Malaria

Symptoms Of Malaria

Malaria is an acute febrile illness which can cause a wide variety of symptoms that range from no symptoms in the early course of infection to severe symptoms and even death. After a bite by the infected Anopheles mosquito, it usually takes around a week to a month for the first symptom to appear. This period is known as the incubation period. The incubation period for an infection with P.falciparum (a type of malarial parasite, Plasmodium) is shorter as compared to the one with P.malariae (another malarial parasite).

The symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death. Some people with malaria experience cycles of malaria "attacks”, which usually starts with shivering and chills, followed by a high fever and sweating before it returns to normal temperature.

The attacks (malarial paroxysm) occur in three stages:

•  Cold stage -- sudden feeling of cold and shivering
•  Hot stage -- high fever
•  Sweating stage --stage before the temperature returns to normal

Other symptoms include:

•  Headache
•  Nausea and vomiting
•  Body pain especially in the muscles and joints
•  Loss of appetite

In severe cases, symptoms that may occur include:

• Anemia
• Bleeding
• Jaundice
• Convulsions

Causes Of Malaria

Malaria is caused due to a bite by a female anopheles mosquito infected by the Plasmodium parasite. The bite transfers the parasite (sporozoites) into the blood which travels to the liver. In the liver, the parasites mature and multiply to form merozoites. This is followed by an invasion of the red blood cells that causes malaria.

Since the malaria parasite is found in red blood cells of an infected person, it can also be transmitted rarely through blood transfusions, organ transplant or by shared use of contaminated syringes or needles. Other mode of transmission can be from infected mother to child during pregnancy or labour.

In humans, malaria is caused by five different species of the parasite. These are P. falciparum, P. malariae, P. ovale, P. vivax and P. knowlesi. Among these, P. falciparum is the most common one (~75%) followed by P. vivax (~20%).

In India, malaria is mainly caused by P. vivax and P. falciparum. Malaria due to P. vivax is more prevalent in plain areas, while P. falciparum is responsible for most of the malaria cases in hilly areas and those covered with forests.

Risk Factors For Malaria

The following factors are associated with high rates of malarial transmission:

• Staying or travelling to regions where malaria is endemic or highly prevelent. These include tropical, subtropical or areas of lower elevation.
• Areas with high mosquito breeding sites 
• Open air or tented accomodations
• Wetter and hotter months of the year
• Conditions that lead to lower immunity (immunosuppression)
• Age group with low immunity (children under 5 years of age or elderly)

Why do mosquitoes bite you more than the others?

Additionally, there might be times when you might have wondered why mosquitoes bite you more than others. Well, this could be because of

• 'O' Blood type 
• Mosquito attracting genes
• Pregnancy 
• Consumption of alcohol

The reason being that alcohol consumption, pregnancy, and even exercise increase your metabolic rate. You exhale more CO2 and this  attracts mosquitoes.

Diagnosis Of Malaria

The cyclical pattern of symptoms is a classical sign of malaria, and prompts the doctor to suspect malaria. The symptoms are generally periodical, and occur in cycles of 48 or 72 hours depending on the kind of malaria-parasite one is infected with. Your doctor will examine the symptoms and check for an enlarged liver or spleen to make a diagnosis. He/she might also take medical history along with symptoms. 

Diagnosis involves finding the type of parasite causing malaria. Tests include:

1. Peripheral smear for Malaria

Also known as microscopy of thick blood smear, these are blood smears in which malarial parasites can be seen with thin and thick blood smears under a microscope. It helps to detect and identify the malarial parasite.

2. Antigen tests 

Also known as a rapid diagnostic test, it is a blood test that helps to detect circulating parasite antigens. However, this test does not distinguish between the type of the malarial parasites. In most cases, it is followed by a blood smear which gives accurate information on the severity and the type of the parasites. These “Rapid Diagnostic Tests” (RDTs) offer a useful alternative to microscopy in situations where reliable microscopic diagnosis is not available.

3. PCR test

Polymerase Chain Reaction (PCR) test or molecular test, is most useful for confirming the species of malarial parasite after the diagnosis has been established by either smear microscopy or RDT. Moreover, it shows accurate results even if your parasite count is less or if the results of the blood smear are not proper.

4. Antibody tests

As the name suggests, this test helps you to detect the presence of antibodies in the blood which usually occurs post an infection. It uses either indirect immunofluorescence (IFA) or enzyme-linked immunosorbent assay (ELISA) technique. It does not detect current infection but rather identifies past exposure. 

5. Drug resistance test

It is recommended in some cases where the malaria parasites are resistant to drugs. This test helps the doctor to decide if certain drugs can work or not to treat your condition and decide your treatment accordingly.

6. Other tests

In most cases, a complete blood count (CBC) is advised to check for parameters such as hemoglobin and blood cell count. This can give your doctor an idea about how severe the infection is and if you suffer from other conditions such as anemia due to the condition. Other tests that might be recommended (in rare cases) include tests to detect hypoglycemia, renal failure, hyperbilirubinemia, and acid-base disturbances.

Note: Malaria can be lethal and may lead to severe complications and requires hospitalization, if misdiagnosed or not treated in time.

Prevention Of Malaria

Prevention of malaria can be achieved by public health and community-based programs that aim at controlling the breeding of mosquitoes and destroying their breeding sites. On an individual level the following measures can be practised:

• Wear clothes that cover arms, legs, and feet

• Avoid sleeping or staying long in open areas

• Use mosquito repellents in your home and clothes

• Use mosquito screens on doors windows to prevent entry of mosquitoes in the homes

• Use bed nets for all members of the family during night time

• Use mosquito zapping devices like electric bats

• Invest in mosquito-repelling plants, like tulsi and lemongrass

Use the following tips to prevent breeding of mosquitoes:

• Do not overwater potted plants and always empty the trays to prevent it from becoming a breeding ground. 

• Change water regularly for indoor plants and decorative items where water can be collected such as birth baths, tabletop fountains, flower vases and fish tanks.

• Empty out the water from AC trays, refrigerator trays and other containers such as feeding bowls of pets or birds.

• Clean these tanks at least once every 15 days to break the breeding cycle of mosquitoes, which is around 15-20 days. 

• Turn over empty pails and buckets when not in use and cover the containers with proper lids to prevent mosquitoes from breeding.

• Use dustbins with well-fitting lids and throw your trash every day as uncovered trash cans attract mosquitoes.

• Practice regular fogging with mosquito repellents or larvicides and also spray pesticides like DDT on the possible breeding places of mosquitoes.

• Mosquito repellent bands can be worn on the wrist just like a fitness band or a watch. They are available as chemical bands which are DEET-impregnated and natural ones which contain essential oils like citronella oil, eucalyptus oil or mint oil.
• Mosquito patches are stickers which need to be stuck on clothes i.e. on collars, sleeves, skirts, or shorts. They are available in both chemical and herbal forms.
• Body lotion or mosquito sprays which contain synthetic repellents like DEET and permethrin or natural repellents like citronella, which offers protection against mosquitoes. 
• Mosquito repellent sticks are similar to incense sticks but are loaded with mosquito repellents. You can light these sticks and place them in open spaces such as gardens, terraces or balconies.
• Mosquito nets are conventional options used to fight mosquitoes, The wire mesh of these nets must be extremely fine so as to prevent the entry of mosquitoes. An ideal wire mesh for this purpose should have 18 X 18 strands per inch in either direction (length and width). You can also install a wire mesh for window screens. 

Specialist To Visit

See a doctor if you have a high fever with chills and have mosquitoes breeding around your home. Also, if you experience a combination of symptoms such as sweats, headaches, body aches, weakness, nausea, and vomiting along with fever and chills, then do not think twice before visiting a doctor. Experts that can help you to diagnose and treat malaria include:

• General physician

• Pediatrician (for kids)

• Internal medicine specialist

• Infectious disease specialist

Treatment Of Malaria

The medicines prescribed depend on various factors such as the species of malarial parasite and the severity of the disease. Often the doctor prescribes a combination of drugs.

In most cases, the treatment for malaria includes administration of the medicine Chloroquine. For the severe form of disease IV Quinine or Quinidine may be given. Primaquine is used to kill dormant liver forms of P. vivax and P. ovale. Recently, chloroquine resistance has been seen in P. falciparum from some areas. 

For chloroquine resistant malaria, Mefloquine, Halofantrine and Lumefantrine can be used along with artemisinin-based combination therapies (ACTs). ACT is a combination of two or more drugs that work against the malaria parasite in different ways. Examples are artemether-lumefantrine (Coartem) and artesunate-mefloquine. 

Other drugs that may be prescribed include atovaquone-proguanil combinations, quinine sulfate combinations, primaquine phosphate, doxycycline, tetracycline, clindamycin. Also, drugs like paracetamol are prescribed to provide relief from pain, fever and body aches, which are commonly seen in people with malaria.

Here is a complete list of medications for malaria you may want to know.
Click To Read!

Home Care For Malaria

Try the following home remedies to bring down fever and treat other symptoms of malaria:

1. Boil some basil leaves along with black pepper (kalimirch) in 2 glasses of water until reduced to half. Drink this decoction whenever you have a fever.

2. Drink neem tea after meals to treat malaria. Boil a few neem leaves in water and use this decoction as tea.

3. Eat grapefruit or drink its juice to combat the malaria parasite.  

4. Take half an inch of cinnamon (dalchini) stick and grind it. Boil in water. Drink it with honey and a pinch of black pepper.

5. Eat citrus fruits such as orange, lime, and lemon to boost immunity and speed up recovery. 

Diet for malaria

In addition to taking medicines and using home remedies to treat malaria, eating a healthy and balanced diet can play a key role in improving your condition and fasten your recovery. 

During the active disease

A diet consisting of juices and very light foods like rice, dal, vegetables with minimal fat content is highly recommended. Fresh seasonal fruits and fresh juices such as mangoes, apples, grapes, grapefruits papaya, and pineapple should also be given.

During the recovery period

A diet of fresh fruits and vegetables, milk, paneer, whole grains and nuts is advised. Tulsi is a natural anti-malarial and a few leaves boiled in water may be given daily along with the allopathic medicines.

After recovery

As there are high chances that a person might feel weak even after he/she is recovered from malaria. This is why a diet rich in protein is recommended to help the body repair the damage the infection has dealt. Cereals, pulses, nuts and meats are a great source of protein. Dark leafy green vegetables that are rich in iron, rice and whole grains should be consumed to help patients get back to normal health. 

Complications Of Malaria

Malaria is a serious condition which if left unattended may lead to death. Although malaria can be a deadly disease, illness and death from malaria can usually be prevented with proper diagnosis, timely treatment and care.

If left untreated, it can cause severe organ failure and other health complications like:

• Cerebral malaria that causes neurological abnormalities

• Severe anemia due to destruction of the red blood cells

• Blood in the urine or stools

• Acute respiratory distress syndrome (ARDS) which causes a severe inflammatory reaction in the lungs

• Abnormalities in blood coagulation

• Hypotension or low blood pressure

• Hypoglycemia or low blood glucose

• Difficulty in breathing

• Organ failure (lung, liver, or kidney failure)

• Rupture of spleen leading to massive bleeding

• Meningitis might occur, if malaria infects the brain

Alternative Therapies 

Some of the common alternative therapies for protection from mosquito bites and malaria include:

1. Neem oil: Neem oil is an effective indoor mosquito repellent. Mix neem oil and coconut oil in equal portions and rub it on your body (all exposed parts). This will protect you from mosquito bites for at least eight hours.

2. Eucalyptus and lemon oil: The mixture of lemon oil and eucalyptus oil is effective in repelling mosquitoes. Both contain cineole, which has antiseptic and insect-repellent properties when applied to the skin. Mix lemon oil and eucalyptus oil in equal proportions and use it on exposed areas of your body.

3. Citronella oil: Citronella oil is an essential oil extracted from citronella grass. This oil has been known to prevent mosquito bites extremely efficiently. Apply citronella oil all over the body. You can also add a few drops of this essential oil in a candle or vaporizer. You can also use it as a spray for mosquito-prone areas of the house.

4. Camphor: known as “kapura” is an effective mosquito repellant. Light a small piece of camphor in your room and close all doors and windows. Leave the room closed for 15 min.

5. Tulsi: Tulsi plant is effective in killing mosquito larvae and keeping mosquitoes away. Plant a few Tulsi shrubs near your windows and doors. There are different varieties of basil like lemon basil and cinnamon basil that are more effective in warding off mosquitoes.

6. Marigold: The marigold plant has a distinct smell that keeps mosquitoes and other insects away. This is mainly due to the compound called pyrethrum which is also found in certain insect repellents. It is easy to grow and maintain. You can grow these plants in pots and place them in your garden.

7. Geranium: Geranium is an attractive flowering plant that grows easily with basic care. It is commonly grown indoors in hanging pots and therefore great for warding off mosquitoes inside the house. It needs lots of light and well-drained soil.

8. Lavender: The sweet lavender aroma that is highly sought after for perfumes is what repels mosquitoes. Even though it is widely grown in Europe, it can be grown in India too with little care. It can be grown indoors in pots with well-drained soil.