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Malaria is characterized by cycles of chills, fever, pain, and sweating. Historical records suggest malaria has infected humans since the beginning of mankind. The name "mal aria" (meaning "bad air" in Italian) was first used in English in 1740 by H. Walpole when describing the disease. The term was shortened to "malaria" in the 20th century. C. Laveran in 1880 was the first to identify the parasites in human blood. In 1889, R. Ross discovered that mosquitoes transmitted malaria. Of the four common species that cause malaria, the most serious type is Plasmodium falciparum malaria. It can be life-threatening. However, another relatively new species, Plasmodium knowlesi, is also a dangerous species that is typically found only in long-tailed and pigtail macaque monkeys. Like P. falciparum, P. knowlesi may be deadly to anyone infected. The other three common species of malaria (P. vivax, P. malariae, and P. ovale) are generally less serious and are usually not life-threatening. It is possible to be infected with more than one species of Plasmodium at the same time. What are malaria symptoms and signs? The symptoms characteristic of malaria include flulike illness with fever, chills, muscle aches, and headache. Some patients develop nausea, vomiting, cough, and diarrhea. Cycles of chills, fever, and sweating that repeat every one, two, or three days are typical. There can sometimes be vomiting, diarrhea, coughing, and yellowing (jaundice) of the skin and whites of the eyes due to destruction of red blood cells and liver cells. People with severe P. falciparum malaria can develop bleeding problems, shock, liver or kidney failure, central nervous system problems, coma, and can die from the infection or its complications. Cerebral malaria (coma, or altered mental status or seizures) can occur with severe P. falciparum infection. It is lethal if not treated quickly; even with treatment, about 15%20% die.
Etiologic Agent: Protozoa of genus plasmodia 1. The disease is caused by four species of protozoa: a. Plasmodium falciparum (malignant tertian) · This is considered as the most serious malarial infection because of the development of high parasitic densities in blood (RBC) with tendency to agglutinate and form into microemboli. · This is most common in the Philippines.
· It is manifested by chills every 48 hours on the 3rd day onward especially if untreated. and shaded streams usually in the mountains. c. 14 days for P. · This is rarely seen in the Philippines. Falciparum 2. c. trees. curtains. It assumes a 36º position when it alights on walls. d.b. and the like. 12 days for P. vivax and ovale 3. Plasmodium ovale is the rare type of protozoan species. It is brown in color. Incubation period: 1. It usually does not bite a person in motion. b. It is bigger in size than the ordinary mosquito. Plasmodium malariae (Quartan) · It is less frequently seen. It breeds in clear. e. 30 days for P. Plasmodium vivax (Benign tertian) · This is nonlife threatening except for the very young and the old. 2. flowing. f. The primary vector of malaria is the female Anopheles mosquito which has the following characteristics: a. d. · This specie is nonlife threatening. · Fever and chills usually occur every 72 hours usually on the 4th day after onset. malariae . It is a night-biting mosquito.
5. with feeling of well-being in between Splenomegally. malariae. Mode of Transmission: 1. 3. On rare occasions. falciparum. Clinical Manifestations: 1. one to two years in P. Risk factors include traveling in areas in which such mosquitoes are found or. 4. it is transmitted from shared contaminated needles. and not more than one year on P. 2. rarely. Paroxysms with shaking chills Rapidly rising fever with severe headache Profuse sweating Myalgia.Risk Factors of Malaria Malaria comes from being bitten by a mosquito carrying the malaria organism. transplacental transmission of congenital malaria is a rare case. being bitten by a mosquito that has previously fed on an "imported" case of malaria (such that the case can occur in an area of the world where malaria is not endemic). hepatomegally . However. 3. 4. Period of Communicability: Untreated or insufficiently treated patient may be the source of mosquito infection for more than three years in P. vivax. The disease is transmitted mechanically through the bite of an infected female anopheles mosquito 2. It can be transmitted parenterally through blood transfusion.
6. In cerebral malaria a. 8. Splenomegally 9. This is done to detect malarial parasite antigen in the blood. Malarial smear ± In this procedure. stained. The parasite enters the mosquito¶s stomach through the infected human blood obtained by biting or during blood meal. The patient must be closely monitored. 2. a number of young parasites are released which work their way into the salivary gland of the mosquito. then. The female alone plays the role of a vector and definitive host in conveying the disease from man to man (sexual propagation). a film of blood is placed on a slide. Paroxysms may last for 12 hours. maybe repeated daily or after a day or two. Changes in sensorium. and examined microscopically. severe headache. In humans. Convulsions and gastrointestinal symptoms are prominent c.6. 4. BUN creatinine. Young merozoites invade a new batch of RBC. Pathogenesis: 1. and parasitic count . It gives a result within 10 to 15 minutes. 2. Daily monitoring of patient¶s serum bilirubin. The organisms are carried in the saliva into the victim when the mosquito bites again. Intake and output should be closely monitored to prevent pulmonary edema. Erythrocytic merozoites are produced leading to the rupture of RBC upon the release of the tiny organisms. a. the organisms invade the RBC where they grow and undergo sexual schizogony. The parasite undergoes sexual conjugation. Jacksonian or grand mal seizure may occur Diagnostic Procedure: 1. and vomiting b. Rapid diagnostic test (RDT) ± This is a blood test for malaria that can be conducted outside the laboratory and in the field. After 10 to 14 days. 8. Orthostatic hypotension 7. 7. Fever maybe continuous b. 3. Nursing Management: 1. 5. b. In children: a. to start another schizonic cycle.
Watch for any signs especially abnormal bleeding. commercial names Coartem and Riamet) Artesunate-amodiaquine (Therapy only) Artesunate-mefloquine (Therapy only) Artesunate-Sulfadoxine/pyrimethamine (Therapy only) Atovaquone-proguanil. trade name Malarone (Therapy and prophylaxis) Quinine (Therapy only) Chloroquine (Therapy and prophylaxis. determine the arterial blood gas and plasma electrolyte 3. trade name Lariam (Therapy and prophylaxis) Primaquine (Therapy in P. delirium. During the febrile stage. Evaluate the degree of anemia. and ice cap on the head will help bring the temperature down. convulsion. Consider severe malaria as medical emergency that requires close monitoring of vital signs. Application of external heat and offering hot drinks during chilling stage is helpful. ovale only. prophylaxis for semi-immune pregnant women in endemic countries as ³Intermittent Preventive Treatment´ ± IPT) Hydroxychloroquine. If the patient exhibits respiratory and renal symptoms. trade name Plaquenil (Therapy and prophylaxis) . 4. confusion. 5. As the temperature falls and sweating begins. warm sponge bath maybe given. usefulness now reduced due to resistance) Cotrifazid (Therapy and prophylaxis) Doxycycline (Therapy and prophylaxis) Mefloquine. 9. and coma. tepid sponges. Encourage the patient to take plenty of fluids. Treatment and Medications: Anti-Malarial Drugs y y y y y y y y y y y y y y Artemether-lumefantrine (Therapy only. 12. 11. Watch for neurologic toxicity (from quinine infusion) like muscular twitching. 8. 6. Provide comfort and psychological support.2. not for prophylaxis) Proguanil (Prophylaxis only) Sulfadoxine-pyrimethamine (Therapy. The bed and clothing should be kept dry. vivax and P. 10. alcohol rubs. 7.
7. 5. People living in malaria-infested areas should not donate blood for at least three years. Malaria cases should be reported. 2. 8. Insect repellents must be applied to the exposed portion of the body. A thorough screening of all infected persons from mosquitoes is important. 6. Mosquito breeding places must be destroyed. . Mosquito nets should be used especially when in infected areas. Blood donors should be properly screened. 4. 3.Prevention and Control: 1. Homes should be sprayed with effective insecticides which have residual actions on the walls.
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