Tropical malaria

Description:

Heavier current is peculiar to this form of malaria but comparison with a tetrian and quartan malaria. There are more also less virulent strains of tropical malaria. Smaller correctness of a feverish curve (fever of remittiruyushchy or even constant type), smaller distinctness of separate stages of a malarial attack is characteristic of tropical malaria. Quite often in the period of decrease in temperature there comes chilling and the second rise, and then the second critical recession of temperature again.

Symptoms of Tropical malaria:

The minimum duration of an incubation interval makes 7 days, fluctuations up to 10 - 16 days. The prodromal phenomena at the end of an incubation interval are characteristic: indisposition, fatigue, headache, joint pains, nausea, appetite loss, feeling of chilling. Initial fever has constant or wrong character, initial fever. Patients with tropical malaria often have no attack symptoms, typical for malaria: the fever is not present or is poorly expressed, the feverish period lasts till 30 - 40 o'clock, temperature falls without sharp sweating, muscular and joint pains are expressed. The cerebral phenomena are noted - the headache, confusion of consciousness, sleeplessness, spasms, quite often develops hepatitis with a cholemia, there are symptoms of respiratory pathology (the phenomenon of bronchitis, bronchial pneumonia); the abdominal syndrome (abdominal pains, nausea, vomiting, diarrhea) is quite often expressed; function of kidneys is broken.
Such variety of organ symptoms complicates diagnosis, is the reason of wrong diagnoses.
Duration of tropical malaria is from 6 months till 1 year.
At the persons who for the first time are meeting with an infection and not having immunity the heavy and complicated tropical malaria, its malignant form can develop: the malarial coma, hemoglobinuric fever, an acute renal failure, an algidny form which is usually connected with very high parasitemia (100 000 plasmodiums in 1 мкл blood).
The malarial coma - cerebral pathology at tropical malaria differs bystry, rough, sometimes in fulminant development and the heavy forecast. In its current allocate three periods: somnolention, a sopor and a deep coma at which lethality is close to 100%.
Quite often cerebral pathology is burdened by an acute renal failure.
Not less heavy current characterizes the hemoglobinuric fever pathogenetic connected with an intravascular hemolysis. Most often it develops at persons with genetically caused enzimopeniya (deficit of enzyme G-b-FD) against the background of reception of antimalarial drugs. Can end with death of the patient from an anury owing to development of an acute renal failure.
The Algidny form of tropical malaria meets less often and is characterized by a choleroid current.

Reasons of Tropical malaria:

The causative agent of tropical malaria - P. falciparum is more adapted for existence in territories with hot climate where the seasonal break of transfer shorter or completely is absent. The specified adaptive mechanisms are expressed in the bigger thermal constants necessary for end of a sporogony, and lack of a phenomenon of a latention in an organism of the vertebral owner.

Treatment of Tropical malaria:

At treatment of tropical malaria with "a malignant current" (a heavy current with development of complications) apply quinine in the form of intravenous slow (within 4 hours) drop injections. In these cases it is recommended to begin treatment with a dose of quinine of 20 mg on 1 kg of body weight, further to use a dose of 10 mg/kg. As the entered liquid apply 5% glucose solution. An interval between intravenous drop injections of quinine — 8 hours. The daily dose of quinine should not exceed 30 mg/kg. Such therapy is carried out to the patient's getting out of serious condition then pass to its peroral introduction. If at the patient the acute renal failure develops, the daily dose of quinine decreases to 10 mg/kg, in view of drug cumulation.
As an alternative method of treatment of this form of tropical malaria, first of all, in areas where resistance to quinine is noted (in particular, in some Areas of Southeast Asia), it is possible to use derivatives of an artemizinin for parenteral (intramuscular or intravenous) the introductions appointed within 7 days (on 25 mg/kg in the first day and 12.5 mg/kg — in the next days) in a combination with one dose of a meflokhin. When peroral or parenteral administration of drugs is impossible (for example, at treatment of heavy malaria in field conditions or at children of early age), it is possible to use артемизинин in the form of rectal suppositories (RectocapO). RectocapO at patients with tropical malaria does not give full parazitotsidny effect, but prevents a lethal outcome and gives time for transportation of the patient in clinic.