Malaria

Malaria:

Definition:

Malaria is an infectious febrile disease caused by female Anopheles mosquito. Malaria parasite is transmitted by this mosquito from one patient to a healthy person. WHO reports that 300 to 500 million people catch Malaria every years and in 1 to 2 million are fatal. 90% of mortality occur in children under five in Africa. Malaria was a global disease in the past, but nowadays severely is reduced in Europe and is more common in Africa and Southeast Asia. In America the majority of those who have suffered from malaria are travelers who have traveled to other areas. Usually Malaria is divided into uncomplicated and severe and generally malaria can be healed if it is diagnosed and in time attention. The important thing about this disease-causing parasites is becoming resistant to the old antiphrastic drugs and Anopheles mosquitoes insecticide. Information are based on the centers of drug-resistant malaria which is published each year by the World Health Organization (WHO). There is an interesting point about malaria that the patients in African countries who have certain blood disorders such as Sickle-cell disease (in which red blood cells are sickle-shaped) and thalassemia are more common are mostly survived and lived. The reason is that this type of anemia cause resistance form fatal malaria.

Transmission:

Malaria is a protozoan disease called Plasmodium that has five species. P. falciparum is associated with high mortality risk in humans. Malaria parasites have two hosts, a vertebrate host (humans) and other invertebrate hosts (female Anopheles mosquito). Asexual parasites reproduction is in the liver and red blood cells in the human body and sexual reproduction will be done in mosquito. After amplification the parasites enter liver cells and begin to multiply rapidly. So each parasite who enters will produce about 10 thousand parasites. Then the parasites rupture liver cells and attack the blood cells. Then they reproduce again. For this procedure they need hemoglobin which will be finished in 2 to 3 days. In this condition the cell is full of parasite and cell cannot handle the size anymore which result to an explosion. The parasite then attack other cells and they get out numbered in blood.

Ambient temperature is an important factor in the spread of malaria parasites that enter the body. In hot weather they reproduce quickly in Anopheles mosquito and get ready to infect healthy people but in the cool temperature the parasite reproduction takes longer so a lot of short-lived mosquitoes die and cut malaria transmission cycle.
Other risk factors for malaria are crowded and unhygienic living conditions and specific geographic regions such as Latin America, Asia and Africa.

Malaria is transmitted in four ways:

1.     Sting of an infected female anopheles:
It is the most common method of transmission. The mosquitoes forced to drink blood to fertilize their eggs at night and it might be from an infected person with malaria. Then, the Plasmodium will be transformed and proliferated in Anopheles stomach and enter salivary glands within one or two weeks. The mosquitoes transmit the disease with drinking blood from healthy people and subjects them to parasite. This mosquito can only live in hot area so the spraying will take place early spring which is beginning of mosquito activity. It will be done on stagnant water surface such as marsh. The outbreak happens in summer and in winter it will be decreased.

2.     Blood Transfusion

It seems that malaria can stay hidden for more than 30 years. So transfusion of blood from a infected but healthy to a healthy human can transmit disease.

Medical equipment

Transmission of malaria by medical equipment and intravenous contaminated syringes in drug abusers is possible in particular.

Congenital transmission

Malaria in pregnancy may be transferred to the fetus through the umbilical cord. Symptoms appears usually three months after in the infant.

Symptoms:

Malaria is a very common cause of fever in tropical countries. It begins with the fatigue, weakness, headache, body aches, and fever which is associated exactly the same with common viral illnesses like colds. There are severe and recurrent fevers which in some cases reaches above 40 degrees before treatment of patients so that the patient has a high fever and chills once every three days, which continued for several hours and then they recover from it.

The temperature rise is actually a defense mechanism to eliminate malaria parasites because the parasites are killed at high temperatures. Another body's defense mechanism is to trap infected red blood cells with the spleen. Enlarged spleen, with the loss of red blood cells, infected patients will get anemia. The parasites enter the body through symptoms appearance is 7 to 30 days. Symptoms of malaria can be divided into two categories:

Uncomplicated malaria:

In this type malaria attack takes between 6 to 10 days which has fever, sweating, headache, vomiting, body pain, general pain, splenomegaly, and mild jaundice, enlarged liver and decreased respiratory rate.
In countries where malaria is rare is possible that symptoms attributed to the flu, colds or infectious diseases (especially if they are not suspicious to malaria), but in countries where malaria is common, even without diagnostic tests is recognizable.

Severe malaria:
Severe malaria occurs when it effect or impact on the patient's blood or metabolism. A major problem is created in patients with malignant malaria (falciparum) is that the infected red blood cells develop an appendix or a blister which adhere to the walls of arteries and each other which lead to stop blood movement in the arteries. 

Apart from early signs of malaria symptoms the severe disease include:
- Impact on the brain that cause abnormal behavior, seizures, coma and other neurological imbalances which is the leading cause of death in patients with severe malaria.
- Anemia and severe anemia caused by destruction of red blood cells.
- The presence of hemoglobin in the urine due to destruction of red blood cells
- Pulmonary edema or Acute Respiratory Distress Syndrome (ARDS)
- Dark urine.
- Unusual bleeding (nose, gums, and more)
- Hypoglycemia, especially in children and pregnant women is a cause to the death.
- Abnormalities in blood clotting
- Cardiac arrest and shock
- Acute renal failure (kidney failure)
- Metabolic acidosis (high acidity of body fluids and tissues)

Treatment:

Malaria is a serious disease that can be fatal (especially when it is caused by falciparum malaria). The WHO recommendations in endemic areas is the treatment should began up to 24 hours after the first symptoms. Patients with mild malaria don not need hospitalization. Patients with severe malaria requiring hospitalization. In non-endemic areas patients must be brought under quarantine.

In some countries (except the US) anti-malarial drugs are found in the form of suppositories and many are available as an injection into a vein. Rapid diagnosis of severe malaria in order to reduce complications and to preserve the lives of patients. 

Drug treatment is based on the variable of mild and severe. The most important drug in the treatment of mild disease is Chloroquine. Another one for the cure and prevention is called Primaquine. For treating the severe malaria in the first stage is Artesunate or Mefloquine and Fansidar. Fansidar is a combination of Sulfadoxine and pyrimethamin. It is available in three form of injections, suppositories and tablets. In patients who cannot tolerate the oral medication because of nausea and vomiting, injection can be used. Each time a patient can take oral medication, oral treating should be continued. If a listed drug therapy was unsuccessful or the prohibition of drugs is listed, the second phase of drug treatment with Coartem starts. Coartem is a combination of two drug under name of Artemether (20 mg) and lumefantrine (120 mg).

In cases of unavailability, the drug banning or failure to follow the second step, the third step with a combination of two drugs Quinine and either Doxycycline or tetracycline is initiated. In pregnant women and children Clindamycin instead of Doxycycline or tetracycline is given.

Prevention:

Malaria Eradication by the means the complete elimination of malaria parasites and interruption of transmission in most endemic areas of the world are not practical, the number of cases and deaths due to malaria should be to reduced and controlled.

For this purpose, the following measures are recommended:

- Health education and cooperation between the residents in the malaria-plagued regions to implant an actions to combat malaria.

- Improvement of the environment through drying swamps and pools which is the mosquito spawning site.

- Dissolution or spray of oil, gasoline and oil in the wetlands, where the water is stagnant and anopheles larval habitat.

- The biological control of mosquitoes using fish that eat plain or microbial anti-larval.

- Spraying adult mosquitoes resting places, such as human and animal residential areas.

- Fast and affordable access to health services for the diagnosis and early treatment.

- Closely monitor the people movement from affected areas to other areas (immigration control)

- Extensive information broadcast to the people, especially in the vulnerable group.

- History evaluation of blood donors, travelers or residence in high-risk areas for malaria.

Following measures to protect healthy people against the bite of anopheles in prone areas is important:

- Try not to leave the house at sunset to sunrise. Wear long-sleeved shirts and long pants at night. Avoid wearing dark clothing.

- Apply to bare parts of the body an insect repellent.

- live in buildings that are well made and are in uncontaminated area.

- Use of the beds that have mosquito nets and insecticide-treated.

- Install nets on windows and doors

- Install light, electrical or chemical traps.

- Use of chemical repellents, especially for pregnant women and children.

America's government wants to combat this disease more than eve. It is a USAID measures to reduce malaria:

- Malaria Prevention.

- Effective treatment options for this disease.

- Protection of pregnant women against malaria.

- Development of specific drugs for this disease.

- Find new tools and methods to control and prevent malaria.

- Plan according to the needs of the population.

USAID's focuses currently on two subject. One is the vaccine against Malaria that the test have been started in Kenya and the other is protecting the protecting the ladies from the disease. According to the organization's slogan, pregnant woman with malaria are most important to be treated. The organization's efforts have been very impressive over the past few years in Rwanda, Senegal and Zambia. Right now many researchers and scholars in America and Europe are trying and testing a vaccine to prevent malaria. Many hope is on the vaccine that will be manufactured against this deadly disease.

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