Malaria – Symptoms, Complications and Diagnosis
Overview
Malaria is a disease caused by a parasite that is transmitted to humans through the bites of infected mosquitoes. The mosquito that spreads malaria is called Female Anopheles mosquito. This mosquito carries the parasites named Plasmodium that enters the human bloodstream through the mosquito bite. When the mosquito bites the infected person, it sucks the blood containing the parasite. When the same mosquito bites a healthy person, it releases Plasmodium into the blood of that person. Once the parasite enters the human bloodstream, it travels to the liver where it matures and multiplies in number. As the parasites mature and grow in number, they start entering the human bloodstream and infecting the red blood cells. Eventually, they damage the red blood cells and cause symptoms of malaria to occur.
The cause of malaria fever, Female Anopheles mosquito, thrives under hot temperature and humid weather conditions. For this reason, malaria is a common disease in tropical and subtropical regions. In 2018, approximately 228 million cases of malaria were registered out of which 93% belonged to the African Region, 3.4% cases were from the South-East Asian Region and 2.1% were from East Mediterranean Region. The number of people who did not receive proper malaria treatment and died in 2018 is close to 405000 and 67% of these people where children. The reasons why these areas are most affected by this disease are the delayed diagnosis of malaria, lack of information regarding malaria symptoms and its treatment. Children and pregnant women are most vulnerable to malaria, as their immunity to fight the disease is weak.
Female Anopheles is the transmitter of malaria. So, it is very rare that malaria fever gets transferred from one person to another. Though less often, the infection can be passed from a woman to her child during pregnancy or transmitted through blood transfusion, organ transplant or use of contaminated syringes.
Malaria Fever can be life-threatening. After the mosquito bite, it takes 7 to 30 for the symptoms of malaria fever to surface. This period of 7 to 30 days is called the incubation period. Malaria has several symptoms. But these symptoms vary, depending on the type of malaria a person is affected by. There are two types of malaria. Let’s talk about these two types of malaria and their symptoms.
Uncomplicated Malaria
Symptoms of uncomplicated malaria are similar to that of common flu. Symptoms of uncomplicated malaria are:
- Fever
- Chills
- Sweating
- Nausea and vomiting
- Headache
- Diarrhoea
- Feeling of weakness and illness
When a person is affected by uncomplicated malaria, its symptoms initially stay for 6 to10 hours. They disappear for some time after this and then reoccur every alternate day. The symptoms of malaria fever surface in stages which are:
- In the first stage, the person feels cold and start shivering
- In the second stage, the person suffers fever, headache, and vomiting
- In the last stage, the person sweats a lot and stays fatigued
Uncomplicated malaria diagnosis usually gets delayed as symptoms of this type of malaria fever resemble that of a common flue. This further leads to a delay in malaria treatment and as a result, it gets converted into severe malaria. Let’s understand what severe malaria is.
Severe or Complicated Malaria
The cause of severe malaria fever is parasite Falciparum. Severe malaria can lead to organs dysfunction and even failure. Hence, severe malaria symptoms must be detected as early as possible and the person should be given required malaria treatment. Here are some of the symptoms of severe malaria.
- Severe anaemia
- Vital organ dysfunction and failure like kidney dysfunction
- Jaundice
- Severe anaemia
- Prostration
- Lying in prone position
- Unconsciousness
- Seizures
- Confusion
- Convulsions
- Deep breathing and respiratory distress
Severe malaria is the major reason behind the high mortality rate worldwide. The regions that are most affected by severe malaria are African regions, South-East Asian regions, and Eastern Mediterranean Region and Western Pacific Region. These areas lack proper malaria treatment and hence, the number of people infected with malaria is high and so is the death rate.
Complications
Delayed diagnosis of malaria symptoms and treatment can result in serious complications like:
- Cerebral malaria: Swelling of the brain or brain damage may occur if parasite filled blood cells block small blood vessels to the brain.
- Breathing problems: Fluid gets accumulated in the lungs and leads to difficulty in breathing.
- Organ failure: Malaria can cause kidneys or liver failure or rupture the spleen.
- Anaemia: Due to Malaria, red blood cells get damaged which can result in anaemia.
- Low blood sugar: Severe forms of malaria itself can cause low blood sugar.
Diagnosis
Malaria can be prevented from becoming severe and life-threatening, if malaria symptoms are diagnosed and treatment is started on time. Anyone showing signs of malaria should get the tests done and start with treatment immediately.
If your doctor suspects that you have malaria, he might prescribe you following tests for malaria diagnosis:
- Thick and Thin Blood Smears
Thin Blood Smears: A small drop of blood is applied and spread onto a glass slide and then treated with a special stain to examine under a microscope for the morphology of infected cells and parasites.
Thick Blood Smears: A larger sample of blood is examined under the microscope so that the parasites are more likely to be seen. The number of infected red blood cells can also be calculated to determine the degree to which a person is infected.
2. Rapid Diagnostic Tests RDT (Rapid Diagnostic Test) is a strip, which detects malaria Antigens in a blood sample collected. If infected, the colour of strip changes indicating that the host is infected.
3. Molecular Test (Polymerase Chain Reaction) This test is done where microscopic examination is not possible for malaria. It is used to determine the species of parasite. It is useful for cases in which the number of malaria parasites in the blood is low or when there are different types causing the infection.
4. Antibody Testing (Serology) These tests detect antibodies in the blood that are produced by the body in response to malaria infection. They usually cannot diagnose an acute infection but help determine if a person was previously exposed or not.
5. Susceptibility Testing Malarial parasites have become resistant to the drugs commonly used to treat infections. This test is done to find out how much the parasite is drug susceptible.
Prevention
Causes of malaria fever are the mosquitoes carrying Plasmodium. These Mosquitoes are most active between dusk and dawn. Following steps can be taken to stay protected from mosquito bites:
- Wear clothing that covers most of your body
- Apply insect repellant to skin and clothing
- Use an insect repellent that contains DEET or picaridin.
- Use a spray containing permethrin on clothing.
- Use mosquito nets and bed nets
For people travelling to areas affected by malaria, taking the above-mentioned preventive measures to become even more important as they lack immunity to fight this disease. They should consult their doctor and ask for medicine to protect themselves from getting infected with malaria. Often, the drugs given to prevent malaria are the same as the drugs used for malaria treatment.
Malaria can relapse. Therefore, people who underwent malaria diagnosis and got it treated should take preventive measures as well.
Treatment
The purpose of malaria treatment is to destroy plasmodium parasite travelling in a person’s bloodstream. Commonly used drugs to treat malaria after its diagnosis are chloroquine, doxycycline, quinine, and mefloquine. However, the choice of drug depends on factors like:
- Kind of parasite that has infected the person
- The severity of the symptoms
When the medicine is given based on the kind of parasite infecting the person, at times it happens that the prescribed medications are incapable of combating the parasite because of parasite’s resistance to the drug. In such cases, doctors are more than one medicine or change the course of malaria treatment.
Malaria is a disease that causes severe illness and death in tropical and subtropical counties. Therefore, several international labs are conducting research and testing to develop a vaccine to fight Malaria. Till the time R&D is being carried out, the World Health Organization recommends that artemisinin-based combination should be used to treat uncomplicated malaria.
