Malaria attack

Every patient with malaria should be examined for simultaneous infection with more than one species of Plasmodium. Infections with both P. falciparum and P. vivax are among the most commonly encountered mixed infections. In patients with falciparum malaria, attacks of P. vivax malaria may later develop it is important not to misinterpret this delayed P vivax form as a relapse of P. falciparum infection. If a mixed infection is identified, a combination of 4-aminoquinoline and primaquine should be administered, since the primaquine helps to eliminate any persisting tissue forms of P. vivax. 

Note The main objective in the clinical management of patients suffering from an acute malaria attack is the prompt elimination of the parasite form responsible for the symptoms, that is, the asexual erythrocytic form. Drugs that are particularly effective in this regard are called schizontocidal or suppressive agents. They include such compounds as amodiaquine, chloroguanide, chloroquine, hydroxychloroquine, pyrimethamine, quinine, and tetracycline. 

Although the therapeutic benefits of the mercurials are by today s standards doubtful, and more likely outright harmful, quinine really is effective against malaria. In order to understand quinine, one must understand malaria. Malaria is a tropical and subtropical disease transferred to humans from the bite of the Anopheles mosquito, which carries the Plasmodium protozoa. Once in the bloodstream these parasites cause intermittent or remittent fevers, violent chills, headache, vomiting, and in severe cases coma and death. More often the malaria attacks are so debihtating that the sufferer succumbs to some secondary... 

Spiegel A, Tall A, Raphenon G, Trape JF, Druilhe P (2003) Increased frequency of malaria attacks in subjects coinfected by intestinal worms and Plasmodium falciparum malaria. Trans R Soc TropMed Hyg 97 198-199... 

Aibrecht Durer German painter 1471-1528 Died in Nuremberg in April, likely from recurrent malaria attacks... 

There are four types of Plasmodium which are responsible for three distinct forms of malaria. Each form of malaria can be distinguished by the length of time between the recurrent malaria attacks. 

Quartan malaria—Attacks occur every fourth day, or 72 hours apart hence, the name quartan. 

In an uncomplicated attack of malaria (for all plasmodia except chloroquine-resistant P. falciparum and P. vivax), the recommended regimen is chloroquine 600 mg (base) initially, followed by 300 mg (base) 6 hours later, and then 300 mg (base) daily for 2 days.3 In severe illness or falciparum malaria, patients should be admitted to an acute care unit and quinidine gluconate 10 mgsalt/kg... 

A combination of pyrimethamine, sulfonamide, and qninine is the dmg of choice for acute attacks of malaria and its chloroquine-resistant forms. 

Malaria For the suppressive treatment and treatment of acute attacks of malaria caused by Plasmodium vivax, P. malariae, P. ovale, and susceptible strains of P. falciparum. 

Quinine is the principal alkaloid derived from the bark of the cinchona tree. It has been used for malaria suppression for over 300 years. By 1959 it was superseded by other drugs, especially chloroquine. After widespread resistance to chloroquine became manifest quinine again became an important antimalarial. Its main uses are for the oral treatment of chloroquine-resistant falciparum malaria and for parenteral treatment of severe attacks of falciparum malaria. Quinine is a blood schizonticide with some gametocytocidal activity. It has no exoerythrocytic activity. Its mechanism of action is not well understood. It can interact with DNA, inhibiting strand separation and ultimately protein synthesis. Resistance of quinine has been increasing in South-East Asia. 

The malarial parasite is a single-cell protozoan (plas-modium). Although more than 100 species of plasmodia have been identified, only four are capable of infecting humans Plasmodium malariae, P. ovale, P. vivax, and P. falciparum) the rest attack a variety of animal hosts. P. falciparum and P. vivax malaria are the two most common forms. 

P vivax malaria is the most prevalent type of infection and is characterized by periodic acute attacks of chills and fever, profuse sweating, enlarged spleen and liver, anemia, abdominal pain, headaches, and lethargy. Hyperactivity of the reticuloendothelial system and hemolysis are the principal causes of the enlarged spleen and liver these effects often result in anemia, leukopenia, thrombocytopenia, and hyperbilirubinemia. The cyclical nature of the acute attacks (48 hours for... 

In areas where chloroquine-resistant P. falciparum is common, a combination of a rapidly acting blood schi-zonticide and pyrimethamine-sulfadoxine may be the treatment of choice. An acute attack of malaria caused... 

It is indicated in acute attack of multidrug resistant P. falciparum malaria where quinine is not effective. 

Herbal medicines that control the attack of diseases such as asthma and malaria should be taken 1-2 hours before an attack. 

Hoffman, S.L. (2000) Infectious disease. Research (genomics) is crucial to attacking malaria. Science 290, 1 509. 

Clinical Use. Primaquine is typically used to treat the relapses of specific forms of malaria,12 and is generally administered in acute or severe exacerbations, or when other drugs (chloroquine, mefloquine) are ineffective in suppressing malarial attacks. Primaquine may also be used to prevent the onset of malaria in individuals who are especially at risk because of prolonged exposure to the disease.50 This drug is administered orally. 

C. It is the drug of choice for the treatment of an acute attack of falciparum or vivax malaria. 

Dose. For an acute attack of malaria, 2 g of hydroxychloroquine sulphate given over three days (1.2 g on the first dayX In rheumatoid arthritis, initially 400 to 800 mg daily. 

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