MALARIA

Malaria

Malaria is caused by the protozoa of the genus plasmodium, transmitted to man almost always by the infected female anopheles mosquito.

Depending on the period of invasion. Multiplication and finally rupture of the red cell. Febrile episodes occur at varying intervals.

This cycle in the red cells takes 48 hours for P. vivax and P. ovale resulting in tertian periodicity. P. malariae takes 72 hours resulting quartan fever. P. falciparum takes shorter period and produces more constant fever.

The incubation  period is 10-15 days. Clinical manifestations vary according to different species of plasmodium.

Malaria should be considered as one of the causes of   P. U.O.

A typical paroxysm may be divided into 3 stages:

 

    1. A cold stages

    2. The hot stages

    3. Sweating stages

Tertian malaria

Paroxysm occur on alternate days. Spleen becomes palpable during the second week.

Quartan malaria :

   

    (a). paroxysm occur at an interval of 2 days.

    (b). clinical features simulating acute nephritis namely scanty urine.

    (c). albuminuria and haematuria may occur.

    (d). chronic form of the disease may be associated nephrosis.   

       

Falciparum malaria:

    (a) The onset may be insidious and the fever continuous, remittent or irregular.

     (b) Typical paroxysms are unusual.

     (c) Splenomegaly occurs of few days.

     (d) Serious complications may suddenly develop producing malignant symptoms. and more Doctor here

                                                              

The pernicious manifestations include:

1. Cerebral malaria

2. Hyperpyrexia

3. Gastro-intestinal type.

4. Algid malaria

5. Pulmonary oedema

6. Renal failure

7. Hypoglycemia

8. Spontaneous bleeding and disseminated intravascular Coagulation (DIC)

9. Black water fever

Treatment

*Acute attack of al forms of malaria:

   The initaial treatment of acute malaria is the same irrespective of its rype.

1. In uncomplicated cases:

    (a). Chloroquine diphosphate  or chloroquine sulphate, 600mg of base initially; 300mg of base after 6 hours; then 300mg of base daily for 3-6 days, or,

   

    (b) Amodiaquine-600mg base followed 6 hours later by 400mg – 1^st then 400mg base        daily for 3-6 days

   

2.In special circumstances:

    (a) Quinine dihydrochloride : This is available as ampoules containing 600 mg in 2 ml (300mg/ml).One ampoule (60 mg) is to be diluted with 500 ml of 5 percent dextrose in normal saline and administered slowly by intravenous drip in 4 hours. It may be repeated, if necessary, after 8 hours.

   (b) Comatosed patient should also receive: Dextran75 , one unit every 12 hours by drip to reduce intravascular sludging.