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Malaria

Jungle Fever

Malaria is a major cause of death worldwide and is brought about by the protozoan parasite Plasmodium acquired from a bite of a female Anopheles mosquito carrier. Malaria are still endemic in warm climates and in most third world countries around the globe. It is essentially non-existent in highly developed and first world countries like the United States and Europe.


Presentation

The typical malaria infection will present with recurrent attacks of high grade fever with moderate to severe chills. Patients will also present with profuse diaphoresis (sweating) as the core body temperature drops. Other common signs and symptoms of malaria include vomiting, headache, and diarrhea. These signs usually develop within a few weeks from the mosquito bite; however, some parasites may lie dormant within the blood stream for months to years.

Splenomegaly
  • We report the case of a 12-year-old child who was admitted to our Department, with 7 days' history of high fever and splenomegaly. His father had similar symptoms starting on the same day.[ncbi.nlm.nih.gov]
  • Hyperreactive malarial splenomegaly (also called “tropical splenomegaly syndrome”) occurs infrequently and is attributed to an abnormal immune response to repeated malarial infections.[cdc.gov]
  • Symptoms and signs include fever (which may be periodic), chills, sweating, hemolytic anemia, and splenomegaly. Diagnosis is by seeing Plasmodium in a peripheral blood smear and rapid diagnostic tests.[merckmanuals.com]
  • Splenic rupture may be associated with P vivax infection secondary to splenomegaly resulting from RBC sequestration. P vivax infects only immature RBCs, leading to limited parasitemia.[emedicine.medscape.com]
Fever
  • Fever remains a major public health problem. In Burkina Faso, more than half of febrile children are considered not to be infected by malaria. This study prospectively assessed probable (treatable) causes of fever in Burkinabe children.[ncbi.nlm.nih.gov]
  • Thirty hours later the peripheral parasitaemia cleared with resolution of fever and haemoglobinuria.[ncbi.nlm.nih.gov]
  • A 28 year-old-male patient presented to Aristide Le Dantec Hospital for recurrent fever.[ncbi.nlm.nih.gov]
  • Fever was persistent despite antimalarials in the absence of any coexisting bacterial or viral infection.[ncbi.nlm.nih.gov]
  • Common symptoms that are widely used as indicators for malaria such as, fever, headache, and tiredness were not significantly associated with malaria.[ncbi.nlm.nih.gov]
Chills
  • CASE REPORT A 29-year-old primigravida at 37 weeks of gestation, with no significant medical history, presented complaining of fever, chills, and generalized body aches.[ncbi.nlm.nih.gov]
  • Malaria is a parasitic infection that causes recurrent attacks of fever and chills. Malaria claims approximately 1 million lives annually on a worldwide scale.[symptoma.com]
  • A 43-year-old Hispanic woman presented to the clinic complaining of fever, chills and cough for 14 days. The patient reported a recent trip to Asia 12 days prior to presenting symptoms.[ncbi.nlm.nih.gov]
  • Malaria is a mosquito-borne parasitic infection, characterized by fever, shaking chills, headaches, muscle pains, nausea, general malaise, and vomiting (1).[ncbi.nlm.nih.gov]
  • ., and Joan Uehlinger, M.D. 1 Citing Article Figure 1 A 23-year-old man with sickle cell disease was admitted after reporting fever and chills. He had emigrated from West Africa three months earlier.[nejm.org]
Anemia
  • AbstractRecently, reports of delayed hemolytic anemia after treatment with artemisinin and its derivatives have emerged.[ncbi.nlm.nih.gov]
  • Anemia, Leukopenia, and thrombocytopenia are commonly observed hematological abnormalities in malaria and typhoid patients.[ncbi.nlm.nih.gov]
  • We describ the case of a young soldier who, after returning from Central Africa, presented a fever associated with petechial purpura and gingivorrhagia, hemogram showed deep thrombocytopenia and macrocytic normochrome anemia, thick peripheral blood smears[ncbi.nlm.nih.gov]
  • The erythrocyte rupture and the progressive anemia causes the main presentation in malaria.[symptoma.com]
  • Anemia often accompanies malaria disease; however, iron supplementation therapy inexplicably exacerbates malarial infections.[ncbi.nlm.nih.gov]
High Fever
  • We report the case of a 12-year-old child who was admitted to our Department, with 7 days' history of high fever and splenomegaly. His father had similar symptoms starting on the same day.[ncbi.nlm.nih.gov]
  • Why Malaria Is Harmful Malaria can cause high fever , chills, and flulike symptoms that can be life-threatening when not treated quickly. The disease is caused by Plasmodium parasites, which are carried by Anopheles mosquitoes .[webmd.com]
  • Signs and symptoms include paroxysmal high fever, sweating, chills, and anemia.[fpnotebook.com]
  • Malaria is a mosquito-borne disease that can cause infected people to become very sick with high fever, chills, and flu-like illness. It can also cause death.[niaid.nih.gov]
Malaise
  • Both Ebola and malaria are often characterized by fever and malaise and can be clinically indistinguishable, especially early in the course of disease.[ncbi.nlm.nih.gov]
  • Malaria is a mosquito-borne parasitic infection, characterized by fever, shaking chills, headaches, muscle pains, nausea, general malaise, and vomiting (1).[ncbi.nlm.nih.gov]
  • Signs and symptoms Symptoms of malaria may include: fever, which may come and go, or may be constant chills profuse sweating malaise (feeling of unwellness) muscle and joint pain headache confusion nausea loss of appetite diarrhoea abdominal pain cough[sahealth.sa.gov.au]
  • More commonly, the patient presents with a combination of the following symptoms: Fever Chills Sweats Headaches Nausea and vomiting Body aches General malaise In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza[cdc.gov]
  • Common symptoms of malaria include: High fever (can often be 104 F and higher) Chills Shaking Extreme sweating Fatigue Discomfort (called malaise) and body aches Headache Nausea, vomiting, and diarrhea Anemia Jaundice (yellowing of the skin and eyes)[familydoctor.org]
Diarrhea
  • A 15-year-old boy who had traveled to Africa (South Africa, Kenya, and Nigeria between January 3 and 25, 2011) presented with fever persisting over 5 days, headache, diarrhea, and dysuria, approximately 17 days after his return from the journey.[ncbi.nlm.nih.gov]
  • Symptoms Patients usually presents with intermittent fever, chills, vomiting, headache and diarrhea. Diagnosis Diagnosis is made by demonstration of the Plasmodium merozoite or trophozoite in the blood from blood smears.[symptoma.com]
  • Malaria symptoms include chills, flu-like symptoms, fever, vomiting, diarrhea, and jaundice. A blood test can diagnose it. It can be life-threatening. However, you can treat malaria with drugs.[medlineplus.gov]
  • Misdiagnosis of fever can lead to overuse of ACT as well as avoidable deaths from other febrile illnesses like pneumonia and diarrhea.[psi.org]
Hypotension
  • A 76-year-old male presented with fever, hypotension, tachycardia, and a urinalysis consistent with a urinary tract infection. He was admitted to the intensive care unit and initiated on broad-spectrum antibiotics.[ncbi.nlm.nih.gov]
  • […] abdominal pain chills and sweats diarrhea, nausea, and vomiting (these symptoms only appear sometimes) headache high fevers low blood pressure causing dizziness if moving from a lying or sitting position to a standing position (also called orthostatic hypotension[medbroadcast.com]
  • In severe malaria the illness may evolve with a number of complications: low blood pressure (hypotension) kidney failure possible haemorrhage (bleeding) effects on the liver (eg infectious jaundice) shock and coma may also develop, and the condition may[netdoctor.co.uk]
  • Other patients may die from shock and others from hypoxia and hypotension secondary to acute pulmonary oedema or sometimes aspiration pneumonia. Most deaths occur within 48 hours of admission.[jnnp.bmj.com]
Orthostatic Hypotension
  • hypotension ) muscle aches poor appetite In people infected with P. falciparum, the following symptoms may also occur: anemia caused by the destruction of infected red blood cells extreme tiredness, delirium, unconsciousness, convulsions, and coma kidney[medbroadcast.com]
Tachycardia
  • A 76-year-old male presented with fever, hypotension, tachycardia, and a urinalysis consistent with a urinary tract infection. He was admitted to the intensive care unit and initiated on broad-spectrum antibiotics.[ncbi.nlm.nih.gov]
Jaundice
  • A 5-year-old immunocompetent girl presented with fever, jaundice, hepatosplenomegaly and pancytopenia. The peripheral blood smear demonstrated mixed malaria infection (Plasmodium vivax and Plasmodium falciparum).[ncbi.nlm.nih.gov]
  • Infant presented with pallor, jaundice and massive spleen. Laboratory tests revealed anaemia, thrombocytopenia and bilirubinemia. Peripheral smear examination revealed parasitaemia.[ncbi.nlm.nih.gov]
  • A 61 years old asplenic man was admitted to a tertiary referral hospital in Sabah, Malaysia, with severe knowlesi malaria characterized by hyperparasitaemia (7.9 %), jaundice, respiratory distress, metabolic acidosis, and acute kidney injury.[ncbi.nlm.nih.gov]
  • Malaria symptoms include chills, flu-like symptoms, fever, vomiting, diarrhea, and jaundice. A blood test can diagnose it. It can be life-threatening. However, you can treat malaria with drugs.[medlineplus.gov]
Hepatomegaly
  • Patients with heavy hepatocyte load may present with hepatomegaly.[symptoma.com]
  • Enlargement of the liver (hepatomegaly) and spleen (splenomegaly) may be found during a physical examination. Malaria is usually diagnosed with a blood test that screens for the presence of malaria parasites.[betterhealth.vic.gov.au]
Hepatosplenomegaly
  • A 5-year-old immunocompetent girl presented with fever, jaundice, hepatosplenomegaly and pancytopenia. The peripheral blood smear demonstrated mixed malaria infection (Plasmodium vivax and Plasmodium falciparum).[ncbi.nlm.nih.gov]
Kidney Failure
  • failure , seizures , coma and even death.[healthdirect.gov.au]
  • Along with high fever, shaking chills and sweating , symptoms can include: Throwing up or feeling like you're going to Headache Diarrhea Being very tired ( fatigue ) Body aches Yellow skin ( jaundice ) from losing red blood cells Kidney failure Seizure[webmd.com]
  • In severe malaria parasites may attack the brain, causing convulsions and coma and leading to breathing problems, kidney failure, and/or severe anemia. Each year about eight million malaria patients develop life-threatening complications.[doctorswithoutborders.org]
Dark Urine
  • Nausea/vomiting, poor appetite, chills, bitter taste in the mouth and dark urine were symptoms that were significantly associated with malaria among the adult clients (P .05) but not fever (P .06).[ncbi.nlm.nih.gov]
Headache
  • She presented with fever and headache. Thick smear from blood revealed trophozoites of P. falciparum at parasite density of 52,300 parasites/μl.[ncbi.nlm.nih.gov]
  • A 15-year-old boy who had traveled to Africa (South Africa, Kenya, and Nigeria between January 3 and 25, 2011) presented with fever persisting over 5 days, headache, diarrhea, and dysuria, approximately 17 days after his return from the journey.[ncbi.nlm.nih.gov]
  • He presented with fever (39 C), soreness, headache and vomiting. The blood pressure was 120/80 mmHg. The rest of the examination was normal.[ncbi.nlm.nih.gov]
  • Malaria is a mosquito-borne parasitic infection, characterized by fever, shaking chills, headaches, muscle pains, nausea, general malaise, and vomiting (1).[ncbi.nlm.nih.gov]
  • The main symptoms were febrile, including the highest axillary temperature of 40 C, headache, and chills. A peripheral blood smear showed parasitemia (53 913 asexual parasites/μl) of Plasmodium falciparum.[ncbi.nlm.nih.gov]
Confusion
  • Along with high fever, shaking chills and sweating , symptoms can include: Throwing up or feeling like you're going to Headache Diarrhea Being very tired ( fatigue ) Body aches Yellow skin ( jaundice ) from losing red blood cells Kidney failure Seizure Confusion[webmd.com]
  • Signs and symptoms Symptoms of malaria may include: fever, which may come and go, or may be constant chills profuse sweating malaise (feeling of unwellness) muscle and joint pain headache confusion nausea loss of appetite diarrhoea abdominal pain cough[sahealth.sa.gov.au]
  • Diagnosis and treatment If diagnosis is based on clinical symptoms alone, malaria may easily be confused with any of several other diseases.[britannica.com]

Workup

A detailed clinical history of the patient with a history of travel in malaria endemic areas would usually clinch the diagnosis. Blood tests are paramount in the diagnosis of malarial diseases. Malarial peripheral smears can demonstrate whether the host is infected, what particular plasmodium strain is causing the infection, whether malarial infections have affected other bodily organs, and resistant strains to certain anti-malarial drugs.

Plasmodium Falciparum
  • Our study illustrates that, in a 10 μm microvessel in low-hematocrit conditions (18% and 27%), the Plasmodium falciparum-infected red blood cells (Pf-IRBCs) and healthy ones first form a train of cells.[ncbi.nlm.nih.gov]
  • The Anopheles species and Plasmodium falciparum infection rate were determined using PCR assays. In this study, 98.5% of the malaria infections were due to Plasmodium falciparum. Malaria transmission occurred in the four districts.[ncbi.nlm.nih.gov]
  • A peripheral blood smear showed parasitemia (53 913 asexual parasites/μl) of Plasmodium falciparum. The patient had not used any chemoprophylaxis against malaria in Nigeria when he worked there as a construction worker between 2009 and 2014.[ncbi.nlm.nih.gov]
  • We report a case of severe falciparum malaria following nosocomial Plasmodium falciparum transmission in nonendemic Germany.[ncbi.nlm.nih.gov]
  • A recent study provides evidence that Plasmodium falciparum infection alters the aldehyde composition of human foot odor, and suggests that this may be the proximate cause of increased attraction.[ncbi.nlm.nih.gov]

Treatment

In cases of malarial infections, the choice of anti-malarial drug and duration of treatment are heavily dependent on the type of etiologic agent, severity of the symptomatology, age of patients and whether the patient is pregnant. The following anti-malarial agents are commonly used to treat malaria.

  • Quinine sulfate
  • Chloroquine
  • Hydroxychloroquine
  • Mefloquine
  • Malarone
  • Primaquine [9]

High doses of quinine and chloroquine may cause complications of methemoglobinemia among patients; thus, frequent blood monitoring is imperative [10].

Prognosis

The majority of uncomplicated malarial cases carries a good prognosis with early treatment. Patients who are treated early will usually show signs of marked improvement in the signs and symptoms. An afebrile period of more than 96 hours after 48 hours from the start of antimalarial treatment is good prognostic indicator. Infections with Plasmodium falciparum especially with complications spell out a grimmer prognosis with relatively high mortality rates if left untreated.

Cerebral malaria is the most common cause of deaths among children and adult patients. Even with adequate medications and treatment, cerebral malaria carries a mortality rate of 15 to 20% in most cases. Patients with hemoglobinopathies like sickle cell anemia, Thalassemia, and Hemoglobin C have an inherent resistance to P. vivax and P. falciparum infections and complications [8]. However, they may not be immune to Plasmodium parasitemia which usually confers no significant medical signs and symptoms.

Etiology

There are at least five Plasmodium species that cause human malaria, these are: Plasmodium falciparum, Plasmodium malariae, Plasmodium vivax, Plasmodium ovale, and Plasmodium knowlesi [2]. The prevalence of the etiologic agents vary from region to region of endemicity where hosts are usually infected by a singles species of Plasmodium at a time. In 5% to 7% of cases, multiple species of the Plasmodium parasites can infect a human host at the same time [3]. Different species of malaria may have a different incubation period varying from 2 to 4 weeks that is why malarial prophylaxis is continually given for weeks after the traveler has returned home from a malaria infected region.

Epidemiology

In the United States, isolated cases of malaria are predominantly imported from other tropical and subtropical countries because they have successfully eradicated the parasite during the 19th century until the turn of the 20th century [4]. Although, recent CDC reports as of 2010 have shown an increase of approximately 14% compared to the 2009 malaria census which are largely due to airport passenger transmissions [5]. The massive death annual death toll that reaches more than a million cases on malaria are predominantly seen among the children from the sub-saharan regions of Africa and are usually caused by the P. falciparum species. The life threatening malarial infections has been amply documented to reach approximately 300 to 500 Million infections per year worldwide [6].

There are no sexual predilection for malarial infections. Infected mothers may result to fetal complications like anemia, low-birth weight, premature birth, and death. Maternal malarial infection during the first trimester of pregnancy often results to abortion or miscarriage [7].

Sex distribution
Age distribution

Pathophysiology

After the infected female Anopheles mosquito takes her blood meal on the human skin, she injects up to 15 malarial sporozoites in the blood stream which rapidly enter the liver cells. The sporozoites then undergoes rapid reproduction in the hepatocytes by asexual fission to form the pre-erythrocytic schizonts. The malarial merozoites multiply by the thousands within the hepatocyte schizont until they are released to the blood stream to attach to red blood cells. The merozoites may rapidly reproduce within the erythrocytes to form malarial trophozoites where red blood cell (rbc) rupture takes place after the schizont is filled and a new set of merozoites is released in the blood stream to infect a new sets of rbc.

The erythrocyte rupture and the progressive anemia causes the main presentation in malaria. The erythrocytic rupture releases toxins to the blood stream and induces cytokine release from macrophages causing the distinct fever and chills in the patients. Patients with heavy hepatocyte load may present with hepatomegaly. Larger merozoites in the blood develop to either male or female gametocytes which are ingested by the mosquito through a blood meal where they sexually reproduce within the mosquito vectors. The same cycle repeats in every human and mosquito infection encountered.

Prevention

The most effective way to prevent malaria is to avoid visiting regions with known malarial endemicity. When visits becomes unavoidable, adequate drug prophylaxis should be taken at the prescribed period before the trip to avoid parasitic infections. Patients suspecting malaria infections should opt for prompt medical attention and treatment to prevent serious complications.

Summary

Malaria is a parasitic infection that causes recurrent attacks of fever and chills. Malaria claims approximately 1 million lives annually on a worldwide scale. Because many malarial strains are now immune to common anti-malarial drugs, it is most prudent to take drug prophylaxis before travelling to tropical and subtropical countries where malaria is still endemic. Current researche on malaria is focusing on the development of a vaccine to eradicate this worldwide menace [1].

Patient Information

Definition

Malaria is a major cause of death worldwide and is brought about by the protozoan parasite Plasmodium acquired from a bite of a female Anopheles mosquito carrier.

Cause

The five Plasmodium parasite species (P. falciparum, P. malariae, Plasmodium vivax, P. ovale, and P. knowlesi) cause malaria.

Symptoms

Patients usually presents with intermittent fever, chills, vomiting, headache and diarrhea.

Diagnosis

Diagnosis is made by demonstration of the Plasmodium merozoite or trophozoite in the blood from blood smears.

Treatment and follow-up

Anti-malarial agentsare Quinine sulfate, Chloroquine, Hydroxychloroquine, Mefloquine, Malarone and Primaquine.

References

Article

  1. Olotu A, Fegan G, Wambua J. Estimating individual exposure to malaria using local prevalence of malaria infection in the field. PLoS One. 2012; 7(3):e32929 (ISSN: 1932-6203)
  2. Cox-Singh J, Davis TM, Lee KS, Shamsul SS, Matusop A, Ratnam S, et al. Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening. Clin Infect Dis. Jan 15 2008; 46(2):165-71.
  3. Marchand RP, Culleton R, Maeno Y, Quang NT, Nakazawa S. Co-infections of Plasmodium knowlesi, P. falciparum, and P. vivax among Humans and Anopheles dirus Mosquitoes, Southern Vietnam. Emerg Infect Dis. Jul 2011; 17(7):1232-9.
  4. Cullen KA; Arguin PM. Malaria surveillance--United States, 2011.MMWR Surveill Summ. 2013; 62(5):1-17 (ISSN: 1545-8636)
  5. Malaria Surveillance — United States, 2010. Centers for Disease Control and Prevention. Accessed November 13, 2014.
  6. Centers for Disease Control and Prevention. Malaria. Accessed November 13, 2014.
  7. McGready R, Lee S, Wiladphaingern J, Ashley E, Rijken M, Boel M, et al. Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study. Lancet Infect Dis. Dec 12 2011.
  8. Taylor SM, Parobek CM, Fairhurst RM. Haemoglobinopathies and the clinical epidemiology of malaria: a systematic review and meta-analysis. Lancet Infect Dis. Mar 22 2012.
  9. Janeczko LL. Primaquine protects against P. vivax malaria relapse. Medscape Medical News. Jan 3, 2013.
  10. Amaratunga C, Sreng S, Suon S, et al. Artemisinin-resistant Plasmodium falciparum in Pursat province, western Cambodia: a parasite clearance rate study. Lancet Infect Dis. Nov 2012; 12(11):851-8.

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Last updated: 2017-08-09 18:17