Malaria: Causes, Symptoms and Treatment

Malaria infection causes high levels of morbidity and mortality in Sub-Saharan Africa, especially in Nigeria. It is an entirely preventable and treatable disease if tackled early enough. However, there are growing problems with drug resistance that are posing a threat to the global fight against malaria. 

Malaria

Malaria is an acute illness caused by Plasmodium parasites, which are spread to people through the bites of an infected female Anopheles mosquito. Once an infected mosquito bites a human, the parasites multiply in the host’s liver before infecting and destroying red blood cells. It is preventable and curable.

Children aged under 5 years are the most vulnerable group affected by malaria.. There are 5 parasite species that cause malaria in humans though two of them pose the greatest threat.The five of them are Plasmodium (p) falciparum, P. vivax, P. malariae, P. ovale and P. knowlesi.

If it isn’t treated, malaria can cause severe health problems such as seizures, brain damage, trouble breathing, organ failure and death.

Causes

Malaria is caused by a single-celled parasite of the genus, plasmodium. The parasite is transmitted to humans most commonly through mosquito bites. In very rare cases, pregnant women with malaria can transfer the disease to their children before or even during death

Symptoms

The hallmark of malaria is fever. Initially, symptoms may mimic the flu. Malaria symptoms usually appear 10 days to one month after the person was infected, The symptoms may be mild. Some people do not fall sick after infection. This is because the malaria parasites can live in the human body for several years without causing any symptoms at all.

  • Impaired consciousness
  • Multiple convulsions
  • Fevers and chills
  • Abnormal bleeding
  • Signs of anemia
  • Prostration
  • Deep breathing
  • Respiratory distress
  • Rapid heart rate
  • General feeling of discomfort
  • Nausea and vomiting
  • Cough
  • Diarrhea
  • Muscle or joint pain
  • Seizure
  • Kidney failure
  • Bloody stools
  • Convulsions

Diagnosis

Malaria is diagnosed from a blood smear when the parasite is seen under the microscope. There are other tests available but microscopy remains the cornerstone of diagnosis. 

●      Microscopic Diagnosis

Malaria parasites can be identified by examining under the microscope a drop of the patient’s blood, spread out as a ‘blood smear’ on a microscope slide. Before the examination, the specimen is stained to give the parasites a  distinctive appearance. However, this technique remains the golden standard for laboratory confirmation of malaria.

●      Clinical diagnosis

This type of diagnosis is done based on the patient’s symptoms and on physical findings at the examination. Clinical findings should always be confirmed by a laboratory test for malaria. The first symptoms of malaria (most often fever, chills, sweats, headaches, muscle pains, nausea and vomiting) are often not specific and are also found in other diseases (such as the “flu” and common viral infections). Likewise, the physical findings are often not specific (elevated temperature, perspiration, tiredness). In severe malaria (primarily caused by Plasmodium falciparum), clinical findings (confusion, coma, neurological focal signs, severe anaemia, respiratory difficulties) are more striking and may increase the index of suspicion for malaria.

●      Rapid diagnostic test.

 Also called RDT or antigen testing, this is a quick option when blood draws and smears aren’t available. Blood taken from a prick on your finger is put on a test strip that changes colour to show whether you have malaria or not. This test usually can’t tell which of the four common species of malaria parasites caused your infection. It also can’t tell whether the infection is minor or major. Your doctor should follow up on all results with blood smears. This RDT is approved for use by hospital and commercial laboratories.

●      Quantitative Buffy Coat Technique

The Quantitative Buffy Coat (QBC) technique is a commercially available test based on fluorescence microscopy. The test uses a specially made glass capillary tube of precise internal diameter containing acridine orange as a vital stain. After the tube is filled with blood, it is capped and a small plastic float is inserted. The float displaces precisely 90 percent of the interior tube space along its length, and when centrifuged, settles at the plasma-red blood cell interface, physically expanding the length of the buffy coat layer 10-fold. White blood cell components appear as discrete bands and can be accurately quantified with a specially designed optical device. The float also extends into and expands the top portion of the red blood cell layer where the parasitized red blood cells, because of their lower density, are concentrated. The centrifuged tube is observed directly, using a fluorescence microscope. Since the contrast between stain and background is high, parasitized red blood cells are easily seen. It is a relatively new technique. It is a quick and efficient method of processing batches of blood specimens. 

●      Antibody test

Doctors use the antibody test to detect malaria . Sometimes, they can be found in samples such as saliva. Scientists are discovering more antibodies all the time. The results of some antibody tests can be diagnostic. Doctors usually use this test to find out if you have had malaria before. It looks for antibodies that show up in the blood after infection.

●      Serology

Diagnosis of malaria using serological methods is usually based on the detection of antibodies against asexual blood-stage malaria parasites. It is highly sensitive and specific.

Treatment

  1. Medications

Malaria is treated with prescription drugs to kill the parasite. The types of drugs and the length of treatment will vary depending on the age of the patient, the severity of your symptoms and many other factors.  Some of the common antimalarial drugs include:

  • Chloroquine phosphate Chloroquine is the preferred treatment for any parasite that is sensitive to the drug. But in many parts of the world, parasites are resistant to chloroquine, and the drug is no longer an effective treatment.
  • Artemisinin-based combination therapies (ACTs). ACT is a combination of two or more drugs that work against the malaria parasite in different ways. This is usually the preferred treatment for chloroquine-resistant malaria. Examples include artemether-lumefantrine (Coartem) and artesunate-mefloquine.
  • Atovaquone-proguanil
  • Primaquine phosphate
  • Quinine sulfate with doxycycline.

Prevention

  1. Antimalarial drugs can also be used to prevent malaria.Some of these drugs include
  2. Chloroquine
  3. Quinine
  4. Atovaquone
  5. Proguanil
  6. Artemether and lumefantrine
  7. Mefloquine
  8. Doxycycline
  9. Clindamycin
  10. Vector control

Vector control of malaria refers to any method to limit or eradicate malaria-carrying Anopheles mosquitoes. It is one of the most effective ways of controlling malaria.

  1. Indoor residual Spraying (IRS)

IRS involves spraying insecticide, once or twice a year, on all indoor surfaces where mosquitoes are likely to rest.  This has been found to reduce the survival of mosquitoes that enter the home. It is estimated that 5% of at-risk populations are protected by this method.

  1. Larviciding

This involves treating the breeding sites of the mosquito with substances that kill the larval stages of the insect. It is effective, but only in areas where mosquito breeding sites are fixed in one place and easy to find.

  1. Long-lasting insecticidal nets

LLIN are mosquito nets that are also sprayed with an insecticide. They provide a physical and chemical barrier to the mosquito vector at night, when the mosquito is most likely to bite. The nets also result in the large-scale killing of mosquitoes when used by entire communities.

  1. Chemoprophylaxis

Malaria chemoprophylaxis is only for travellers to malaria-endemic countries, which are classified in three (or four) groups, to determine which drug is recommended for chemoprophylaxis. The choice of drugs depends on the travel destination, the duration of potential exposure to vectors, parasite resistance pattern, level and seasonality of transmission, age and pregnancy. In endemic countries, chemoprophylaxis could also be recommended for autochthonous young children and pregnant women, depending on endemicity level and seasonality of transmission.

Tips for preventing malaria infection

  • Determine your level of risk
  • Apply mosquito repellent with DEET (diethyltoluamide) to exposed skin.
  • Wear light coloured cloth
  • Apply permethrin to clothing.
  • Drape mosquito netting over beds.
  • Put screens on windows and doors.
  • Wear full sleeve protective clothing.
  • Stay in well-screened areas at night
  • Spray insect repellants on your exposed skin. The recommended repellent contains N-Diethyl-meta-toluamide (DEET).
  • Use a mosquito net over the bed if your bedroom isn’t air-conditioned or screened. For additional safety, you can treat the mosquito net with the insecticide permethrin.
  • When you go out, in addition to spraying insect repellants on your exposed skin, you can also spray on your clothing. Mosquitoes find it easy to bite through thin clothing.
  • Keep your home and surroundings clean without any junks or wastes.
  • When it comes to controlling the disease, keep an eye out for symptoms like fever with high temperature. As soon as you find any possible signs of malaria, consult your doctor immediately.
  • Make sure you don’t keep your windows and doors open at night as mosquitoes get active during the night and pose a higher risk. You can either use a mosquito or any net to seal your window and then open for the whole day.
  • If you are a regular user of sunscreen, make sure you apply sunscreen first and then use an insect repellent.
  • Treat clothing, mosquito nets, tents, sleeping bags and other fabrics with an insect repellent called permethrin.
  • Wear long pants and long sleeves to cover your skin
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