosquito fish);

protection and reintroduction of some species of insectivorous bats in regions where they have disappeared (a bat can swallow almost half its body weight in one night)192;

directions related to the sequence of the mosquito genome. The genome provides, among other things, a catalog of detoxification genes and mutant genes that encode proteins that target insecticides as single nucleotide changes called "nucleotide polymorphisms" in the genome:

o use of insecticides and repellents directed only against the malaria mosquito,

o Distribution of sterile male malaria mosquitoes in nature,

These measures can only be effective in a limited area. They are very difficult to apply across a continent like Africa. Individuals can avoid being bitten by the malaria mosquito by using mechanical, physical, and chemical means; First of all, remember that Anopheles is active at night:

installation of mosquito nets (with cells of 1.5 mm) impregnated with permethrin or pyrethroid compounds. Increasingly, these nets are available at very reasonable prices (up to $1.70) or are given free of charge to people in endemic areas. These networks are effective for 3-5 years, depending on the model and conditions of use;

installation of mosquito nets on windows;

use of insecticides (pyrethroids, DDT…) on a small scale for spraying in houses (bedrooms);

installation of an air conditioning unit in residential buildings to lower the temperature and allow air to circulate (the mosquito hates air movements that interfere with its movement and sensory ability);

after sunset: loose, long clothing of light colors and abstinence from alcohol (the malarial mosquito likes dark colors, especially black, and alcoholic vapours);

applying insect repellant cream on skin or clothes during sunset. Among all synthetic repellents, the most effective are those containing DEET (N, N-diethyl-m-toluamide). Diethyltoluamide does not kill insects, but its vapors prevent the mosquito from attacking humans.

Generally, products containing 25 to 30% DEET are most effective for longer periods (± 8 hours against crawling insects and 3 to 5 hours against Anopheles). They are also considered safe for adults and children over two years of age as long as the concentration does not exceed 10%. DEET should not be used by pregnant women and children under three months of age. Products over 30% concentration are not approved. Commercial products are applied to skin, clothing, or mosquito nets. However, they should be used with caution on plastics, certain synthetic fabrics such as nylon, rubber, leather, and painted or lacquered surfaces, as they may damage their surface. You should also beware of direct contact with the eyes and ingestion of these substances. Ball applicators are preferred. Percutaneous absorption is 50% in six hours and is eliminated through the urine. The unremoved part (30%) is stored in the skin and fat.

Repellents

Studies have shown that eucalyptus repellent containing natural eucalyptol oil is an effective non-toxic alternative to DEET. In addition, plants such as lemon balm have also proven to be effective against mosquitoes. An ethnobotanical study conducted in the Kilimanjaro region (Tanzania) showed that the most widely used repellents among local residents are plants from the Lamiaceae family of the genus Basil Ocimum kilimandscharicum and lOcimum suave. A study on the use of essential oils extracted from these plants shows that protection against the bites of certain types of malaria vectors increases in 83-91% of cases, and his desire to suck blood in 71.2-92.5% of cases. Icarilin, also known as CBD 3023, is a new repellent from the piperidine chemical family that is comparable in effectiveness to DEET, but is less irritating and does not dissolve plastics. The substance was developed by the German chemical company Bayer AG and sold under the name SALTIDIN. The gel form of SALTIDIN, containing 20% ​​active product, is currently the best option available on the market. However, all possible side effects of the drug for children are still not fully known. Testing of various repellents available on the market has shown that synthetic repellents, including DEET, are more effective than repellents containing natural active ingredients. Do not spray repellents directly on the skin. Soak clothing or mosquito nets with them. Use them with caution, try to avoid irritation of the nasal mucosa or ingestion. The validity of repellents is about 6 months (less when used on clothing, as it is constantly exposed to friction, rain, etc.). Re-use of the repellent is carried out after processing the item with soap. Caution: Do not wear permethrin-soaked clothing on skin that has previously been treated with DEET.

Pregnant women

Prevention

Preventive regimens

As of March 9, 2006, malaria prophylaxis is carried out at three levels, classified by the level of chemoresistance. Each country is classified into a risk group. Before traveling, you should consult with your doctor.

Group 0 countries

Malaria free areas: No chemoprophylaxis needed.

Africa: Lesotho, Libya, Morocco, Reunion, Saint Helena, Seychelles and Tunisia;

Americas: all cities, Antigua and Barbuda, Netherlands Antilles, Bahamas, Barbados, Bermuda, Canada, Chile, Cuba, Dominica, United States, Grenada, Cayman Islands, Falkland Islands, Virgin Islands, Jamaica, Martinique, Puerto Rico , Saint Lucia, Trinidad, Tobago, Uruguay;

Asia: all cities, Brunei, Georgia, Guam, Hong Kong, Christmas Island, Cook Islands, Japan, Kazakhstan, Kyrgyzstan, Macau, Maldives, Mongolia, Turkmenistan, Singapore and Taiwan;

Europe: all countries including Armenia, Azores, Canary Islands, Cyprus, Russia, Baltic countries, Ukraine, Belarus and European Turkey;

Middle East: all cities, Bahrain, Israel, Jordan, Kuwait, Lebanon and Qatar;

Oceania: all cities, Australia, Fiji, Hawaii, Mariana Islands, Marshall Islands, Micronesia, New Caledonia, New Zealand, Easter Island, French Polynesia, Samoa, Tuvalu, Tonga.

Special case - areas with low malaria transmission Given the low transmission in these countries, it is acceptable not to take chemoprophylaxis, regardless of the length of stay. However, it is important to be able, within a few months of returning, to seek immediate medical attention in the event of a fever. Africa: Algeria, Cape Verde, Egypt, Eritrea and Mauritius;

Asia: Azerbaijan, North Korea, South Korea and Uzbekistan;

Middle East: United Arab Emirates, Oman, Syria and Turkey.

When visiting other countries, it is necessary to use chemoprophylaxis adapted to the area visited.

Group 1 countries

Chloroquine-Free Zones: Chloroquine 100mg: One tablet each day (300mg twice a week can also be taken) for a 50kg person (caution in patients with epilepsy because the substance may cause visual impairment or blindness with prolonged use ).

Group 2 countries

Zones of resistance to chloroquine: 100 mg chloroquine (one tablet every day) and 100 mg proguanil (two tablets every day). Chloroquine and proguanil are taken with meals, in one dose or in half doses in the morning and evening, starting one week before departure and up to one month after returning for a person weighing 50 kg. Atovaquone-proguanil can be recommended as an alternative to chloroquine-proguanil.

Group 3 countries

Zones of increased resistance to chloroquine or multiresistance. Doxycycline 199 (main active ingredient) one 100 mg tablet per day, one day before departure (double dose on the first day) and up to 28 days after returning or after leaving the endemic area (taken with plenty of liquid or with food). Doses for children over eight years of age are divided in two. Doxycycline can be taken for several months, but the drug can lead to phototoxicity (a chemical reaction caused by the excessive presence of a photoreactive substance in the skin that reacts with UV or visible light) and the development of fungal infections on the lips and genitals; not recommended for pregnant women (liver problems) or breastfeeding women and children under 8 years of age (reversible slowing of bone growth and irreversible yellowing of teeth with increased risk of caries). It is a derivative of tetracycline (an antibiotic consisting of four fused rings that can penetrate eukaryotic cells that are part of Plasmodium), sometimes used against malaria in combination with quinine for emergency treatment intravenously. Mefloquine or Lariam 200 (Roche) Composition: 250 mg mefloquine The price of a pack of eight tablets is € 34.26 (in Belgium in 2012). Take one tablet per week, starting a few weeks before departure and up to four weeks after returning. To establish the effective concentration of the drug Lariam in the blood upon arrival, it is necessary to start its use 2-3 weeks before departure. Patients who have never taken this product before are advised to start treatment 2-3 weeks before departure to detect possible side effects (dizziness, insomnia, nightmares, agitation, unexplained restlessness, palpitations). The drug will not be prescribed by a doctor if contraindications are found (desire to become pregnant, first trimester of pregnancy, epilepsy, depression, or a heart rhythm disorder treated with drugs such as beta-blockers, calcium antagonists or digitalis). Treatment should be continued for four weeks after return. If well tolerated, Lariam can be taken for several months or even years. With long-term residence in the country (more than three months), chemoprophylaxis should be carried out as long as possible. Travelers are advised to consult with their physician at their destination to assess the relevance and benefit/risk of chemoprevention. As an alternative to mefloquine, Malaron, GlaxoSmithKline's atovaquone-proguanil mixture, may be recommended. Adult formula: 250 mg atovaquone + 100 mg proguanil hydrochloride Box of twelve tablets - € 44.14 (Prices in Belgium in 2012) Formula for children: 62.5 mg atovaquone + 25 mg proguanil hydrochloride Box of twelve tablets - € 18.48 (Prices in Belgium in 2012) One tablet per day, one day before departure and up to seven days after return. If the drug is started only in the host country, it should be continued for up to four weeks after returning. Malarone is generally very well tolerated during short trips. It can be taken for several months (however, its high cost should be taken into account). The duration of continuous use of atovaquone-proguanil, however, should be limited to three months.

L "estimation est difficile du fait du manque de fiabilité des statistiques dans les pays concernés; en 2005, des chercheurs estimaient dans la revue Nature à 515 millions le nombre de malades en 2002 (dans une fourchette allant de 300 à 660 millions), alors que l "estimation de l" OMS en 1999 dans son rapport sur la santé dans le monde était de 273 millions. Cf. la dépêche de John Bonner du 10 mars 2005 (15:18), "Row erupts over WHO"s malaria "miscalculation"", sur le site du New Scientist [(en) lire en ligne]

Murray CJL, Rosenfeld LC, Lim SS et al. Global malaria mortality between 1980 and 2010: a systematic analysis , Lancet, 2012;379:413-431

(en) Keiser J, Utzinger J, Caldas de Castro M, Smith T, Tanner M, Singer B, "Urbanization in sub-saharan Africa and implication for malaria control", dans Am J Trop Med Hyg, vol. 71, no 2, p. 118-27, 2004]