Malaria symptoms

Plasmodium malaria—produces typical malaria symptoms but can persist in the blood for very long periods (decades) while remaining asymptomatic, it can infect others via blood transfusions or mosquito bites. 

Leishmaniasis. This important human parasite has the widest distribution of the trypanosomal infections, affecting an estimated 10 million people. Its many forms and varied clinical picture make it difficult to characterize. Visceral forms mimic malaria symptoms (i.e. enlarged liver and spleen) and can be highly fatal. Large outbreaks have occurred in recent years, especially in northern and eastern Africa, central Asia and Brazil. Sand fly vectors are difficult to control and no serious vector control campaigns have been mounted as a way of managing this still emerging parasitic disease. 

Plasmodium vivax, responsible for the most prevalent form of malaria (benign tertian), has an incubation period of 8—27 days (14 average). A variety seen in northern and northeastern Europe has an incubation period as long as 8—10 months. The disease can cause splenic mpture and anemia. Relapses (renewed manifestations of erythrocytic infection) can occur with this type of malaria. Overall, P. vivax is stiU susceptible to chloroquine however, resistant strains have been reported from Papua New Guinea and parts of Indonesia. Plasmodium malariae the cause of quartan malaria, has an incubation period of 15—30 days and its asexual cycle is 72 hours. This mildest form of malaria can cause nephritis in addition to the usual symptoms. It is a nonrelapsing type of malaria but the ted blood ceU infection can last for many years. No resistance to chloroquine by this plasmodium has been reported. Plasmodium ovale responsible for ovale tertian malaria, has an incubation period of 9—17 days (15 average). Relapses can occur in people infected with this plasmodium. No chloroquine resistance has been reported for this parasite. 

Four different protozoa of the genus Plasmodium -P. falciparum, P. vivax, P. ovale and P malariae - can cause malaria. P. falciparum is the most virulent, being responsible for virtually all fatal malaria cases. Humans are infected by a feeding female Anopheles mosquito (Fig. 2). The clinical symptoms of malaria are associated with the development of the parasite within human red blood cells, while the liver stages remain asymptomatic. The following dtugs (in alphabetical order) are currently in use for the treatment of malaria [5]. 

When an antimalarial drug is given to a hospitalized patient for treatment of malaria, the preadministration assessment includes vital signs and a summary of the nature and duration of the symptoms. Laboratory tests may be ordered for the diagnosis of malaria Additional laboratory tests, such as a complete blood count, may be ordered to determine the patient s general health status. 

Malaria is transmitted by the bites of the Anopheles mosquitoes which introduce into the bloodstream one of four species of sporozoites of the plasmodia (Plasmodium falciparum, P. ovale, P. vivax or P. malariae). Initial symptoms of malaria are nonspecific and may resemble influenza and include chills, headache, fatigue, muscle pain, rigors, and nausea. The onset of the symptoms is between 1 to 3 weeks following exposure. Fever may appear 2 to 3 days after initial symptoms and may follow a pattern and occur every 2 or 3 days (P. vivax, P. ovale and P. malariae). Fever with P. falciparum can be erratic and may not follow specific patterns. It is not unusual for patients to have concomitant infections with P. vivax and P. falciparum. Falciparum malaria must always be regarded as a life-threatening medical emergency. 

Are the symptoms in this patient consistent with malaria ... 

Malaria is a mosquito-borne disease caused by a parasite. The first symptoms of malaria tend to occur after the incubation period. The incubation period in most cases varies from 7 to 30 days. Symptoms include fever, chills and flulike illness. Malaria is commonly encountered in Sub-Saharan and African regions. 

The duration of treatment for skin diseases is often longer than it is for malaria, and therefore, dose-related toxicities are important. The most serious toxicities are ophthalmological. Reversible alterations include ciliary body dysfunction and corneal changes with edema and deposits. Irreversible retinopathy also occurs however, it is less common with quinacrine than with the other two drugs. Toxicity may be asymptomatic, but the earliest symptoms are night blindness, scotoma, or tunnel vision. 

Effective treatment of malaria depends on early diagnosis. Since the patient s symptoms are often relatively nonspecific, it is crucial to examine stained blood smears for the presence of the parasite. Even this procedure may be inconclusive during the early stages of the infection, since the levels of parasitemia can be quite low. Thus, it is important to repeat the blood smear examination several times if malaria is suspected. 

P. vivax, P. ovale, and P. falciparum) is characteristic of malaria and reflects the relatively synchronous passage of the parasites from one red blood cell stage in their life cycle to another. If P. vivax malaria is not treated, the symptoms may subside for several weeks or months and then recur. These relapses are due to a latent liver form of the parasite (see the following section), which is not present in P. falciparum strains. Although the fatality rate of P. vivax malaria is low, it is an exhausting infection and renders the patient more susceptible to other diseases. 

Unchecked P. falciparum malaria is the most serious and most lethal form of the disease. It is responsible for 90% of the deaths from malaria. The parasitemia achieved can be quite high and will be associated with an increased incidence of serious complications (e.g., hemolytic anemia, encephalopathy). P. falciparum malaria produces all of the symptoms listed for P. vivax malaria and in addition can cause renal failure and pulmonary and cerebral edema. The tissue anoxia occurring in P. falciparum infections results from the unique sequestering of infected erythrocytes deep in the capil-... 

The emergence of parasites resistant to chloroquine is an increasingly important problem. Several strains of chloroquine-resistant P. falciparum have been identified. This resistance would lead to the reappearance of overt symptoms of P. falciparum malaria. 

The drug is effective against all four types of malaria with the exception of chloroquine-resistant P. falciparum Chloroquine destroys the blood stages of the infection and therefore ameliorates the clinical symptoms seen in P. malariae, P. vivax, P. ovale, and sensitive P. falciparum forms of malaria. The disease will return in P. vivax and P. ovale malaria, however, unless the liver stages are sequentially treated with primaquine after the administration of chloroquine. Chloroquine also can be used prophylactically in areas where resistance does not exist. In addition to its use as an antimalarial, chloroquine has been used in the treatment of rheumatoid arthritis and lupus erythematosus (see Chapter 36), extraintestinal amebiasis, and photoallergic reactions. 

While its detailed mechanism of action is unknown, it is an effective blood schizonticide that is, it acts against the form of the parasite responsible for chnical symptoms. Orally administered mefloquine is well absorbed and has an absorption half-hfe of about 2 hours the elimination half-hfe is 2 to 3 weeks. Among its side effects are vertigo, visual alterations, vomiting, and such CNS disturbances as psychosis, hallucinations, confusion, anxiety, and depression. It should not be used concurrently with compounds known to alter cardiac conduction or prophylactically in patients operating dangerous machinery. It should not used to treat severe malaria, as there is no intravenous formulation. 

Answer The first and most important step in managing a patient with fever and occasional gastrointestinal symptoms upon return from a malaria-endemic area is to include it prominently in the differential diagnosis. Any delay in the diagnosis and proper treatment places the patient in peril. Untreated P. falciparum in a nonimmune individual can quickly overwhelm the patient in a very short time hence the name malignant tertian malaria. Severe manifestations heralding unfavorable prognosis include... 

Human malaria is caused by four species of Plasmodium namely Plasmodium falciparum, P. vivax, P. malariae and P. ovale. P. vivax is mainly responsible for most of the infections (70%) which results in benign tertian malaria. In P. falciparum and P. vivax infections, the patient has fever with rigors every third day and termed as tertian. The other two, P. ovale and P. malariae are mild in nature in which fever develops every fourth day and termed as benign quartan. Symptoms and complications in P. falciparum malaria are more severe than P. vivax malaria. 

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