Treatment of Malaria

The malaria is an intracellular protozoan infection, endemic in tropical and subtropical countries. Large number of drugs are being used worldwide for the treatment of malaria. Four species of the protozoal parasite Plasmodium cause all infections in human beings and these are: Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium falciparum. The effectiveness of the antimalarial drugs may differ with the species and stage of parasite and the parasite load in the liver and blood circulation. The parasites are inoculated into the human host by blood sucking female anopheline mosquitoes. The sporozoites from the infected mosquito reach the liver and develop into tissue schizonts. These tissue schizonts then rupture, form free merozoites and invade erythrocytes or red blood cells (RBCs) and develop as erythrocytic schizonts and lead to rupture of RBCs. There are different groups of antimalarial drugs for the stages of malarial parasites in the liver and erythrocytes.

Chloroquine (4-aminoquinoline) has been used extensively for the treatment and prevention of malaria. It has considerable efficacy for the treatment of Plasmodium vivax, Plasmodium malariae and Plasmodium ovale infections, however, widespread resistance has been seen against Plasmodium falciparum infection. Effective suppressive prophylaxis has been documented with chloroquine, mefloquine, proguanil and doxycycline as these are schizonticidal drugs. Proguanil and primaquine are best known for causal prophylaxis as these drugs effectively kill the hepatic stages of the parasite. Quinine, chloroquine, primaquine and artemisnins are established gametocidal drugs also. Sulfonamides (sulfadoxine and dapsone) and aminoalcohols (halofantrine and lumefantrine) are also used in the treatment of malaria but are more toxic drugs. The drug toxicity may lead to acute hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD)deficiency. Consult your physician for the diagnosis and treatment of malaria.

What causes Malaria ?

The malaria is a protozoan infection endemic in tropical and subtropical countries. Four species of the protozoal parasite Plasmodium cause all infections in human beings and these are: Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium falciparum. The malaria remains the most devastating infection worldwide with around 500 million clinical cases every year.

The symptoms of malaria may be non specific like: high grade fever, lack of sense of well being, headache, muscle aches, fatigue and sometimes chest pain also. The clinical presentation of malaria depends on the species of the parasite, parasite load in the blood circulation, patient's immune status and presence of other diseases. The classical malarial symptoms are fever spikes with chills and rigors at regular intervals. Enlargement of spleen is very common among otherwise healthy individuals in the endemic areas. In untreated cases of malaria, mild jaundice and slight enlargement of liver are also common. The enlargement of spleen and liver may be more pronounced in infants and children. Plasmodium falciparum causes the most severe disease and may lead to cerebral malaria, hypoglycemia (low level glucose in blood), lactic acidosis, pulmonary edema swelling of lungs) and impairment of kidney function.

Malaria: Prevention Is Better Than Cure

Malaria could be a serious and life threatening disease if not diagnosed and treated properly. Treatment of malaria had been known to general physicians even before the discovery of causative organism, the Plasmodium, a parasite. The parasite of malaria was discovered by Laveran in 1880 and in 1898, Sir Ronald Ross worked out the mosquito cycle with parasite of birds. There are four known species of malarial parasite causing malaria in human beings. These species are Plasmodium vivax, Plasmodium ovale, Plasmodium falciparum and Plasmodium malariae. Infection is caused by bites of infected female Anopheles mosquitoes. The incubation period for P. vivax and P. ovale is around two weeks, for P. falciparum 8-12 days and for P. malariae incubation period is three to four weeks. The surest way of diagnosing malaria is through microscopic examination of peripheral blood film. Anyone having high grade fever (around 104 to 105^o F) and chills should get tested for malaria. Febrile paroxysm (bout of fever) starts generally in the early afternoon however it may start at any time if mixed infection (infection of two or more malarial parasite species). Malarial parasites of animals (P. berghei of rats and mice, P. knowlesi of monkeys etc) do not infect human beings. Each paroxysm shows a succession of three stages:

1. The cold stage: Lasting 20 minutes to one hour.


2. The hot stage: Lasting one hour to 4 hours.


3. The sweating stage: Lasting 2 to 3 hours.
   

The total duration of the febrile cycle could be from 6 to 10 hours. The febrile cycle may vary with the species of malarial parasite. Malarial parasites are found in all countries extending from 40^o south to 60^o north. The tropical zone is the endemic home of all malarial parasites infecting man. Prevention: Malaria eradication could only be possible through coordinated efforts of the people and the government agencies involved in the control of mosquitoes since malaria is a serious public health problem in all the tropical and subtropical regions of the world. If you go through the pages of the history of science and malaria, you would find that malaria had taken more human lives than any other disease. To control mosquito breeding always keep storage water tanks covered with mosquito tight lids. Larvae eating fish (gambusia or guppy) should be introduced in stagnant water ponds. Insecticides should be sprayed regularly at home, the work place and drains. Use mosquito nets at night and protective clothing during the day time. Consult your physician and take prophylactic medicine if malaria is endemic. Prevention is always better than cure since it saves our money, time and health.