Definition of Malarial

Today is our topic of discussion Definition of Malarial

Table of Contents

Vector-borne disease:

These are the diseases caused by an infectious microbe that is transmitted to human by blood-sucking arthropods (mosquitoes, fleas, lice, biting flies, bugs, mites and ticks). Example – Malaria, filarial, dengue and kala-azar.

Definition:

Malaria is a protozoal disease caused by infection with Plasmodium and transmitted to man by infected female Anophelene mosquito.

Bangladesh situation:

About 12 million people in 13 districts of the north-eastern border belt live in malaria high-risk areas. The three Hill Tract Districts (Bandarban, Khagrachari and Rangamati) and Cox’s Bazar report more than 80 percent of the malaria cases and deaths every year. These areas experience a perennial transmission of malaria with two peaks in pre-monsoon (March-May) and post-monsoon (September-November) periods.

Epidemiological determinants:

Agent factors:

Agent:

a. Plasmodium vivax

b. Plasmodium falciparum

c. Plasmodium malarie and

d. Plasmodium ovale

Reservoir of infection:

Human

Period of communicability:

As long as gametocytes exist in blood to infect vector mosquito.

Host factors:

Age:

All ages are affected.

Sex:

Males are at risk than females.

Pregnancy:

Pregnancy increases risk.

Socio-economic development:

Malaria has positive relationship with poor socioeconomic development.

Housing:

Ill-ventilated and ill-lighted houses provide ideal indoor resting places for mosquitos.

Population mobility:

Migration of people help spread of malaria.

Occupation:

Malaria has positive relationship with agricultural practices

Human habits:

Sleeeping out of doors, reluctant to use mosquito nets etc. has a role.

Immunity:

Immunity to malaria is acquired only after repeated exposure over several years.

Environmental factors:

Geographic and climatic conditions are favourable to transmission.

Vector of malaria:

Female anopheline mosquito.

Mode of transmission:

Vector transmission: Bite of an infected female anopheles mosquito to human to feed blood.
Direct transmission: Blood transfusion.
Congenital: Congenital infection of the newborn from an infected mother may occur.

Incubation period:

7 to 12 days (may be 4 to 6 months) after beaten by an infected mosquito.

Life cycle of plasmodium (malaria parasite):

On entering human, the plasmodium undergoes a series of changes (asexual cycle) until reaches a sexual stage, in the gut of mosquito (sexual cycle)-

Sexually mature parasite transmitted to a person by bite of the mosquito Sporozoites discharged from the salivary glands of mosquito→ Develop in hepatocytes (exoerythocytic/pre-erythrocytic cycle) as schizonts →Transform and discharge as merozoites into bloodstream → Merozoites infect RBC → Develop into schizonts and merozoites→ Reinfecting other RBC (erythrocytic cycle) → Destruction of RBC and release of the parasite’s waste products produce the episodic chills and fever → Some merozoites from blood transform into gametocytes → Taken by mosquito→ Sexual development in the gut of mosquito.

Clinical features:

The classical malaria has typical pattern of fever with paroxysm. Between paroxysms temperature is normal. Stages of fever run sequentially as below-o

Cold stage – Feeling of intense cold, vigorous shivering, rigor, lasts 15 to 60 minutes.com
Hot stage – Intense heat, dry burning skin, lasts 2 to 6 hours.
Sweating stage – Profuse sweating, declining temperature, exhausted, weak →→→ sleep, lasts 2-4 hours.
Advanced stage: Plasmodium clogs the capillaries of brain and other organs. 5. Features of complication.

Uncomplicated malaria:

Symptomatic malaria without signs of severity or evidence (clinical or laboratory) of vital organ dysfunction.

Diagnosis:

Blood TC, DC: Leucopenia with monocytosis and anaemia
Blood for MP: Demonstration of malaria parasite in the blood film.oitti to lev
Rapid diagnostic tests

Treatment of malaria:

Empirical treatment –

Suspected uncomplicated malaria:

Choloroquine tablet (150 mg base):

1st day 4 tabs. (600 mg)

2nd day 3 tabs. (450 mg)

3rd day 3 tabs. (450 mg)

Malaria in chloroquine sensitive area:

Tab. Chloroquine (150 mg) – 4 tablets (600 mg) at diagnosis followed by 2 tablets (300 mg) in 6 hours then I tablet (150 mg) two times daily for 3-7 more days (initial dose for children 5-15 mg/Kg).

Infection with P. falciparum in chloroquine resistant area:

Tab. Quinine 600 mg (10 mg/Kg) – 3 times daily till better (usually 3-5 days) followed by a single dose of 3 tablets of Fansider (sulfadoxine 1500 mg combined with pyrimethamine 75 mg).

Uuncomplicated P. falciparum malaria (WHO recommended ):

Artemether plus lumefantrine (fixed-dose formulation containing 20 mg of artemether and 120 mg of lumefantrine) – bd for 3 days (total 6 doses) with each dose as follows –

5-14 kg: 1 tablet

15-24 kg: 2 tablets

25-34 kg: 3 tablets; and

> 34 kg: 4 tablets

Uncomplicated P. falciparum malaria in pregnancy:

First trimester: Quinine plus clindamycina – 7 days (artesunate plus clindamycin for 7 days if this treatment fails).

Second and third trimesters: Quinine plus clindamycin for 7 days.

Treatment for severe malaria/cerebral malaria:

Hospitalization
Inj. Quinine (10 mg/Kg) or Chloroquine 5 mg/Kg: IV infusion with 5% DA over 2-4 hours; repeated at intervals of 8-12 hours until able to take oral drugs which can be given upto 12 doses with each dose of 600 mg.
For pyrexia: Paracetamol desbalgne ni ommagoiq forinos sielam lo esfuma
For cerebral oedema: IV mannitol & dexamethasone
For anaemia: Packed cell transfusion
Maintenanace of fluid balance
For oliguria: Inj. Frusemide
General supportive care

Complication of malaria/falciparum/severe/complicated malaria:

Severe anaemia
Organ damage due to anoxia:

a. Brain: Confusion and coma

b. Kidney: Dark urine or no urine (renal failure)

c. Lungs: Cough, pulmonary oedema

d. Intestine: Diarrhoea

e. Liver: Jaundice

Intravascular haemolysis: Blackwater fever
Hypoglycaemia Cosmins amon bus aizonga) 1902 (
Hyperpyrexia
Metabolic acidosis
Splenic rupture
In pregnancy: Maternal death, abortion, still birth, and LBW

Prevention and control of malaria:

Management of malaria cases in community:

Case detection
Treatment
Mass drug administration

Active intervention to interrupt malaria transmission with community participation:

Planning and development of control strategy:

To maximize the utilization of resources.

Vector control strategies:

Anti-adult measures:

Spraying of insecticides periodically: DDT, malathion & fenitrothion
Space application: Application of insectcide in the form of fog or mistila 1
Individual protection: Promotion of use of Insecticide Treated Nets by people at risk.

Anti-larval measures:

Larvicides: Oiling the collections of standing water or dusting them with ‘paris green’
Source reduction: Adoption of techniques to reduce mosquito breeding sites.
Integrated control: Integration of bioenvironmental and personal protection measure.

Campaigning:

Increasing awareness of the people for vector control.

Difficulties of malaria control programme in Bangladesh:

Health system mismanagement
Development of drug resistance
Unplanned urbanization and development activities
Deteriorating sanitation
Lack of awareness
Climate change
Uncontrolled population migration llamosvormingplaterials to offe
Poor socio-economic condition

Roll Back Malaria (RBM):

It is the programme by WHO started in 1998 in Bangladesh. The vision of the programme is to make ‘every house in the community shall be the hospital for malaria and the community it’s outdoor.

The ultimate aim of the programme is empowering the community for control of malaria through six elements –

a) Evidence based dicision

b) EDPT (Early Diagnosis and Prompt Treatment)

c) Multiple prevention

d) Focused research

e) Well coordinated actions

f) Dynamic global movement operating at the community level.

See also :

Stem cell banking pros and cons