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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
  • Abstract 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]
  • When compared to no nets and in areas of stable malaria, ITNs also had an impact on severe malaria (45% PE, 95% CI 20 to 63), parasite prevalence (13% PE), high parasitaemia (29% PE), splenomegaly (30% PE), and their use improved the average haemoglobin[ncbi.nlm.nih.gov]
  • 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
  • For a thorough discussion of yellow fever and guidance for vaccination, see the Yellow Fever section earlier in this chapter.[wwwnc.cdc.gov]
  • The correct diagnosis of these non-malaria fevers is a major concern, and there is an urgent need to develop more point-of-care diagnostic tests and capacities to identify and treat the causes of these fevers.[ncbi.nlm.nih.gov]
  • Fever is common in malaria, and drugs and sponging are widely used for symptomatic relief. Some researchers have suggested that fever reduction may prolong malaria illness.[ncbi.nlm.nih.gov]
  • Thirty hours later the peripheral parasitaemia cleared with resolution of fever and haemoglobinuria.[ncbi.nlm.nih.gov]
  • In most of the world a small fraction of fever is due to malaria, and reflex treatment with ACT does not make medical or economic sense.[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]
  • 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 parasitic infection that causes recurrent attacks of fever and chills. Malaria claims approximately 1 million lives annually on a worldwide scale.[symptoma.com]
  • […] for a rare disease Malaria Disease definition A life-threatening parasitic disease caused by Plasmodium ( P. ) parasites that are transmitted by Anophles mosquito bites to humans and is typically clinically characterized by attacks of fever, headache, chills[orpha.net]
  • Rupture of the red blood cells occurs in a synchronized manner, resulting in the periodic episodes of chills and fever that are typical of malaria. Copyright 2017 · All Rights Reserved · MaxAnim[maxanim.com]
Anemia
  • Abstract AbstractRecently, reports of delayed hemolytic anemia after treatment with artemisinin and its derivatives have emerged.[ncbi.nlm.nih.gov]
  • Malaria is a parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anemia. Malaria is caused by a parasite that is passed to humans by the bite of infected anopheles mosquitoes.[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]
  • OBJECTIVE: Anemia, Leukopenia, and thrombocytopenia are commonly observed hematological abnormalities in malaria and typhoid patients.[ncbi.nlm.nih.gov]
High Fever
  • Abstract 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]
  • fever, sweating, shaking chills, and anemia; malaria in animals is caused by other species of plasmodia. 084 Malaria 084.0 Falciparum malaria [malignant tertian] convert 084.0 to ICD-10-CM 084.1 Vivax malaria [benign tertian] convert 084.1 to ICD-10-[icd9data.com]
  • Why Malaria Is Harmful Malaria can cause high fever , chills, and flu-like 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]
  • Why Malaria Is Harmful Malaria can cause high fever, chills, and flu-like 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]
Malaise
  • The protean and nonspecific clinical findings occurring in malaria (fever, malaise, headache, myalgias, jaundice and sometimes gastrointestinal symptoms of nausea, vomiting and diarrhoea) may lead physicians who see malaria infrequently to a wrong diagnosis[ncbi.nlm.nih.gov]
  • 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]
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]
  • Symptoms include fever (with or without other signs or symptoms such as headache, muscular aches and weakness, vomiting, diarrhea). Typical cycles of fever, shaking chills, and drenching sweats may then develop.[dndi.org]
Hypotension
  • CASE REPORT: 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]
  • […] auscultation Significant bleeding Including recurrent or prolonged bleeding from nose gums or vein puncture sites; haematemesis or melaena Shock Compensated shock is defined as capillary refill 3 s or temperature gradient on leg (mid to proximal limb), but no hypotension[severemalaria.org]
  • He became aparasitemic but developed refractory hypotension on day 5 and died the following morning. Case 3 .[doi.org]
  • Furthermore, any patient who presents with extreme acidotic breathing (rapid, deep breathing with retractions), hypotension, anuria, or significant GI bleeding belongs in this group.[emedicine.com]
  • He became aparasitaemic but developed refractory hypotension on Day 5 and died the following morning.[ncbi.nlm.nih.gov]
Tachycardia
  • CASE REPORT: 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]
  • Tachypnea, pyrexia, and tachycardia were common clinical signs ( table 1 ). The results of baseline laboratory investigations are summarized in table 2 .[doi.org]
Jaundice
  • Abstract 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]
  • The protean and nonspecific clinical findings occurring in malaria (fever, malaise, headache, myalgias, jaundice and sometimes gastrointestinal symptoms of nausea, vomiting and diarrhoea) may lead physicians who see malaria infrequently to a wrong diagnosis[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]
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]
  • Symptoms Fever, often recurring Chills Rigors Headache Cough Myalgia Gastrointestinal upset Signs Fever Splenomegaly Hepatomegaly Jaundice /- abdominal tenderness Signs of severe disease (usually P. falciparum ) Impaired consciousness.[patient.info]
  • His chest was clear on auscultation, but he had hepatomegaly on abdominal palpation. Malaria was suspected, and a thick film was reported to show P. malariae “ ” (this grading indicates 10 parasites/high-power microscopy field).[doi.org]
Hepatosplenomegaly
  • Abstract 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]
  • However, if it is known to be greater than 10% or if the patient is experiencing life-threatening complications (ie, coma, respiratory failure, coagulopathy, fulminant kidney failure), exchange transfusion may be investigated as a treatment option.[emedicine.com]
  • Health problems that may result from malaria include: Brain infection (cerebritis) Destruction of blood cells ( hemolytic anemia ) Kidney failure Liver failure Meningitis Respiratory failure from fluid in the lungs ( pulmonary edema ) Rupture of the spleen[nlm.nih.gov]
  • 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]
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 CONCLUSION: Misuse of ACTs following overtreatment of malaria based on clinical diagnosis[ncbi.nlm.nih.gov]
Headache
  • Although fever represents the cardinal feature, clinical findings in malaria are extremely diverse and may range in severity from mild headache to serious complications leading to death, particularly in falciparum malaria.[ncbi.nlm.nih.gov]
  • Search for a rare disease Malaria Disease definition A life-threatening parasitic disease caused by Plasmodium ( P. ) parasites that are transmitted by Anophles mosquito bites to humans and is typically clinically characterized by attacks of fever, headache[orpha.net]
  • 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]
  • 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]
Confusion
  • Group 1 includes all patients who present with prostration or altered mental status (ie, confusion, agitation, or coma).[emedicine.com]
  • PMNS signs were confusion (72%), fever (46%), seizures (35%), cerebellar impairment (28%), psychosis (26%), and motor disorders (13%).[ncbi.nlm.nih.gov]
  • 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]
  • 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]
Stroke
  • Malaria may have been a contributory factor rather than the sole cause in our patient who presented with a stroke.[doi.org]
  • The disease was not stroke, hepatic coma, or neonatal encephalopathy. It was general paresis of the insane (GPI), the dreaded neurosyphilis, and the magical remedy was “fever therapy,” induced by injecting blood from malaria patients.[pediatrics.aappublications.org]
  • Erythropoietin therapy for acute stroke is both safe and beneficial. Mol Med. 2002; 8 :495–505. [ PMC free article ] [ PubMed ] [ Google Scholar ] 83. Casals-Pascual C, Idro R, Picot S, Roberts DJ, Newton CR.[ncbi.nlm.nih.gov]
Altered Mental Status
  • Group 1 includes all patients who present with prostration or altered mental status (ie, confusion, agitation, or coma).[emedicine.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.

Hyponatremia
  • Hyponatremia is probably associated with continued oral hypotonic fluid intake in the setting of hypovolemia and does not require treatment beyond rehydration. [6] Overly aggressive treatment of hyponatremia may lead to death.[emedicine.com]
Plasmodium Falciparum
  • However, almost all available drugs have been compromised by the highly adaptable parasite, and the increasing drug resistance of Plasmodium falciparum continues to be the main problem.[doi.org]
  • Metabolic information is extracted from the universal metabolic databases and presented in a format suitable to Plasmodium falciparum.[web.archive.org]
  • falciparum malaria control in highly seasonal transmission areas of the Sahel sub-region in Africa WHO Policy recommendation on intermittent preventive treatment during infancy with sulphadoxine-pyrimethamine (IPTi-SP) for Plasmodium falciparum malaria[who.int]
  • Cytoadhesion of Plasmodium falciparum ring-stage-infected erythrocytes. Nat Med. 2000 ;6(11): 1264 - 1268.[doi.org]
  • Basigin is a receptor essential for erythrocyte invasion by Plasmodium falciparum. Nature 480, 534–537 (2011). 84. Tham, W.H., Healer, J. & Cowman, A.F. Erythrocyte and reticulocyte binding-like proteins of Plasmodium falciparum.[dx.doi.org]

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