Malaria

Malaria's disease overview

What is

malaria?

malaria is one of the most common infectious diseases and is a very serious problem for public health. The disease is caused by Plasmodium parasites, transmitted from one to another when these people are burned.

Disease is common in tropical and subtropical regions of the Americas, Asia and Africa. Each year, about 515 million people get sick, from 1 to 3 million deaths - most children in the southern part of the Sahara and African desert. Malaria is often accompanied by poverty, backwardness and is a big obstacle to economic development.

Everyone can infect malaria. The immunity with malaria is incomplete and short, so it can be re -infected immediately. There is no cross -immune immunity, so one person may infect two or three types of malaria parasites.

When treated properly, people with malaria can often recover completely. However, severe malaria can progress extremely quickly and cause death within just a few hours or days. For most serious cases, there must be a special care and treatment regime, the mortality rate can be up to 20%.

malaria in children causes blood loss and direct brain damage due to brain malaria. Children who survive brain malaria are at risk of neurological and cognitive impairment, behavioral disorders and epilepsy.

Causes of Malaria's disease

pathogens: malaria parasites of the genus Plasmodium (Apicomplexa industry). In humans, malaria caused by 5 species: Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale, Plasmodium vivax and Plasmodium Knowlesi.

The most dangerous is Plasmodium Falciparum and Plasmodium Vivax. The other two species (Plasmodium ovale, Plasmodium malariae) also cause disease but less death. Particularly, Plasmodium Knowlesi, common in Southeast Asia, causes malaria in monkeys but can also cause serious illness in humans.

Malaria parasites do not exist in the external environment, only exist in human blood and in the body of mosquitoes transmitting disease

Intermediate transmission: Anopheles mosquito

There are about 422 species of Anopheles in the world but only about 70 species of malaria transmission, of which about 40 species are the main mosquitoes. In Vietnam, there are 15 species of Anopheles disease, including 3 main species of disease, namely Anopheles Minimus, Anopheles Dirus and Anopheles Epiroticus.

Anopheles Minimus mosquitoes are distributed in the nationwide mountainous areas with a height of less than 1,000 meters, thriving at the beginning and the end of the rainy season. Anopheles Dirus mosquitoes are distributed in the mountains from 20 latitudes to the South, thriving in the middle of the rainy season. Anopheles Epiroticus mosquitoes are distributed in the southern coastal region.  

Malaria developed year -round, the northern mountainous provinces developed the highest in the beginning and the end of the rainy season. In the central provinces, the Central Highlands and the Southeast, the malaria develops high during the rainy season.

After mosquitoes spread the disease and suck the blood of the patient, the male and female intercourse will combine in the stomach of the mosquito. The ovule goes through the stomach wall and forms a cocoon on the outside of the stomach, where the parasites grow to form thousands of young parasites called applying. When the cocoon broke the coincidence, the coincidence moved to concentrated in the salivary gland of the mosquito. At environmental temperature from 20-300C, after 10 days, parasites complete the cycle of sexual development in the mosquito body and can transmit the disease until mosquitoes die. At this temperature, mosquitoes can live for about 4 weeks.

The holder: The person is the only holder of malaria parasites

The transmission period:

Time from the first fever to the occurrence of cells in the blood is 2-3 days for Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and 7-10 days with Plasmodium falciparum. The patient is also a source of infection when there is a cell in the blood.

Patients who are not treated or treated without thorough treatment may be a source of mosquitoes for more than 3 years for Plasmodium Malariae, 2 years for Plasmodium VIVAX and 1 year for Plasmodium Falciparum.

Blood for stored parasites of malaria parasites can be transmitted for at least 1 month.

Symptoms of Malaria's disease

Incubation period from the time of mosquito parasites malaria burning until clinical manifestations depending on the type of parasite: Plasmodium falciparum infection for 9-14 days, an average of 12 days, Plasmodium infection Vivax from 12 - 17 days, an average of 14 days, infection of Plasmodium Malariae from 20 days to months, infection of Plasmodium ovale from 11 days to 10 months. Malaria due to blood transfusion, the incubation period depends on the number of parasites in the blood transferred but generally the time of incubation is short for a few days.

According to the basis of malaria classification of the World Health Organization, malaria in Vietnam is divided into two clinical levels:

  • Normal malaria or malaria without complications

    • Malignant malaria or malaria with complications

    Signs of malaria Different depending on the clinical form

    Common malaria signs:
  • Infection: The first fever is usually not typical, continuous high fever for a few days.
  • Typical fever: A typical malaria through the following three stages:

    • The cold tremor: The whole body trembles, the lips are pale, goosebumps. The chilling period lasts about 30 minutes - 2 hours.

    The hot fever: The cold decreases, the patient feels hot, the body temperature can be up to 400C - 410C, red face, hot dry skin, fast circuit, fast breathing, headache, thirst, may be painful Instant spleen. The hot fever period lasts about 1-3 hours.

    Sweating stage: The body temperature decreases rapidly, sweating, thirst, reducing headache, normal vessels, patients feel comfortable.

  • Penguin fever: Fever does not become a attack, only seeing cold, lasting about 1-2 hours. This fever is common in patients who have been infected with malaria for many years.
  • Cold parasites (healthy people): blood tests with parasites but no fever, still living and normal labor. This form is common in heavy malaria.
  • The cycle of fever varies depending on the type of parasite.

    • Fever caused by plasmodium falciparum: daily fever, severe fever, or malaria and death if not treated promptly.

    Fever caused by plasmodium vivax: usually a fever from Japan (1 day away from a fever).

    Fever caused by Plasmodium Malariae and Plasmodium ovale: Fever in Japan or 3 days 1 day.Malignant malaria signs:

    brain (accounting for 80-95% of malignant malaria):

  • Signs of malignant malignancy is to have conscious disorders (libidies or struggling, delirium, nonsense), continuous high fever, a lot of insomnia, severe headaches, severe headaches, vomiting or diarrhea.
  • Mental syndrome: Sudden coma or slowly, deeply coma. Temple seizures. Muscles disorders, pupils stretch.
    • other signs: respiratory disorders or respiratory failure due to brain edema. Blood pressure decreased by dehydration, or hypertension due to brain edema. Vomiting and diarrhea.
  • may experience kidney failure, little or urinary urine, high blood uremus, hemoglobin due to massive hemolysis.
  • Malignant malaria mortality rate of 20-50%.

    • Hemotic pigmentation:

  • is a severe evolution due to massive hemolysis, cardiovascular collapse, renal failure.
  • Fever into severe, vomiting or yellow, back pain. Jaundice, mucosa due to hemolysis. Hemorrhage, reddish -brown urine then turn coffee or watercolor color, decreasing urine even leads to anuria. Anemia and lack of acute oxygen. Red blood cells and hemoglobin plummeted.

    • Cold body

    The whole body is cold, the blood pressure drops, the skin is pale, sweating, headache.

    lungs

    Difficulty breathing, fast breathing, cyanosis, can cough out pink foam. The bottom of the lungs has many moist rans, snoring.

    Liver

    Jaundice, nausea and vomiting. Yellow feces, yellow urine are high in honey. Coma.

    digestive

    Abdominal pain, vomiting, acute diarrhea, heat lowering.

    malaria in pregnant women

    Pregnant women with malaria are prone to malignant malaria or miscarriage, stored fetus or premature birth.

    congenital malaria (rare)

    Mothers are pregnant with malaria and have a pregnancy cell damage between mother and child blood. The disease appears early after birth, babies fussing, fever, jaundice, spleen liver.

    malaria in children

    Children over 6 months of age are susceptible to malaria because there is no immunity from the mother and hemoglobin F. Children with malaria are often constantly high or oscillating, vomiting, diarrhea, abdominal distention, liver spleen enlargement , showing signs of meninges and convulsions. High mortality rate.

    Transmission route of Malaria's diseaseMalaria

    Is malaria contagious?

    Malaria is transmitted by blood. There are 4 transmission methods including:

  • Mosquito transmitted: is the main method. Lesions (rare). Come on?

    People at risk for Malaria's disease

    Risk factors of malaria include:

  • Low educational level and socio -economic conditions
  • Customs backward customs, cultivation practices for shifting and sleeping overnight on the fields, in the forest
  • Free migrants into the malaria area

    • Prevention of Malaria's disease

  • Propaganda and control of malaria prevention, when a fever, patients need medical facilities for examination and treatment.
  • Sleeping at home, cultivating or sleeping in the forest.
  • Mosquito prevention is still considered the most effective measure:

    • Kill mosquitoes with surface spray in walls and impregnated with mosquito killer chemicals once a year before the rainy season

    Mosquito cremation

    Luminescence, clear sewers around the house, build a home far away from the forest and far from water sources, wear long clothes in the evening

    Restricting larvae: clearing the flow, salvaging moss to make the water surface

  • Preventive medicine: The heavy malaria has a prophylactic policy for those who enter the short -term malaria areas, pregnant women in the malaria area, newcomers come. Settle in malaria area. In our country today, because malaria has dropped sharply, it is not taken in preventive medicine but only provides drugs for the above subjects to treat themselves when they have malaria.

    • Safety of blood transfusion, especially for people with a history of malaria or have lived in malaria.

    Diagnostic measures for Malaria's disease

    Diagnosis of malaria with clinical and subclinical symptoms

    Clinical disease: Patients with typical clinical symptoms or non -typical fever without blood test or negative test results but have the following 4 characteristics:

  • Currently fever (over 37.50C) or fever in the last 3 days
  • Unexpectedly the cause of other fever
  • Being or going back to malaria within 9 months back
  • Treatment with malaria drugs has a good response within 3 days

    • Diseases to identify malaria: Patients with positive malaria parasites in the blood are confirmed through blood tests.

    Testing method:

  • Giemsa dyeing method: Giemsa dyed blood is illuminated under an optical microscope.  This method is considered a gold standard to find malaria parasites.
  • ACIDINE ORANGE METHODS.
  • Method of QBC (Quantative Buffy Coat) Soi microscopy.
  • Rapid Diagnostic Test (Rapid Diagnostic Test) is based on the method of immunity to detect malaria antigen in the blood.
  • Polymerase Chain Reaction (PCR): Has high sensitivity and specificity, can detect 1 parasite/mm3 blood, diagnose malaria Relapse or re -infected malaria.
  • Methods of detecting antibodies of malaria parasites: indirect fluorescence method (indirect fluorescent antibody test (ifat) and immune method (enzyme-linked-olmunosorbent Assay - Elisa) all detect antibodies in serum patients with malaria.

    • Differentiate diagnosis with some similar diseases:

  • Distinguish malaria infected with typhoid, fever, dengue dengue fever, infection of the upper respiratory tract (flu virus, adenovirus).

    • Distinguish recurrent malaria from blood infections, urinary tract infections, biliary tract infections, liver abscess.

    Malaria's disease treatments

    Principle of treatment:

  • Early diagnosis, treatment as soon as possible to limit death and reduce spread.
  • Treatment of cutting attacks in combination with anti -spreading treatment (Destruction of cells) and anti -relapse treatment (eliminating sleep in the liver with plasmodium vivax, plasmodium ovale). >
    • Treatment of normal malaria. Treatment of fever:

    infection of Plasmodium vivax:

  • chloroquine total doses of 25mg/kg of 3 -day division weight: Day 1 and 2 days orally 10 mg/kg weight, 3 or 5 mg/kg on weight or
  • or Artesunat Total dose of 16 mg/kg of weight divided into 7 days of treatment: 1 day 1 oral 4 mg/kg weight, from Monday to Saturday oral 2 mg/kg Weight (do not use Artesunat for pregnant women in the first 3 months except in malaria)
  • or Quinin sulfate dose of 30 mg/kg/24 hours divided 3 times a day, treatment for 7 days.

    • Plasmodium falciparum infection:

  • Combined drugs with Artemisinin derivatives: Arterakine or CV Artecan tablet (40mg dihydroartemisinin + 320mg piperaquine phosphate)

    • Dosage:

    Under 3 years: 1 tablet first day, two days after every 1/2 tablet.

    From 3 to under 8 years old: 2 tablets first, two days after 1 tablet each day.

    from 8 to under 15 years old: 3 tablets on the first day, two days after each day 1.5 tablets.

    From 15 years old: First day 4 tablets, two days after each day 2 capsules.

    Not for pregnant women in the first 3 months.

    Treatment against recurrence and spread:
  • Dosage: 0.5mg of bases/kg weight/24 hours

    • With Plasmodium Falciparum 1 day

    With Plasmodium vivax for 10 consecutive days

  • Do not use Primaquine for children under 3 years old, pregnant women, people with liver disease and people with enameled G6PD.
    • Treatment of malignant malaria:
  • Artesunate intravenously

    • Dosage: First hour 2.4 mg/kg weight, 24 hours after injection repeat 1.2 mg/kg weight, then 1 dose every day 1.2 mg/kg of weight until the patient can take it, then switch to oral medication for 7 days.

  • Attention to treat symptoms and complications depending on the malaria.

    • See also:

  • Instructions for treatment when malaria
  • What is the hard malaria disease?
  • Identify malaria signs

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