Plasmodium is causitive agent of malaria. wikemedia commons
Malaria is a protozoan disease caused by parasite named plasmodium. it is transmitted via bite of female Anopheles Mosquito containing sporozoites of plasmodium parasite in their saliva.
Male anopheles do not cause malaria because they do not feed on human blood
Female anopheles is vextor of malaria. public domain
Anopheles mosquito is carrier of a disease and not the causative agent of the disease.
Four species of genus plasmodium infect humans and they are as following.
Of all the species the most severe form of malaria is causes by P. falciparum.So I will discuss clinical spectrum under two headings. First one is severe malaria due to P. falciparum and sexond heading will include manifestations of other three species .
FALCIPARUM MALARIA
For sake of understanding it better, I will divide its manifestations into two phases.
A. Prodromal Phase=During this phase patient will experiance
B. Classical Malarial Paroxysm=This phase represents the manifestations during which time the organism's activity is at peak. Patient looks severely ill. Manifestations include.
Types of fever in malaria
Quotidian fever, a fever which recurs every 24 hours, typical of Plasmodium falciparum or Plasmodium knowlesi malaria
Tertian fever a fever that records after 48 hours, it is typical of Plasmodium vivax or Plasmodium ovale malaria
Quartan fever , recur after 72 hours and is typical of Plasmodium malariae malaria.
The patients with falciparum malaria are more likely to develop comolications involving multiple systems of body especially nervous system.These complications are more commom in non-immune people, children and pregnant female in endemic areas.Comolicatioms include-
a. Cerebral Malaria = Cerebral malaria is a name given to a barrage of signs and symptoms resulting from diffuse encephalopathy in a person with p. falciparum infection after ruling out other causes of encephalopathy.Features include
In cerebral malaria, CSF is clear and has normal pressure.But lactic acid and protein levels are elevated.
b. Anemia = Likely causes of anemia are
c. Hypoglycemia = It is a frequennt compilation in malaria.Probable reaaons are
d. Fluid and acid base disturbance.
Manifests as low JVP, hhpovolemia, oliouria, renal failure and lactic acidosis.
e. Circulatory collapse It is seen in patients with gram negative septicemia and pulmonary edema, hypoglycemia , massive gastrointestinal bleed, lactic acidosis.
Itamifests are very low blopd preasure, cold clammy extremities, drowsy patient, cynosis, thready pulse etc.
f. Spontaneous Bleeding and DIC.
Bleeding from multiple sites manifest as gum bleeding, nose bleed, petechiae, subconjuctival bleeding, haemetemesis (Blood in vomitus), malena (Blood in stool) etc.
g. Haemoglobinuia (Black water fever) - it is a severe but rare complication of falciparum malaria. It is seen in patients with G6PD deficiency and other enymw defciencies. It manifest as mild fever and dark urine due to intravascular haemolysis.
There is no parasitemia in BWF.
h. Jaundice- it is due haemolysis and malarial hepatopathy. Haemolysis is due to destruction of infect d red cells in spleen. Malarial hepatopathy is due to clogging of hepatic microvasculature by infected red cells .
Severe inflammation is never seen in malarial hepatopathy*.
| P. vivax. | P. ovale | P. malarae |
|---|
Fever type
| Tertian | Tertian | Quartan |
|---|---|---|
| Anemia. | do. | do |
| Thrombo- | do. | do |
| cyopenia | ||
| Mild | do. | do |
| jaundice | ||
| High Risk | low risk. | low risk |
| of spleniic rupture | ||
| No relapse | No relapse | Relapse seen |
A. MICROSCOPY
a. It is the most common test done in case of Malaria patients.
Patient's blood is examined under microscope after preparing slides. Two types of slides are prepared l--thick and thin thin.
Thick slides are used to estimate the degree of parasitaemia, that is, the parasite load in patient's. blood.
Thin slides are used to identify the specie{s) of the plasmodium infecting the patient.
b. Quantative Buffy Coat examination. it is more sensitive then microscopy..The centrifuged buffy coat is stained qith flourochrome and examined under UV light. Plasmodium parasite lights up under UV light and is therefore easy to detect.
c. Bome Marrow Examination- in some cases despite severe parasitaemia, parasites are not detected in blood smear because of sequestration of parasitised cells in deep vascular beds.
In such cases bone marrow is aspirated and examined under microscope to detect parasites or their pigments.
B. IMMUNODIAGONOSIS
C. Complete Blood Counts - Patients with Malaria may have normocytic normochromic anaemia and raised ESR. TLC is low but there may be neurophilic leucocytosis.
D. Other non-specific findings
Plasma viscosity may be increased. CRP may be elevated.
Electrolyte abnormalities like low sodium, magnesium and blood glucose. Low pH.
in severe cases performing time and partial thromboplastin time may be increased.
E. Neuroimaging
In cerebral malaria there may be brain edema, hyperintense white matter and cortical infarcts.
MOsquito control measures
A. Anit-larval measures
Chemical Control -it invalid use of larvicidal agents like Mineral oil , Paris green , malathion etc.
Biological Control Use of fishes which feed on larvae and in this way serve as natural control measures. Examples includeGambiensis affenis, labester reticulate etc.
B. Anti-adult measures
Residual and Space spray- it includes insecticides which prevent development of mosquitoes in environment for longer period of time, for example, DDT has residual effect of 6 to 12 months and BHC has residual effect of 2 months.
Genetic control- it includes techniques to alter the genotype of the adult mosquitoes so as to render them non-infectious. Techniques like
Personal protection measures
Use of insecticide treated bad nets to avoid contact of mosquito and humans
Use of clothes like full sleeve shirts
Management
Only drugs given in malaria will be discussed. Dosage and schedules will not be discussed.
UNCOMPLICATED MALARIA
| Plasmodium species | Drug |
|---|---|
| P. vivax | Cloloroquine |
| P. falciparum. | Artemesnin based combination therapy (ACT} |
| P. Falciparum in pregnancy | |
| First trimester | quinine |
| Second trimester | ACT |
| Third trimester | ACT |
| COMPLICATED MALARIA | |
| P. Falciparum | |
| Clloroquine sensetive | chloroquine |
| Resistant | Quinine or Artemesnin derrivatives |
Redical care of malaria dur to p. Vivax and p. Ovale- Primaquine is DOC (drug of choice).
Chemoprophylaxis of malaria -it is indicated in travellers to malaria endemic areas
Short term (<6 weeks} - doxycycline.
Long term (>6 weeks)- mefloquine.
References
Proud Member of 
Join air-clinic's discord server here
Know everything related to health.
Join the @steemSTEM here
A community project to promote science technology engineering and mathematics postings on Steemit.
Please support 
If you want to give him witness voting decisions on your behalf, visit https://steemit.com/~witnesses again and type in "surpassinggoogle" in the second box as a proxy
