Malaria

Symptoms: Chills, fever, headache, stomach pain, fatigue (extreme tiredness), diarrhoea, nausea and vomiting

Causes: Plasmodium parasite species, bite of an infected female Anopheles mosquito

Risk Factors: Age, travelling, pregnancy, immune system deficiencies

Prevalence: 249 million cases worldwide (2022). 33.8 lakh cases in India (2022).

Severity: Mild to severe

Which doctor to consult: General Physician, Internal Medicine Specialist, Infectious Disease Specialist, Paediatrician (in case of children)

Overview:

Malaria is a serious infection caused by parasites of the genus Plasmodium. It spreads primarily through the bites of infected female Anopheles mosquitoes. Blood transfusion and contaminated needles can also transmit malaria.

Early symptoms include fever, headache, and chills. Severe symptoms may include extreme tiredness, impaired consciousness, Jaundice (yellowing of the eyes and skin), dark or bloody urine and abnormal bleeding.

Infants, young children, pregnant women, travellers, and people with HIV or AIDS are at higher risk of severe infection.

Avoid mosquito bites by using insecticides, sleeping under treated nets, and covering your body. Antimalarial medications can prevent and treat malaria. Early treatment for mild cases can prevent severe illness.           

Symptoms:

A few individuals with malaria experience cycles of malarial attacks. Typically, an attack begins with chills and shivering, followed by a high fever, then sweating and a return to normal temperature. 

Usually, 10 to 15 days after being bitten by an infected mosquito, symptoms start. Some people may only experience mild symptoms, particularly those who have previously caught malaria. Certain malaria parasite species, however, can remain dormant (inactive) in your body for up to a year.

People with malaria may experience the following symptoms:

• Chills

• Fever

• Headache

• Nausea and vomiting

• Stomach pain

• Diarrhoea

• Fatigue (extreme tiredness)

• Muscle or joint pain

Severe symptoms include:

• Difficulty breathing

• Jaundice (yellowing of eyes and skin)

• Impaired consciousness

• Dark or bloody urine

• Abnormal bleeding

• Multiple convulsions

Causes:

A single-celled parasite belonging to the genus Plasmodium causes malaria. These parasites are transmitted to humans, most commonly through mosquito bites. Here’s how it happens:

Mosquito Transmission Cycle:

• A mosquito bites an infected person.

• The mosquito ingests the parasite along with the blood.

• The parasite matures in the mosquito’s body.

• The infected mosquito then bites a non-infected person, transmitting the parasite into their bloodstream.

• Once inside the human host, the parasites travel to the liver.

• After maturing in the liver, they leave and infect red blood cells.

Types of Malaria Parasites:

There are several species of Plasmodium parasites that cause malaria in humans. Among them, Plasmodium falciparum is the most deadly.

Other modes of transmission:

People can contract malaria by exposure to infected blood as the parasites that cause malaria affect red blood cells. Examples include: 

• From mother to fetus 

• By means of blood transfusions 

• By exchanging drug injection needles

Risk Factors:

Here are some risk factors associated with malaria:

Tropical and subtropical regions: Living in or travelling to regions where malaria is common is the biggest risk factor for developing the disease. These include tropical and subtropical regions of the Pacific Islands, South and Southeast Asia, Sub-Saharan Africa, Central America and Northern South America. 

Immune system deficiency: Malaria can have severe impacts on people who have immune system deficiencies, including HIV.

Pregnancy: Pregnant women are at increased risk of malaria infection due to factors like a lowered immune system, which can reactivate a previous infection or make them more susceptible if bitten by an infected mosquito.

Age: Young children, infants, and older adults are more vulnerable to severe disease.

Travel: Travelers coming from areas with no malaria are at risk, especially if they lack immunity.

Poverty and lack of healthcare access: People living in poverty and without access to healthcare are more likely to have complications from malaria.

Possible Complications:

If you have malaria, you may experience various symptoms, and in some cases, complications can arise. Here are the possible complications associated with malaria:

Cerebral Malaria: This severe form of malaria can lead to swelling of the brain or brain damage. It may cause seizures (fits) and coma.

Breathing problems: Accumulation of fluid in the lungs (pulmonary oedema) can make it difficult to breathe.

Organ failure: Malaria can cause kidney or liver failure. Rupture of the spleen is also a possibility. Any of these conditions can be life-threatening.

Anaemia: Malaria damages red blood cells, leading to anaemia (lack of blood). 

Hypoglycemia (low blood sugar): Low blood sugar can result from severe malaria. Very low blood sugar levels can result in coma or death. 

Remember that complications are more likely if you have immune system deficiencies or if you are not in good health. Even healthy individuals can develop complications from malaria, especially if left untreated. If you experience any symptoms after travelling to a malaria-prone area, seek prompt medical attention. Children and pregnant women in endemic areas are particularly at risk for severe complications.

Certain strains of the malaria parasite, which usually cause milder forms of the disease, can persist for years and cause relapses.

Prevention:

Certainly! Preventing malaria involves a combination of personal protective measures and environmental control. Here are some key preventive strategies to keep in mind:

Avoid mosquito bites: Use insect repellent, cover your arms and legs, apply repellent (sprays containing Permethrin) to clothing, use window screens and sleep under mosquito nets.

Mosquito control: Apply insecticides indoors to kill adult mosquitoes. Avoid pooling stagnant water around your home, as this is where mosquitoes breed. Change pool water frequently.

Antimalarial medications: If you are travelling to an area where malaria is common, take prescribed antimalarial drugs.

Vaccine: Since October 2021, children residing in areas with moderate to high P. falciparum malaria transmission have been advised by WHO to get the RTS,S/AS01 malaria vaccine. It has been demonstrated that vaccination significantly lowers the risk of malaria, including deadly severe malaria, among young children. WHO recommended R21/Matrix-M, a second safe and effective malaria vaccine, in October 2023. It is expected that the availability of two malaria vaccinations will make it possible for a broad-scale development across Africa.

When to see a doctor?

If you get a fever while residing in or shortly after visiting a place with a high risk of malaria, consult your doctor. If your symptoms are severe, seek immediate medical attention.

Diagnosis:

To diagnose malaria, your doctor will request blood tests, perform a physical examination, and evaluate your medical history. The primary diagnostic tests for malaria include:

Microscopy: The diagnosis of malaria mainly involves examining blood films under a microscope. A blood sample is collected, stained, and examined for the presence of malaria parasites. This method allows the identification of parasite species.

Rapid Diagnostic Tests (RDTs): RDTs are widely used due to their high diagnostic performance, availability, and relatively low cost. These tests detect specific malaria antigens (such as histidine-rich protein 2 or Plasmodium lactate dehydrogenase) in a blood sample. RDTs provide rapid results and are particularly useful in resource-limited settings.

Treatment:

Malaria treatment is influenced by numerous factors, such as:

• the type of malaria

• whether a malaria parasite is resistant to a medication

• the age or weight of the malaria patient

• whether the person is pregnant

Medications:

The most common medicines for malaria include:

Chloroquine phosphate: It is the preferred treatment for parasites sensitive to the drug. However, resistance to chloroquine is common in many parts of the world.

Artemisinin-based combination therapies (ACTs): It is a combination of two or more drugs that have different mechanisms of action against the malaria parasite. ACT is usually preferred for chloroquine-resistant malaria. Examples include:

• Artemether+lumefantrine

• Artesunate+mefloquine

Other common antimalarial drugs include:

• Atovaquone+proguanil

• Quinine sulfate with Doxycycline

• Primaquine phosphate

Supportive Care:

In addition to medication, supportive care is crucial. This may include managing symptoms, staying hydrated, and getting adequate rest.

Hospitalization might be necessary in severe situations, particularly if complications arise.

Remember, early treatment improves outcomes, so do not delay seeking medical help if you suspect malaria.