Malaria

Description:

Malaria is a group of local infectious diseases of a protozoan etiology which are transmitted to the person by mosquitoes, with a characteristic paroxysmal recurrent fever, a gepatosplenomegaliya, anemia, jaundice.

Malaria reasons:

The causative agent of malaria are plasmodiums: pl. vivax causes 3-hdnevny vivaks-malaria, pl. ovale – the causative agent of 3-hdnevny malaria, pl. malariae – the causative agent of 4-hdnevny malaria, pl. falciparum causes tropical malaria.
Infection source – the sick person or a gamete carrier. The main way of transfer of malaria – transmissible, and also hemotransfusion, the malaria taken from the patient or at the carrier. Also vertical way of transfer is possible. The susceptibility of the person to a malarial infection makes 100%. Distribution depends on geographical conditions.
All life cycle of a malarial plasmodium passes in a stage of a sporogony and a schizogony.
During the patient's krovososaniye 2 types of gametocytes – macrogametocytes (men's sex cells) and microgametocytes (female sex cells) which turn into macrogametes and microgametes respectively get into a stomach of a mosquito. The following stage of a sporogony – formation of a zygote, and from it – ookletka. In the subsequent the oocyst in which there is multiple fission of a kernel and cytoplasm, forming sporozoita is formed. They get to a hemolymph, and then to sialadens of a mosquito. From this point the mosquito is capable to infect people.
The stage of a schizogony occurs in a human body. At the beginning the fabric schizogony takes place. Sporozoita, getting into hepatocytes, there pass certain stations of development, turning serially in fabric schizonts, fabric merozoites,  and, breaking function of hepatocytes, leave in blood. The stage of an erythrocyte schizogony is characterized by multiple transformations of a merozoite, leading up the begun pathogeny circle to a sporogony stage again.

Malaria symptoms:

The incubation interval depends on the activator: for tropical malaria it makes 8-16 days, for vivaks-malaria – 10-14 days, for 3-hdnevny malaria – 7-30 days, for 4-hdnevny malaria – 21-40 days. For vivaks-malaria the activator development cycle in an organism comes to an end only in 8-19 hours, and sometimes and in 2 years.
The onset of the illness is acute, the intoksikatsionny syndrome is expressed. Complaints to pain in muscles, spin, breast, stomach can take place. Body temperature increases to 39-41C. The initial fever of constant type lasts 3-7 days, in the subsequent the typical malarial paroxysm which proceeds in 3 stages forms: fever, heat, perspiration. The tremendous, sudden fever is characteristic, integuments during this period get a gray shade, tsianotichna lips, the headache, an ache in a waist, nausea, short wind, tachycardia, temperature increase is expressed. Fever duration – 2-3 hours. The stage of heat replaces a fever: temperature increases to 41C, there is an expressed headache, thirst, vomiting, nausea. Integuments are dry, the person is hyperemic, eyes shine. Tachycardia is observed. Duration of a stage of heat from 3 to 8 hours, and at tropical malaria of 24-36 hours. Then plentiful, profuse sweat is observed, body temperature can decrease to subnormal, pulse urezhatsya, the ABP falls, features are pointed.
Then increase in a liver and spleen is diagnosed, there can be jaundice.

Complications:

- malarial coma
- malarial алгид (infectious and toxic shock)
- acute intravascular hemolysis
- acute renal failure
- fluid lungs
- malarial hepatitis
- anemia
- nephrosonephritis
- rupture of a spleen
- syndrome of a tropical splenomegaly ("disease of a big spleen")

Diagnosis:

For diagnosis of malaria use paraclinic researches:
1. Parasitological: a research of a thick drop and a thin blood smear for the purpose of identification of a malarial plasmodium and degree of a parasitemia.
2. Serological methods – RIF, REMA, IFA, RIGA.
3. All-clinical isslovaniye of blood find hypochromia anemia, a poikilocytosis, an anisocytosis, a reticulocytosis, thrombocytopenia.
4. In the general analysis of urine the proteinuria, a cylindruria, an erythrocyturia, a leukocyturia takes place.
5. In biochemical blood test: increase in level of hepatic tests.

Treatment of Malaria:

The diagnosed malaria or suspicion on it is the indication to hospitalization in infectious department.
In the period of a fever the dietary table No. 2 or No. 5 is shown, at normalization of temperature - No. 15. At a severe disease, at development of complications it is necessary to adhere to a bed rest, in other cases – the mode ward.
Causal treatment:
1. Concerning malaria ovale, vivax and malariae is effective chloroquine (делагин) according to the scheme: 1 g of drug, in 6-8 hours – 0,5 g is appointed to the first reception. For 2-3 days – on 0,5 g disposable. Kruus – 5 days. Primachinum is applied within 14 days in a dose 0,027 once a day, or by 7 days in the same to a dose, but 2 times a day. Use of one chloroquine does not exempt an organism from fabric forms.
2. For treatment of tropical uncomplicated malaria: quinine per os hydrochloride on 0,5 g 3 times a day in a combination with doxycycline on 1,0 g 2 times a day 7 days. Doxycycline replacement with clindamycin of 0,4 g 3 times a day is possible. An alternative is мефлохин on 15 mg/kg once. For the purpose of gametocidal action apply Primachinum on 0,027 g within 3 days once a day.
3. With a heavy current it is necessary to apply intravenous drop infusions on 10 mg/kg of quinine of a hydrochloride to tropical malaria, parting  in normal saline solution. Treatment is supplemented with clindamycin or doxycycline.

Also the complex of antimalarial treatment includes disintoxication therapy by crystalloids and colloids.