Every thing you want to know about Malaria

Malaria

Definition of Malaria :

-acute and chronic parasitic disease transmitted by the bite of infected mosquitoes and it is confined mainly to tropical and subtropical areas.

Etiologic Agent:

 Four species of protozoa:

1.       Plasmodium falciparum

2.       Plasmodium vivax

3.       Plasmodium malariae

4.       Plasmodium ovale

The primary vector of malaria is the female Anopheles mosquito.

> breeds in clear, flowing, and shaded streams usually in the mountains

> bigger in size than the ordinary mosquito

> brown in color

> night-biting mosquito

> usually does not bite a person in motion

> assumes a 36 degree position when it alights on walls, trees, curtains, and the like.

Incubation Period of Malaria

12 days for P. Falciparum

14 days for P. vivax and ovale

30 days for P. malariae

Period of Communicability: untreated or insufficient treated patient may be the source of mosquito infection.

Mode of Transmission of Malaria

Through the bite of an infected female anopheles mosquito.

Parenterally through blood transfusion.

Occasionally, transmitted from shared contaminated needles.

Transplacental transmission for congenital malaria (rare)

Clinical Manifestations of Malaria

1. Paroxysms with shaking chills.

2. Rapidly rising fever with severe headache

3. Profuse sweating

4. Myalgia, with feeling of well-being in between

5. Splenomegaly, hepatomegally

6. Orthostatic hypotension

7. Paroxysms may last for 12 hours, then, maybe repeated daily or after a day or two.

8. In children:

a. fever maybe continuous

b. convulsions and gastrointestinal symptoms are prominent

c. splenomegally

9. In cerebral malaria:

a. changes in sensorium, severe headache, and vomiting

b. Jacksonian or grand mal seizure may occur

Diagnostic Procedure of Malaria

Malarial smear – a film of blood is placed on a slide, stained, and examined microscopically.

 Rapid diagnostic test (RDT) –blood test for malaria that can be conducted outside the laboratory and in the field.

- gives a result within 10-15 minutes.

- detect malarial parasite antigen in the blood.

Pathogenesis of Malaria

·         The parasite enters the mosquito’s stomach through the infected human blood obtained by biting or during blood meal.

·         The parasite undergoes sexual conjugation.

·         After 10 to 14 days, a number of young parasitesare released and invade the salivary gland of the mosquito.

·         The organisms are carried in the saliva into the victim when the mosquito bites again.

·         The parasites invade the RBC where they grow and undergo asexual propagation.

·         RBC ruptures or bursts releasing tiny organisms (merozoites)

·         Merozoites invade new batch of RBC to start another schizonic cycle.

·         Indefinite malaise and slowly rising fever occur for several days.

·         There is shaking chills, rapidly rising temperature, and profuse sweating.

Management of Malaria

·        Medical

a.       Anti-malarial drugs

-          Chloroquine

-          Quinine

-          Sulfadoxine for the resistant P. falciparum

-          Primaquine for relapse of P. vivax & ovale

b.      Erythrocyte exchange transfusion for rapid production of high levels of parasites in the blood.

·         Nursing Management

b. The patient must be closely monitored.

c. Intake and output should be closely monitored to prevent pulmonary edema.

> daily monitoring of patient’s serum bilirubin, BUN creatinine, and parasitic count.

> if the patient exhibits respiratory and renal symptoms, determine the ABG and plasma electrolyte.

c. During the febrile stage, tepid sponges, ice cap on the head will help bring the temperature down.

d. Application of external heat and offering hot drinks during chilling stage is helpful.

e. Provide comfort and psychological support.

f. Encourage the patient to take plenty of fluids. g. As the temperature falls and sweating begins, warm sponge baths maybe given.

h. The bed and clothing should be kept dry.

ii. Watch for neurologic toxicity (from quinine infusion) like muscular twitching, delirium, confusion, convulsion, and coma.

j. Evaluate the degree of anemia.

k. Watch for any signs especially abnormal bleeding.

l. Consider severe malaria as medical emergency that requires close monitoring of vital signs.

Prevention and Control of Malaria

·         Malaria cases should be reported.

·         A thorough screening of all infected persons from mosquitoes is important.

·         Mosquito breeding places must be destroyed.

·         Homes should be sprayed with effective insecticides which have residual actions on the walls.

·         Mosquito nets should be used especially when in infected areas.

·         Insect repellents must be applied to the exposed portion of the body.

·         People living in malaria-infested areas should not donate blood for at least 3 years.

·         Blood donors should be properly screened.