Malaria- What is Malaria ?

24 year old Satish works in a MNC in Delhi. One fine Sunday morning he complained of headache, severe body ache. He also said that he had nausea and vomiting. He could barely rise up from bed.  He recorded a temperature of 104 deg F. He was shivering and also feeling cold. He was taken to a doctor and after a battery of investigations diagnosed with malaria.

India corresponds to 70% of malaria in the South East Asian region. Annually India reports two million cases and 1000 deaths.  The forested pockets in Orissa, Jharkhand, Madhya Pradesh and Karnataka are areas where the prevalence of the disease is very high. Malaria they say affects 36% of the world’s population; around 2020 million people in 107 countries are affected.

What is malaria?

Malaria is an infectious disease that is caused by plasmodium parasite which infects the red blood cells and is characterized by fever, body ache, chills and sweating. Similar disease has also been described in the holy Vedas. It derives its name from mal aria which means ‘bad air’ in Italian. Of the four species that cause malaria (plasmodium vivax, plasmodium falciparum, plasmodium ovale, plasmodium malariae) plasmodium falciparum is the most serious and can cause serious complications. An individual can be infected with two species at the same time.

How does one get malaria?

The life cycle of malaria is complicated and it involves two hosts- the human being and the mosquito. Once bitten by a female anopheles mosquito, the malarial parasite enters the blood stream. It travels all through his blood stream to reach the liver. In the liver the parasite matures and multiplies. Some of the parasites stay there whereas the other parasites move out from the liver attacking red blood cells. The parasite then multiplies in the red blood cells. In the next 48-72 hours, more parasites are released into the blood.  This is the reason why the chills of malaria are generally seen after 48 to 72 hours corresponding to the release of the malarial parasite in the blood.

What are the symptoms of malaria?

After been bitten by an infected mosquito, the disease takes around 14 days to manifest. Common symptoms are fever, chills, vomiting, nausea, body ache, headache, cough and diarrhoea.  The cycle of fever and chills usually repeats after 48 hours (this corresponds to the release of parasite from the blood cell). After a few cycles of fever the person also develops anaemia due to breakdown of red blood cells. The spleen which is an organ situated beneath the rib cage on the left side enlarges and is felt in the stomach.

Why is malaria dangerous?

If untreated within 24 hours of the symptoms showing up, it can be a very serious and life threatening disease because of the following complications:

• Severe anaemia caused due to the red blood cells being destroyed.
• Jaundice
• Dehydration
• Cerebral malaria: the infected red blood cells block the vessels in the brain and lead to seizures and coma and eventually death if not treated.
• Very low BP leading to ‘shock’
• Liver failure
• Kidney failure

These symptoms can be more severe in pregnant females, babies and the elderly.

How is malaria diagnosed?

Normally blood is taken from a finger prick at a lab and the parasite is seen within your red blood cells under a microscope. A variety of rapid tests are available that detect the malaria antigen and can diagnose the condition in 10 minutes.

How is malaria treated?

The National Institute of Malaria Research has developed guidelines on diagnosis and treatment of malaria:

• Chloroquine is given to the patient and dose is given depending upon the body weight of the patient. The use of Chloroquine has led to the emergence of many Chloroquine-resistant falciparum malaria cases. For such individuals, a drug called Artemisinin is given.
• Avoid giving anti-malarial drugs on an empty stomach. Always give the first dose under observation.
• Give plenty of fluids
• If no improvement occurs within 48 hours, call the doctor.
• Look for any warning signs of dehydration, reduced urine output, bleeding, seizures or coma.

How can malaria be prevented?

• Mosquitos breed in stagnant water – whether it is a nallah near your house, a pond in the neighbourhood or a water puddle near your house from a long time. Get them closed, cleaned up as soon as possible. Even plants in pots, bird baths, fountains etc should not hold stagnant water. The water in the swimming pools needs to be circulated and chlorinated.
• If you store water in the house due to its shortage, close the container.
• Use mosquito screens, nets, fibre glass meshes or magnetic insect repellent screens for your windows if you live in a mosquito-infested area. If possible, avoid the time immediately after dusk to venture out especially so for children. If you need to, wear clothes that cover your body to a large extent. Cover the exposed parts with a mosquito repellent.
• Indoor residual spraying with an insecticide is also recommended.
• Insecticide treated bed nets should be used in areas where mosquitos and malaria are rampant.
• If travelling to a malaria-endemic area, chemoprophylaxis is given to travellers. Consult your doctor and discuss your travel.