Malaria: symptoms, pathogen, treatment and prevention. Malaria. My experience of illness. Adviсe

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The causative agent of malaria, the development of the disease

The causative agent of malaria, routes of transmission to humans

Malaria is caused by 4 types of microorganisms from the “kingdom Protista” - plasmodium. It is these four varieties that determine the form of malaria. The type “falciparuma” is manifested by a tropical form of infection, “vivaxa” – 3-day malaria, “ovale” – ovalemalaria, 4-day malaria, a consequence of the causative agent Plasmodium “malariae”.

Along with this, infection is possible through a transplacental method (during pregnancy), or through perenteral infection during blood transfusion from a carrier donor. In areas of epidemic foci of malaria, greater susceptibility to infection is observed among children and visiting tourists. The peak of infection coincides with the seasonal activity of insects - in the summer-autumn period.

Having traveled a certain path in search of a fertile environment for reproduction, sporozoites choose the liver and invade its cellular structure - hepatocyte cells. Here the transformation of sporozoites into schizons occurs, turning into large spherical cells.

It manifests itself in response to the reaction of the hypothalamus (the thermoregulatory center of the body) to protein changes in erythrocyte cells and metabolic waste of the pathogen. An addition to the implementation of attacks is allergic reaction the body to repeated processes of antigenic irritations.

Malarial attacks are accompanied by extensive vascular constriction of the peripheral branches during chills and processes of sharp vasodilation during fever.

Such changes increase the secretion of substances that increase the permeability of vascular walls. The possibility of proteins and plasma leaking into the extravascular space causes blood to thicken and slow blood flow. And high thromboplastic activity caused by destructive process(hemolysis) of red blood cells increases blood clotting (hypercoagulation).

• With pronounced disturbances in microcirculation, processes of disseminated (widespread) intravascular hypercoagulation develop.

This leads to acute disturbances in the circulatory system and nutrition of brain structures. Invasion caused by Plasmodium falciparum (tropical form) is manifested by changes in the central nervous system. It can occur in a malignant form. Its genesis is due to:

Symptoms of malaria, the first signs in humans

Main clinical symptom malaria - sudden febrile outbreaks in the form of attacks, followed by regular calm state. Such symptoms of malaria are characteristic of all forms of infection, with the exception of tropical. The initial attack of fever is preceded by the first signs of malaria:

• general poor health of the patient;
• migraine;
• joint and muscle soreness;
• low-grade fever (does not exceed 38 °C).

After three days of this condition, the phases of attacks of malarial fever begin. The sequence of their manifestations is chaotic in the initial period, but over time the duration of the phases acquires a certain clear character with equal intervals.

The time of the intermediate phases is determined by the type of infection - accordingly, an attack is one in three days, or one in four. The onset of fever typically occurs in the afternoon.

Paroxysmal phases of malaria appear:

In the form of chills - slight trembling, or a shaking that covers the whole body. The face and limbs become cold, the skin turns pale and becomes rough and blue. There is an increased heart rate and shallow breathing. The patient can remain in this state for up to three hours.

Fever, manifested by a very high temperature, with a noticeable deterioration of the condition. The heat phase can last up to half a day, accompanied by:

• skin hyperemia of the face and severe thirst;
• hyperemia and dry skin of the body;
• severe migraines
• feeling of muscle heaviness;
• tachycardia and pain in the heart;
• dry tongue covered with a gray coating;
• diarrhea and vomiting;
• state of excitement;
• involuntary convulsions and fainting.

Sweating is the final phase that replaces fever. This phase is characterized by signs of a sharp decrease in temperature (sometimes reaching hypothermia). The patient's condition improves and he falls asleep.

9 Symptoms and Conditions Characteristic of Malaria

1) The development of anemia, provoked by the massive death of red blood cells. It becomes obvious in between feverish intervals. Its symptoms are expressed by a yellowish-sallow skin color and rapid fatigue.

2) . It appears after several attacks of fever and can persist for a long time. Only in the tropical form of infection does an enlargement of the spleen occur immediately after the onset of the attack. In parallel with splenomegaly, there is pain in the organ and its hardening.

• Lack of timely treatment provokes significant growth, which can fill a significant area of ​​the peritoneum.

3) , which develops faster than splenomegaly. There is a significant enlargement and thickening of the liver. Its edge descends below the costal arches, causing painful symptoms in the hypochondrium on the right side.

4) Dysuric processes - frequent urination of light urine in the chill phase, dark urine and a significant decrease in its volume in the heat phase.

5) Disturbances in cardiovascular functions, manifested by signs of hypertension in the initial phase with chills and a sharp drop in blood pressure, in the second phase - fever.

6) Yellowness of the skin and mucous structures, which is one of the early signs of malaria. This process is caused by the release of bilirubin (bile pigment) during the destruction of red blood cells. An important diagnostic indicator is the yellowness of the sclera, which manifests itself even before the coloring of the skin.

7) Skin hemorrhages developing as a result of vascular spasms. External signs are characterized by uneven localization throughout the body of various star-shaped subcutaneous hemorrhagic formations of various shades (from blue to purple).

8) Herpetic rashes that appear in patients due to the activity of herpes virions. The state of the febrile process is aggravated by blistering rashes on the body and blistering malaria on the lips.

9) Nervous disorders, usually manifested in the 3-day form of malaria and the tropical form. Proceeding with constant migraines and insomnia (sleep disorder) and a feeling of exhaustion. The attacks are accompanied by a state of depression, disorientation in space and confusion of speech.

During fever, visual hallucinations and delusional states are observed. A tropical infection is characterized by manifestations of the patient’s violence, sometimes after the attack has passed.

These signs are also characteristic of the manifestations of malaria in children, with the only difference being that it manifests itself more acutely. Its severity depends on the age and state of the child’s immunity. At the first signs of malaria, it is necessary to urgently diagnose and begin immediate therapeutic treatment.

Malaria diagnosis, tests

As an auxiliary diagnostic factor confirming the diagnosis, various methods of serological testing are used - “XRF”, and others.

Additionally, a differentiated analysis of the infection is carried out from a whole bunch of pathologies with similar symptoms (meningoencephalitis, leishmaniasis and sepsis, tuberculosis, relapsing fever, leukemia, or hemolytic jaundice).

Treatment and prevention of malaria, drugs

Treatment of patients with a confirmed diagnosis of malaria takes place in a hospital and begins with ensuring strict rest, establishing a plentiful drinking regimen, strengthening, infusion and symptomatic therapy. In case of a severe clinical picture, procedures for purifying the blood of toxins (hemosorption) and blood filtration using hemodialysis may be prescribed.

For chemotherapy of malaria, both the time-tested natural drug “Quinine” and synthetic analogues are used. To stop shezogony, the drugs Primaquine and Quinocida are prescribed. And medications such as “Chloroquine”, “Pyrimethamine”, “Mecaprine” or “Quinine” have a detrimental effect on merozoites leading to the cell death of erythrocytes.

The treatment regimen for malaria is drawn up in various combinations drugs, depending on the severity of the process and the type of pathogen. Since patients with severe activation of herpes infection show extensive signs of mylarial rashes on the lips at the time of attacks, treatment is supplemented with antiviral drugs that stop the activity of herpes virions - Transferrin, Ceruloplasmin, Lactoferrin.

As preventive measures to prevent malaria, the simplest method is to control pathogen vectors using insecticidal treatment of the area and individual protective measures using various means– mosquito nets, special lotions and creams.

An effective method is drug prophylaxis for people planning trips to places that are unfavorable regions for malaria.

All patients presenting with febrile illness for unknown reasons are advised to undergo a microscopic blood test. This will help identify the disease at an early stage, provide timely treatment, and prevent possible complications.

World Malaria Day

The eleventh anniversary will be celebrated in April 2017 world day fight against malaria - World Malaria Day, established by WHO. The main concept of such an action is aimed at combating malaria, which affects half the world's population.

In African and Asian countries, the incidence of malaria is up to 80% and in the vast majority (about 90%), they end in death.

The primary goal of World Malaria Day is to unite the entire world community in the fight against infection: providing assistance in anti-malaria activities in endemic regions, attracting new funding sponsors, expanding scientific developments to combat malaria and their speedy implementation into practice.

Malaria(Italian mala aria - “bad air”, formerly known as “swamp fever”) - a group of vector-borne infectious diseases transmitted to humans through the bites of mosquitoes of the genus Anopheles (“malaria mosquitoes”) and accompanied by fever, chills, splenomegaly (increase in the size of the spleen) , hepatomegaly (increase in liver size), anemia. Characterized by a chronic relapsing course. Caused by parasitic protists of the genus Plasmodium (80-90% of cases - Plasmodium falciparum).

Malaria causes about 350-500 million infections and about 1.3-3 million deaths in humans each year. Sub-Saharan Africa accounts for 85-90% of these cases, with the vast majority affecting children under 5 years of age. Death rates are expected to double over the next 20 years.

The first chronicled evidence of fever caused by malaria was discovered in China. They date back to approximately 2700 BC. e., during the reign of the Xia dynasty.

What causes malaria

Malaria is caused by protozoa of the genus Plasmodium. Four species of this genus are pathogenic for humans: P.vivax, P.ovale, P.malariae and P.falciparum. In recent years, it has been established that malaria in humans is South-East Asia It also causes a fifth species, Plasmodium knowlesi. A person becomes infected with them at the time of inoculation (injection) by a female malaria mosquito of one of the stages of the life cycle of the pathogen (the so-called sporozoites) into the blood or lymphatic system, which occurs during blood sucking.

After a short stay in the blood, the sporozoites of Plasmodium falciparum penetrate the liver hepatocytes, thereby giving rise to the preclinical hepatic (exoerythrocytic) stage of the disease. Through a process of asexual reproduction called schizogony, one sporozoite eventually produces 2,000 to 40,000 hepatic merozoites, or schizonts. In most cases, these daughter merozoites return to the bloodstream within 1-6 weeks. In infections caused by some North African strains of P.vivax, the primary release of merozoites into the blood from the liver occurs approximately 10 months after infection, coinciding with a short period of mass mosquito breeding in the following year.

The erythrocyte, or clinical, stage of malaria begins with the attachment of merozoites that have entered the blood to specific receptors on the surface of the erythrocyte membrane. These receptors, which serve as targets for infection, appear to be different for different types of malarial Plasmodium.

Epidemiology of malaria
IN natural conditions malaria is a naturally endemic, protozoal, anthroponotic, vector-borne infection.

Malaria pathogens find hosts in various representatives of the animal world (monkeys, rodents, etc.), but as a zoonotic infection, malaria is extremely rare.

There are three routes of malaria infection: transmissible, parenteral (syringe, post-hemotransfusion) and vertical (transplacental).

The main transmission route is transmission. Human malaria is transmitted by female mosquitoes of the genus Anopheles. Males feed on flower nectar.

The main vectors of malaria in Ukraine:
An. messae, An. maculipennis, An. atroparvus, An. sacharovi, An. superpictus, An. pulcherrimus etc.

The life cycle of mosquitoes consists of a number of stages: egg - larva (I - IV instar) - pupa - imago. Fertilized females attack humans in the evening or at night and feed on blood. In females that are not engorged with blood, eggs do not develop. Females engorged with blood remain in the dark corners of residential or utility rooms, thickets of vegetation until the end of digestion of the blood and maturation of the eggs. The higher the air temperature, the faster the development of eggs in the female’s body is completed (gonotrophic cycle): at a temperature of +30°C - up to 2 days, at + 15°C - up to 7 in P. vivax. Then they rush to a pond where they lay eggs. Such reservoirs are called anophelogenic.

The maturation of the aquatic stages of vector development also depends on temperature and lasts 2-4 weeks. At temperatures below +10°C, mosquitoes do not develop. During the warm season of the year, up to 3 - 4 generations of mosquitoes can appear in the middle latitudes, 6 - 8 in the south, and up to 10 - 12 in the tropics.

For sporogony, a temperature of at least +16°C is required. Sporogony of P. vivax at +16°C is completed in 45 days, at +30°C - in 6.5 days. The minimum temperature for sporogony of P. falciparum is +19 - 20°C, at which it is completed in 26 days, at +30°C - in 8 days.

The malaria transmission season depends on this. In the tropics, the malaria transmission season reaches 8-10 months, in the countries of equatorial Africa it is year-round.

In temperate and subtropical climates, the malaria transmission season is limited to the summer-autumn months and lasts from 2 to 7 months.

Sporozoites in mosquitoes overwintering die, so females that emerge in the spring are not carriers of malarial plasmodia, and in each new season, mosquitoes are infected with malaria patients.

Intrauterine infection of the fetus through the placenta is possible if the pregnant mother has an infection, but more often this occurs during childbirth.

With these forms of infection, schizont malaria develops, in which the phase of tissue schizogony is absent.

Susceptibility to malaria is universal. Only representatives of the Negroid race are immune to P. vivax.

The spread of malaria is determined by geographical, climatic and social factors. The distribution boundaries are 60 - 64° north latitude and 30° south latitude. However, the species range of malaria is uneven. The widest range is that of P. vivax, the causative agent of three-day malaria, the distribution of which is determined by geographic boundaries.

The range of tropical malaria is smaller because P. falciparum requires higher temperatures to develop. It is limited to 45° - 50° N. w. and 20° S. w. Africa is the world's hotbed of tropical malaria.

The second place in distribution in Africa is occupied by four-day malaria, the range of which reaches 53° N. w. and 29° S. w. and which has a focal, nested character.

P. ovale is found mainly in the countries of Western and Central Africa and on some islands of Oceania (New Guinea, Philippines, Thailand, etc.).

In Ukraine, malaria has been practically eliminated and mainly imported malaria and isolated cases of local infection secondary to imported ones are registered.

Malaria is brought into the territory of Ukraine from tropical countries and from neighboring countries - Azerbaijan and Tajikistan, where there are residual foci.

The largest portion of imported cases is three-day malaria, which is the most dangerous due to possible transmission by mosquitoes sensitive to this type of pathogen. In second place is the importation of tropical malaria, the most severe clinically, but less dangerous epidemiologically, since Ukrainian mosquitoes are not sensitive to P. falciparum imported from Africa.

Cases of importation with an unknown cause of infection are registered - “airport”, “baggage”, “accidental”, “transfusion” malaria.

The WHO European Bureau, due to political and economic instability in the world, increased migration and the implementation of large-scale irrigation projects, identifies malaria as a priority problem due to the possibility of a return of the infection.

Under the influence of these factors, the formation of new foci of malaria is possible, that is, settlements with adjacent anophelogenic reservoirs.

In accordance with the WHO classification, there are 5 types of malaria foci:
pseudofocus - the presence of imported cases, but there are no conditions for transmission of malaria;
potential - the presence of imported cases and there are conditions for the transmission of malaria;
active new - the emergence of cases of local infection, malaria transmission has occurred;
active persistent - the presence of cases of local infection for three years or more without interruption of transmission;
inactive - transmission of malaria has ceased; there have been no cases of local infection over the past two years.

An indicator of the intensity of the risk of malaria infection according to the WHO classification is the splenic index in children from 2 to 9 years old. According to this classification, there are 4 degrees of endemicity:
1. Hypoendemia - splenic index in children from 2 to 9 years old up to 10%.
2. Mesoendemia - the splenic index in children from 2 to 9 years old is 11 - 50%.
3. Hyperendemia - the splenic index in children from 2 to 9 years is above 50% and high in adults.
4. Holoendemia - the splenic index in children from 2 to 9 years of age is constantly above 50%, the splenic index in adults is low (African type) or high (New Guinea type).

Pathogenesis (what happens?) during Malaria

Based on the method of infection, sporozoite and schizont malaria are distinguished. Sporozoite infection- This is a natural infection through a mosquito, with the saliva of which sporozoites penetrate the human body. In this case, the pathogen goes through the tissue (in hepatocytes) and then the erythrocyte phases of schizogony.

Schizont malaria is caused by the introduction of ready-made schizonts into the human blood (hemotherapy, syringe malaria), therefore, unlike sporozoite infection, there is no tissue phase, which determines the features of the clinic and treatment of this form of the disease.

The direct cause of attacks of malarial fever is the entry into the blood during the disintegration of morulae of merozoites, which are foreign proteins, malarial pigment, hemoglobin, potassium salts, and remnants of red blood cells, which change the specific reactivity of the body and, acting on the heat-regulating center, cause a temperature reaction. The development of an attack of fever in each case depends not only on the dose of the pathogen (“pyrogenic threshold”), but also on the reactivity of the human body. The alternation of attacks of fever characteristic of malaria is due to the duration and cyclicity of erythrocyte schizogony of the leading generation of plasmodia of one or another species.

Foreign substances circulating in the blood irritate the reticular cells of the spleen and liver, causing their hyperplasia, and over a long period of time - proliferation connective tissue. Increased blood supply to these organs leads to their enlargement and pain.

Sensitization of the body by a foreign protein and the development of autoimmunopathological reactions are important in the pathogenesis of malaria. The breakdown of red blood cells during erythrocyte schizogony, hemolysis as a result of the formation of autoantibodies, and increased phagocytosis of red blood cells of the reticuloendothelial system of the spleen are the causes of anemia.

Relapses are typical for malaria. The reason for short-term relapses in the first 3 months after the end of the primary acute symptoms is the persistence of some erythrocyte schizonts, which, due to a decline in immunity, begin to actively multiply again. Late or distant relapses, characteristic of tertian and oval malaria (after 6-14 months), are associated with the completion of bradysporozoite development.

Symptoms of Malaria

All clinical manifestations of malaria are associated only with erythrocyte schizogony.

There are 4 types of malaria: three-day, oval malaria, four-day and tropical.

Each species form has its own characteristics. However, attacks of fever, splenohepatomegaly and anemia are typical.

Malaria is a polycyclic infection, during its course there are 4 periods: the incubation period (primary latent), the primary acute manifestations, the secondary latent period and the relapse period. The duration of the incubation period depends on the type and strain of the pathogen. At the end of the incubation period, symptoms appear - harbingers, prodromes: fatigue, muscle pain, headache, chills, etc. The second period is characterized by repeated attacks of fever, for which a typical staged development is a change in the stages of chills, heat and sweat. During a chill that lasts from 30 minutes. up to 2 - 3 hours, the body temperature rises, the patient cannot warm up, the limbs are cyanotic and cold, the pulse is rapid, breathing is shallow, blood pressure is increased. By the end of this period, the patient warms up, the temperature reaches 39 - 41 ° C, a period of heat begins: the face turns red, the skin becomes hot and dry, the patient is excited, restless, headaches, delirium, confusion, and sometimes convulsions are noted. At the end of this period, the temperature drops rapidly, which is accompanied by profuse sweating. The patient calms down, falls asleep, and a period of apyrexia begins. However, then the attacks are repeated with a certain cyclicity, depending on the type of pathogen. In some cases, the initial (initial) fever is irregular or constant.

Against the background of attacks, the spleen and liver enlarge, anemia develops, all body systems suffer: cardiovascular (myocardial dystrophic disorders), nervous (neuralgia, neuritis, sweating, chilliness, migraines), genitourinary (symptoms of nephritis), hematopoietic (hypochromic anemia, leukopenia, neutropenia, lymphomonocytosis, thrombocytopenia), etc. After 10 - 12 or more attacks, the infection gradually subsides, and a secondary one occurs latent period. If incorrect or ineffective treatment after a few weeks - months, near (3 months), late or distant (6-9 months) relapses occur.

Three-day malaria. Duration of the incubation period: minimum - 10 - 20 days, for infection with bradysporozoites - 6 - 12 or more months.

Prodromal phenomena at the end of incubation are characteristic. A few days before the onset of attacks, chills, headache, lower back pain, fatigue, and nausea appear. The disease begins acutely. For the first 5-7 days, the fever may be of an irregular nature (initial), then an intermittent type of fever develops with a typical alternation of attacks every other day. An attack is characterized by a clear change in the stages of chills, heat and sweat. The period of heat lasts 2 - 6 hours, less often 12 hours and is replaced by a period of sweating. Attacks usually occur in the first half of the day. The spleen and liver enlarge after 2-3 temperature paroxysms and are sensitive to palpation. At 2-3 weeks, moderate anemia develops. This species form is characterized by near and distant relapses. The total duration of the disease is 2-3 years.

Malaria oval. In many clinical and pathogenetic characteristics it is similar to tertian malaria, but differs in a milder course. The minimum incubation period is 11 days; long-term incubation can occur, as with a three-day incubation - 6 - 12 - 18 months; The deadline for incubation is known from publications - 52 months.

Fever attacks occur every other day and, unlike 3-day malaria, occur mainly in the evening. Early and distant relapses are possible. The duration of the disease is 3-4 years (in some cases up to 8 years).

Tropical malaria. The minimum duration of the incubation period is 7 days, fluctuations up to 10 - 16 days. Prodromal phenomena at the end of the incubation period are characteristic: malaise, fatigue, headache, joint pain, nausea, loss of appetite, feeling of chills. The initial fever is of a constant or irregular nature, initial fever. Patients with tropical malaria often do not have the typical symptoms of an attack: no or mild chills, the febrile period lasts up to 30 - 40 hours, the temperature drops without sudden sweating, muscle and joint pain are pronounced. Cerebral phenomena are noted - headache, confusion, insomnia, convulsions, hepatitis with cholemia often develops, signs of respiratory pathology arise (bronchitis, bronchopneumonia); quite often expressed abdominal syndrome(abdominal pain, nausea, vomiting, diarrhea); Kidney function is impaired.

Such a variety of organ symptoms makes diagnosis difficult and causes erroneous diagnoses.

The duration of tropical malaria is from 6 months. up to 1 year.

Malarial coma- cerebral pathology in tropical malaria is characterized by rapid, rapid, sometimes lightning-fast development and a severe prognosis. During its course, three periods are distinguished: somnolence, stupor and deep coma, the mortality rate of which is close to 100%.

Often, cerebral pathology is aggravated by acute renal failure.

Hemoglobinuric fever, pathogenetically associated with intravascular hemolysis, is characterized by an equally severe course. Most often, it develops in individuals with genetically determined enzymopenia (deficiency of the G-6-PD enzyme) while taking antimalarial drugs. It may result in the death of the patient from anuria due to the development of acute renal failure.

The algid form of tropical malaria is less common and is characterized by a cholera-like course.

Mixed malaria.
In areas endemic for malaria, simultaneous infection with several species of Plasmodium occurs. This leads to an atypical course of the disease and makes diagnosis difficult.

Malaria in children.
In malaria-endemic countries, malaria is one of the causes of high mortality among children.

Children under 6 months of age born to immune women in these areas acquire passive immunity and very rarely become ill with malaria. The most severe illness, often with fatal outcome, occurs in children aged 6 months and older. up to 4 - 5 years. Clinical manifestations in children of this age are unique. Often the most striking symptom, malarial paroxysm, is absent. At the same time, symptoms such as convulsions, vomiting, diarrhea, abdominal pain are observed, there are no chills at the beginning of the paroxysm and no sweating at the end.

On the skin there are rashes in the form of hemorrhages and spotted elements. Anemia increases rapidly.

In children of older age groups, malaria usually progresses in the same way as in adults.

Malaria in pregnant women.
Malarial infection has a very adverse effect on the course and outcome of pregnancy. It can cause abortion, premature birth, eclampsia in pregnancy and death.

Vaccinal (schizont) malaria.
This malaria can be caused by any human malaria species, but the predominant species is P. malariae.

In past years, the method of pyrotherapy was used to treat patients with schizophrenia and neurosyphilis, infecting them with malaria by injecting the blood of a malaria patient. This is the so-called therapeutic malaria.

Currently, depending on the conditions of infection with Plasmodium-infected blood, blood transfusion and syringe malaria are isolated. The literature describes cases of accidental malaria - occupational infection of medical and laboratory personnel, as well as cases of infection of organ transplant recipients.

The viability of plasmodium in the blood of donors at 4°C reaches 7-10 days.

It should be noted that post-transfusion malaria can occur in severe form, and in the absence of timely treatment give an unfavorable outcome. Diagnosing it is difficult primarily due to the doctor’s lack of assumption about the possibility of hospital-acquired malaria infection.

The increase in cases of schizont malaria is currently associated with the spread of drug addiction.

When treating such patients, there is no need to prescribe tissue schizontocides. One of the forms of schizont malaria is a congenital infection, i.e. infection of the fetus during intrauterine development (transplacentally if the placenta is damaged) or during childbirth.

Immunity in malaria.
In the process of evolution, humans have developed different mechanisms of resistance to malaria:
1. innate immunity associated with genetic factors;
2. acquired active;
3. acquired passive immunity.

Acquired active immunity caused by past infection. It is associated with humoral restructuring, the production of antibodies, and an increase in the level of serum immunoglobulins. Only a small portion of antibodies play a protective role; in addition, antibodies are produced only against the erythrocyte stages (WHO, 1977). Immunity is unstable, quickly disappears after the body is freed from the pathogen, and is species- and strain-specific. One of the essential factors of immunity is phagocytosis.

Attempts to create artificial acquired active immunity through the use of vaccines continue to be important. The possibility of creating immunity as a result of vaccination with attenuated sporozoites has been proven. Thus, immunization of people with irradiated sporozoites protected them from infection for 3-6 months. (D. Clyde, V. McCarthy, R. Miller, W. Woodward, 1975).

Attempts have been made to create merozoite and gametic antimalarial vaccines, as well as a synthetic multispecies vaccine proposed by Colombian immunologists (1987).

Complications of malaria: malarial coma, splenic rupture, hemoglobinuric fever.

Diagnosis of Malaria

Diagnosis of malaria is based on an analysis of the clinical manifestations of the disease, epidemiological and geographical history data and is confirmed by the results laboratory research blood.

The final diagnosis of the specific form of malaria infection is based on the results of laboratory blood tests.

With the research regimen recommended by WHO for mass examinations, it is necessary to carefully examine 100 fields of view in a thick drop. Study two thick drops for 2.5 minutes. per each more effective than examining one thick drop for 5 minutes. When malaria plasmodia are detected in the very first fields of view, viewing of slides is not stopped until 100 fields of view have been viewed, so as not to miss a possible mixed infection.

When detected in a patient indirect signs malarial infection (stay in a malarial zone, hypochromic anemia, the presence of pigmentophages in the blood - monocytes with clumps of malarial pigment almost black in the cytoplasm) it is necessary to examine a thick drop more carefully and not two, but a series - 4 - 6 with one injection. In addition, if the result is negative in suspicious cases, it is recommended to draw blood repeatedly (4-6 times a day) for 2-3 days.

The laboratory response indicates the Latin name of the pathogen, the generic name Plasmodium is abbreviated to “P”, the species name is not abbreviated, as well as the stage of development of the pathogen (required when P. falciparum is detected).

To monitor the effectiveness of treatment and identify possible resistance of the pathogen to the antimalarial drugs used, the number of plasmodiums is counted.

The detection of mature trophozoites and schizonts - morulae - in the peripheral blood in tropical malaria indicates a malignant course of the disease, which the laboratory must urgently report to the attending physician.

The former have found greater use in practice. More often than other test systems, indirect immunofluorescence reaction (IDIF) is used. Smears and drops of blood with big amount schizonts.

To diagnose tropical malaria, the antigen is prepared from an in vitro culture of P. falciparum, since most patients do not have schizonts in their peripheral blood. Therefore, for the diagnosis of tropical malaria, the French company BioMerieux produces a special commercial kit.

Difficulties in obtaining the antigen (from a patient's blood or from an in vitro culture), as well as insufficient sensitivity, make it difficult to introduce NRIF into practice.

New methods for diagnosing malaria have been developed based on luminescent immunoenzyme sera, as well as using monoclonal antibodies.

The enzyme-linked immunosorbent test system using soluble malaria plasmodium antigens (REMA or ELISA), like RNIF, is used mainly for epidemiological studies.

Treatment of Malaria

The most common drug used to treat malaria today, as before, is quinine. It was replaced by chloroquine for a time, but quinine has recently gained popularity again. The reason for this was the appearance in Asia and then spread throughout Africa and other parts of the world, Plasmodium falciparum with a mutation of resistance to chloroquine.

Extracts of the plant Artemisia annua (Wormwood), which contain the substance artemisinin and its synthetic analogues, have high efficiency, but their production is expensive. Currently (2006) the clinical effects and the possibility of producing new drugs based on artemisinin are being studied. Other work by a team of French and South African researchers developed a group of new drugs known as G25 and TE3, which were successfully tested in primates.

Although anti-malarial drugs are available on the market, the disease poses a threat to people who live in endemic areas where there is no adequate access to effective drugs. According to Doctors Without Borders, the average cost of treating a person infected with malaria in some African countries is only US$0.25 to US$2.40.

Prevention of Malaria

Methods that are used to prevent the spread of the disease or for protection in areas where malaria is endemic include preventative medications, mosquito control, and mosquito bite preventatives. There is currently no vaccine against malaria, but active research is underway to create one.

Preventive medicines
A number of drugs used to treat malaria can also be used for prevention. Typically, these medications are taken daily or weekly at a lower dose than for treatment. Preventive medicines are usually used by people visiting areas at risk of contracting malaria and are rarely used by the local population due to high cost and side effects these medications.

Since the beginning of the 17th century, quinine has been used for prevention. The 20th century synthesis of more effective alternatives such as quinacrine (acriquine), chloroquine and primaquine has reduced the use of quinine. With the emergence of a strain of Plasmodium falciparum resistant to chloroquine, quinine has returned as a treatment but not a preventative.

Destruction of mosquitoes
Efforts to control malaria by killing mosquitoes have achieved success in some areas. Malaria was once common in the United States and Southern Europe, but the draining of swamps and improved sanitation, along with the control and treatment of infected people, have removed these areas from being unsafe. For example, in 2002, there were 1,059 cases of malaria in the United States, including 8 deaths. On the other hand, malaria has not been eradicated in many parts of the world, especially in developing countries - the problem is most widespread in Africa.

DDT has proven itself to be an effective chemical against mosquitoes. It was developed during World War II as the first modern insecticide. It was first used to fight malaria and then spread to agriculture. Over time, pest control, rather than mosquito eradication, has come to dominate the use of DDT, especially in developing countries. Throughout the 1960s, evidence of the negative effects of its misuse increased, eventually leading to the ban of DDT in many countries in the 1970s. Until this time it wide use has already led to the emergence of DDT-resistant mosquito populations in many areas. But now there is the prospect of a possible return of DDT. The World Health Organization (WHO) now recommends the use of DDT against malaria in endemic areas. In addition, the use of alternative insecticides in areas where mosquitoes are resistant to DDT is proposed to control the evolution of resistance.

Mosquito nets and repellents
Mosquito nets help keep mosquitoes away from people and thereby significantly reduce the number of infections and transmission of malaria. Nets are not a perfect barrier, so they are often used in conjunction with an insecticide that is sprayed to kill mosquitoes before they find their way through the net. Therefore, insecticide-impregnated nets are much more effective.

Covered clothing and repellents are also effective for personal protection. Repellents fall into two categories: natural and synthetic. Common natural repellents are essential oils of certain plants.

Examples of synthetic repellents:
DEET (active ingredient - diethyltoluamide) (eng. DEET, N,N-diethyl-m-toluamine)
IR3535®
Bayrepel®
Permethrin

Transgenic mosquitoes
Several options for possible genetic modifications of the mosquito genome are being considered. One potential method for controlling mosquito populations is the method of rearing sterile mosquitoes. Significant progress has now been made towards developing a transgenic or genetically modified mosquito that is resistant to malaria. In 2002, two groups of researchers already announced the development of the first samples of such mosquitoes.

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The birthplace of a dangerous disease, which is considered malaria, is hot, sunny Africa. The disease, which quickly spread across the rest of the continents, affected almost a billion people a year, because the treatment was unknown.

Malaria – dangerous disease, which causes harmful organisms – plasmodia – to enter the human body and its blood. They are carried by malaria mosquitoes; only females are dangerous.

Doctors and scientists are directing a lot of efforts and funds to obtain new effective drugs for malaria and are engaged in its prevention. Despite the measures taken, the incidence of malaria in areas where it is widespread remains very high.

There is a consistently high mortality rate from the disease here, especially many people die in African countries, where children often die.

What is malaria

Malaria

The possibility of becoming infected with it arises during blood transfusion, during transplantation of donor organs from an infected donor. A sick mother (a carrier of malaria) can infect her newborn child with this disease, and it can be transmitted to the fetus during pregnancy.

The human body can be susceptible to simultaneous infection with several types of malaria. This form of it is especially difficult to diagnose and treat, since the sources of infection are different types of plasmodium, for the patient this form of the disease is difficult to tolerate.

It should be noted that this disease is seasonal. The beginning of a mass disease is the establishment of hot and humid weather. Foci of malaria are being monitored and measures are being taken to eliminate them. The population of dangerous areas is checked for the presence of the disease, and treatment is provided if necessary.

Types of malaria

In order to prescribe effective drugs against malaria, it is necessary to determine which of the four types of pathogen causing its symptoms. To do this, doctors carefully monitor the manifestation of its clinical symptoms and conduct blood and urine tests on the patient.

There are four species of Plasmodium that cause different types of malaria in humans:

• tropical - it is provoked by Plasmodium falciparum. This form of malaria is the most dangerous due to its rapid progression and is characterized by high mortality and frequent complications;
• three-day malaria is caused by Plasmodium Vivax, attacks of the disease are cyclical and repeat after about two days;
• The presence of the microorganism Plasmodium malaria causes a four-day form of malaria. With it, patients experience a repetition of attacks after three days on the fourth;
• The pathogen Plasmodium ovale can lead to ovalemalaria, its symptoms are similar to the course of the three-day form of the disease.

The causative agent of malaria

Plasmodium has a two-phase life cycle. The first of them is sporogony or sexual development. In this phase, plasmodia develop outside the human body. The female anafeles mosquito is a carrier of malaria. When bitten by it, from the blood of a person who is a carrier of the disease, the germ cells of the malaria pathogen - female and male - enter the stomach of the mosquito.

Several stages of Plasmodium development occur; its spotocysts enter the salivary glands of the malaria mosquito. To complete all stages of plasmodium development, depending on its type, it takes from 10 to 16 days at an optimal air temperature of 25 degrees Celsius.

With the next attack on a person, a simple mosquito bite occurs, the insect’s saliva infected with Plasmodium sporozoites enters the blood of the bitten person, where malaria is caused by new plasmodia.

If the air temperature is environment decreases and does not exceed 15 degrees Celsius, sporogony may stop.

In the human body, the infection spreads, and asexual reproduction occurs here. Microbiologists call this process the schizogony phase. This phase is divided into two stages. The first of them is fabric. Sporozoites of the causative agent of the disease reach the human liver and penetrate it.

Here, over the course of one to three weeks, the constant development of malarial plasmodium occurs, ultimately in this organ they turn into merozoids.

The tissue stage is characterized by the fact that some sporozoites may not begin their development immediately, they are able to “lurk” here for quite a long time - up to several months, then the development of malaria pathogens still occurs, a person experiences a new attack of the disease, they can occur regularly and repeatedly even after treatment.

The next stage of infection development is when malarial pathogens find a way to penetrate red blood cells and get there. This is the erythrocyte stage of the disease. Plasmodium merozoids in erythrocytes divide, each of them produces up to forty-eight new ones.

The infected red blood cell is destroyed and merozoids come out of it and attack the healthy red blood cell. The cycle of their divisions is repeated, there is constant destruction of important blood cells. The type of developing plasmodium determines the duration of the cycle, ranging from two to three days.

Some of the newly formed merozoids of pathogens are capable of turning into their germ cells; they are formed in the blood vessels of internal organs. Here they actively grow and are divided into male and female.

Then they are again transferred into the body of a female malaria mosquito during a bite, where they complete the stage of their development in her intestines. Thus, the process of spreading the infection is endless.

The main signs of the disease begin to actively fade only when the causative agent of the disease enters the blood and begins to destroy its red blood cells; until this stage, the development of malaria is often hidden and does not make itself felt.

The first thing an adult needs to know is that malaria has 4 forms of manifestation, each period proceeds differently, differs in symptoms, but the treatment is almost the same - quinine. There are such periods of illness:

• mild incubation period of malaria;
• acute manifestations (primary);
• acute manifestations (secondary);
• relapse period (with improper treatment).

The incubation period for malaria in adults is difficult to recognize because the symptoms are identical to other diseases.

Among the main, pronounced signs for which treatment is prescribed:

• severe chills, as a sign of malaria;
• headaches - prolonged pain;
• dysfunction of muscles, accompanied by painful sensations.

The incubation period is considered less dangerous than the second period of primary acute symptoms. Here are the signs:

• attacks of fever that recur with frequent regularity;
• a clear change in fever, profuse sweating and chills;
• high temperature (and the extremities most often become cold);
• high blood pressure, not reduced by medication treatment;
• breathing is rapid and shallow;
• convulsions.

Secondary manifestations (if left untreated) are no less dangerous, because during this period the temperature can jump sharply to 41 degrees. In addition, symptoms are observed:

• enlargement of the spleen and liver as part of malaria;
• defeats of cardio-vascular system;
• severe disorders nervous system.

Once malaria has manifested itself, the symptoms are quite pronounced, but if the patient is negligent, it threatens a period of relapse. Signs in adults usually appear between 12-14 acute attacks, after which they calm down a little.

Malaria is one of the most common acute infectious diseases of protozoal etiology in countries with tropical and subtropical climates. This is a disease with a high risk of infection and high mortality. The risk group consists mainly of children under 5 years of age, as mentioned above.

Therefore, it is necessary to timely detect infection, correctly diagnose it, and urgently begin treatment:

The detection of mature forms of trophozoites or schizonts and gamonts in the peripheral blood is considered dangerous. This is a reason to predict an unfavorable outcome of malaria or the initial stage of malarial coma.

Immunological method:

The basis of the method is the detection of antibodies, as well as soluble antigens, in the patient’s blood or serum.

1. The test is performed on smears and drops of blood with a large number of schizonts.
2. Diagnosis is carried out using special drugs.
3. Such studies are not well tested due to problems in obtaining the antigen.

The method is used to test donors in areas with an increased risk of infection.

To prevent the development of malaria, all people arriving from areas at risk who develop an unfounded febrile state within 3 days undergo a diagnostic examination.

An important condition must be observed that after visiting countries where there is an unfavorable situation and the possibility of contracting malaria, when its very first symptoms appear, you should immediately consult a doctor, take all tests to exclude the disease, or, after confirming the diagnosis, start immediately therapeutic measures or prevention.

Self-medication, taking pills on the advice of friends is unacceptable. Only the doctor makes such a choice for the patient; he selects them individually for each patient. To do this, he takes into account many factors, including the nature of the influence active drug, used in therapy for the causative agent of malaria and the general condition of the patient.

Patients sometimes experience individual characteristics of the body when the pills do not work. In such cases, the doctor conducts additional tests and prescribes other medications and dosage regimens, and carefully monitors the patient’s condition.

The fight against non-tropical forms of malaria (Vivax or ovalemalaria) usually consists of taking drugs: chloroquine is used for three days, with which their types containing primaquine are simultaneously prescribed, the duration of which is long, two to three weeks.

If during therapy the doctor notices that plasmodia are resistant to chloroquine, he replaces this drug with amodiaquine, while continuing to use primaquine. In some cases, the duration of treatment and dose are increased - this depends on the patient’s health condition and the geographic location where the infection occurred.

When treating the four-day form of malaria, medications are prescribed - chloroquine or amodiaquine, the duration of their administration is from three to five days.

The fight against a dangerous tropical form of malaria requires significant effort and medical experience. As noted above, the causative agent of the tropical form of the disease has become the most resistant to chloroquine-based medications.

Therefore, modern treatment is based on the use of artemisin derivatives and their combination.

Tablets are used together, the action of which is aimed at erythrocyte forms of plasmodium. If the course of malaria is not complicated, the scheme of measures uses drugs individually for each patient - these can be artemeter and lumefantrine; artesunate and amodiaquine and others. Severe forms of the disease are treated with other drugs, most often quinine along with doxycycline.

Complicated and cerebral forms of malaria are treated with intravenous injections of drugs - quinine and doxycycline, or the drug artemeter.

Severe forms tropical malaria require increased attention to the patient's condition - it is necessary to take antipyretic tablets, regularly monitor the patient's urine output, and blood transfusions are effective in treatment.

When carrying out therapy, it is necessary to regularly analyze the dynamic changes in the patient’s blood samples to determine the dynamics of his condition.

Anti-malaria drugs, even their modern types, are often ineffective when used to treat patients. This is explained by the level of high resistance of the pathogen to their therapeutic effect, their rapid “accustomment” to pharmaceutical products.

This process has stable dynamics. When choosing a drug against malaria and its prevention, one should also take into account the geographical factor - in each of the areas where the causative agent of the disease is distributed, it is most often addictive to similar drugs.

The World Health Organization, which pays a lot of attention, effort, and research to the fight against malaria, divides antimalarial substances into several types, based on their targeted action:

• for pre-treatment of malaria;
• to relieve its clinical manifestations;
• for primary or radical treatment.

Modern medicine divides all antimalarial therapy into three groups of drugs:

• medications whose targeted action is aimed at destroying plasmodia that live in human red blood cells. The most commonly chosen drugs for patients are, as a rule, quinine, chloroquine, doxycycline, artemisin, pyrimethamine and a number of others;
• Effectively for Vivax and ovalemalaria, the following drugs act on the tissue forms of the malaria pathogen: cinopide and primaquine;
• against the tropical form of the disease, anti-malaria tablets - quinine, primaquine, pyrimethamine - are used to influence the gametes of the pathogen. In the tropical form of malaria, gametes of Plasmodium falciparum can remain in the human blood for up to a week, so treatment with such drugs is vital.

Malaria - dangerous consequences

Types of this disease, except for its tropical form, respond well to treatment and do not lead to the death of the patient. The most dangerous, tropical form of the disease, when untimely or incorrectly treated, most often leads to death.

Frequent complications of malaria are expressed in the following conditions, observed when infected with three-day and four-day forms of the disease:

• severe anemia caused by the destruction of red blood cells;
• swelling of the hands and feet is observed; swelling can be located throughout the patient’s body;
• splenic rupture;
• the protein content in urine increases;
• decreased protein and albumin levels in the blood;
• increased blood clotting.

Malaria, in its tropical form, produces complications that are more severe for sick people:

• the patient develops a malarial coma;
• infectious-toxic shock of the body;
• rapid destruction of red blood cells (acute homolysis of red blood cells);
• there is a sharp violation normal functioning both human kidneys, which leads to irreversible consequences for the patient.

Children are especially affected by malaria; among them, the mortality rate from this disease is very high. This sad fact is associated with the developmental characteristics of a child - children's skin is very delicate and attracts blood-sucking insects.

In countries where the disease is widespread, especially in Africa and Asia, children often do not have the opportunity to eat well and are weakened by many diseases due to the lack of qualified medical care.

Such unfavorable living conditions do not allow them to have good immunity, therefore, their disease develops rapidly, its course occurs in acute stages and leads to irreversible consequences, very often to death.

Some residents of countries where malaria is common have been infected with this disease more than once, and it is possible to develop immunity to its pathogen. Such defensive reaction the body is temporary, it is impossible to acquire immunity for life.

The causative agent of malaria is often invulnerable to long-term use of the same drugs for their destruction and prevention. Therefore modern medical science constantly studies the disease and finds new drugs to destroy its pathogens.

The first precaution is to always take medications, especially before going to an area where outbreaks of diseases are most common. A prerequisite before using preventive medications is a visit to a doctor who will prescribe protective treatment.

Taking medications that protect against malaria should begin several weeks before traveling to a dangerous area, throughout your stay there, and for some time after returning home. An important condition is to undergo a thorough examination in the hospital, especially if malaria is suspected, the symptoms and signs of which are quite acute.

A prerequisite when traveling to a dangerous area is the use of mosquito nets and protective thick clothing that protects against the bites of dangerous mosquitoes.

You can first stock up on special preparations that keep insects at a safe distance.

Detected symptoms or signs of malaria are a reason to urgently go to your family doctor and report your suspicions. Immediate treatment at any stage will allow you to fight the disease quickly and without harm to health.

Depending on the type of malaria, the presence or absence of complications of the disease, the stage of the development cycle of malarial plasmodium, the presence of resistance (resistance) to antimalarial drugs, individual regimens of etiotropic therapy are developed from the presented antimalarial drugs.

Drug group	Drug names	Mechanism of action	Efficacy against malaria species	Reception mode
Quinolylmethanols	Quinine (quinine sulfate, quinine hydrochloride and dihydrochloride, quinimax, hexaquin)	Hematoschizotropic antimalarial drugs effective against plasmodia during the period of erythrocyte schizogony. Prevents the penetration of plasmodia into red blood cells. Gametocidal drug acts on gametocytes (sexual forms), prevents further entry of plasmodium into the mosquito’s body.	All types of plasmodium, including those resistant to chloroquine.	Adults – 2 g/day. for 3 doses orally, 20-30 mg/kg/day. in 2-3 doses intravenously, 3-7 days. Children – 25 mg/kg in 3 doses, 3-7 days.
	Chloroquine (delagil, hingamin)	Hematoschisotropic and moderate gametocidal action.	All types of plasmodia.	Adults – 0.5 g/day. orally, 20-25 mg/kg in 3 injections every 30-32 hours intravenously. Children – 5 mg/kg/day 2-3 days.
	Hydroxychloroquine (plaquenil)	Hematoschisotropic and moderate gametocidal action.	All types of plasmodia.	Adults – 0.4 g/day. inside 2-3 days. Children – 6.5 mg/kg/ days 2-3 days.
	Mefloquine (lariam)	Hematoschisotropic action		Adults: first dose – 0.75, after 12 hours – 0.5 g. Children – first dose – 15 mg/kg, after 12 hours – 10 mg/kg.
	Primaquin	Histoschizotropic drug acts on tissue schizonts of plasmodia, incl. and on hypnozoites (dormant forms). Effective for preventing relapses. Gametocidal action.	Three-day and oval malaria.	Adults: 2.5 mg/kg every 48 hours – 3 doses. Children: 0.5 mg/kg every 48 hours – 3 doses.
Biguanides	Proguanil (bigumal, paludrin)	Histoschisotropic action . Slow hematoschizotropic action.	Tropical malaria, including those resistant to quinine and chloroquine.	Adults: 0.4 g/day. 3 days. Children: 0.1 – 0.3 g/day. 3 days
Diaminopyrimidines	Pyrimethamine (chloridine, Daraprim)	Histoschisotropic action . Slow hematoschizotropic action in combination with sulfadoxine.	Tropical malaria.	Adults: 0.075 g once. Children: 0.0125 – 0.05 g once.
Terpene lactones	Artemisinin (artemeter, artesunate)	Hematoschisotropic action. Reserve drug	All types of malaria.	Adults and children: first dose – 3.2 mg/kg, then 1.6 mg/kg 1-2 times a day for 5-7 days.
Hydroxynaphthoquinones	Atowahon (mepron)	Hematoschisotropic action. Reserve drug, used in the presence of resistance to other drugs.	All types of malaria.	Adults: 0.5 g 2 times a day for 3 days. Children: 0.125-0.375g 2 times a day for 3 days.
Sulfonamides	Sulfadoxine	Hematoschisotropic	Tropical malaria.	Adults: 1.5 g once. Children: 0.25 – 1.0 g once.
Sulfones	Dapsone	Hematoschisotropic action in combination with pyrimethamine.		Adults: 0.1 g/day. Children: 1-2 mg/kg/day.
Tetracyclines	Tetracycline	Hematoschisotropic histoschisotropic action.	Tropical malaria, resistant to the above drugs.	Adults: 0.3 – 0.5 g 4 times a day. Children over 8 years old: 25-50 mg/kg/day.
Lincosamides	Clindamycin	Hematoschisotropic action, low activity, moderate histoschisotropic action.	Tropical malaria, resistant to the above drugs, low activity.	Adults: 0.3 – 0.45 g 4 times a day. Children over 8 years old: 10-25 mg/kg/day.

Caring for a person with malaria

A person suffering from malaria requires constant and careful care, which will reduce suffering during attacks of fever. During the period of chills, it is necessary to cover the patient; you can put heating pads at the feet. During a fever, it is necessary to open the patient, remove heating pads, but prevent hypothermia and drafts. For headaches, you can put a cold pack on your head. After profuse sweating, change the underwear and give the patient rest.

In the room where the patient is located, it is necessary to prevent the entry of mosquitoes (use of nets, insecticides) in order to prevent the spread of malaria.

If complications of malaria occur, the patient is transferred to a ward or intensive care unit.

Diet for malaria

• Interictal period– diet is not prescribed, common table No. 15 with drinking plenty of fluids.
• During an attack of fever – table No. 13 with plenty of drink. Table No. 13 provides for increasing the body's defenses; meals should be frequent and divided.

Recommended products for diet table No. 13:

• low-fat varieties of fish and meat, low-fat broths,
• boiled eggs,
• dairy products,
• mashed rice, buckwheat and semolina porridge,
• boiled vegetables,
• stale wheat bread, crackers,
• ground soft fruits and berries,
• juices, fruit drinks, decoctions,
• honey, sugar.

Prevention of malaria

Prevention of malaria is necessary when living or temporarily staying in countries where malaria is endemic. So, when traveling to a malaria-prone country, you need to prepare in advance. It is advisable for pregnant women, children under 4 years of age and people living with HIV not to travel to countries affected by malaria.

Protection against mosquito bites

• Mosquito nets on windows and doorways, you can sleep under a mesh curtain, tucking it under the mattress.
• Repellents– chemical compounds that repel mosquitoes, but do not kill them, which are applied to human skin or clothing. There are various forms: creams, sprays, aerosols, gels, etc. Use according to the instructions.
• Insecticides– means for killing mosquitoes. It is recommended to treat rooms, nets, and thresholds with an insecticide aerosol. Half an hour after treatment, it is necessary to ventilate the room.

Drug prevention of malaria

Antimalarial drugs are used. It is necessary to clarify the regional resistance of malaria to drugs. Drug prevention does not provide 100% protection, but significantly reduces the risk of disease.

Drugs used to prevent malaria(must start 1 week before travel and continue for 4 – 6 weeks after arriving home) :

• Chloroquine (delagil) 0.5 g for adults and 5 mg/kg/day. children once a week.
• Hydroxychloroquine (Plaquenil) 0.4 g for adults and 6.5 mg/kg for children once a week.
• Mefloquine (Lariam) 0.25 g for adults and 0.05 - 0.25 mg for children once a week.
• Primaquin 30 mg for adults and 0.3 mg/kg for children once every 48 hours.
• Proguanil (bigumal) 0.2 g/day. adults and 0.05-0.2 g for children.
• Primethamine (chloridine) 0.0125 g for adults and 0.0025 – 0.0125 g for children in combination with the drug dapsone 0.1 g for adults once a week.

Identifying and effectively treating patients with malaria

It is necessary to promptly examine patients with suspected malaria, and also be sure to examine patients with each hyperthermic syndrome who arrived from places where malaria is endemic for 3 years. Effective treatment helps to stop further transmission of the pathogen through mosquitoes.

Malaria vaccine

There is currently no official malaria vaccine. However, clinical studies of an experimental vaccine against tropical malaria are underway. Perhaps, in 2015 - 2017, this vaccine will help cope with the malaria epidemic in the world.

What is lip malaria and how does it manifest?

Malaria on the lips manifests itself in the form of small blisters, located close to each other and filled clear liquid. The cause of such lesions on the skin is the herpes simplex virus type 1. Therefore, the use of the term “malaria” to refer to this phenomenon is not correct. Also among the popular designations for the herpes virus on the lips there are such terms as “cold” or “fever on the lips”. This disease manifests itself with local symptoms that develop in accordance with a certain pattern. In addition to local symptoms, patients may also be concerned about some general manifestations of this disease.

The stages of manifestation of herpes on the lips are:

• tingling;
• bubble formation;
• formation of ulcers;
• scab formation;
• healing.

Tingling
initial stage Herpes on the lips is manifested by mild itching. The patient begins to experience a slight tingling sensation in the corners of the mouth, on the inner and outer surfaces of the lips. Along with tingling, the patient may be bothered by the desire to scratch the areas around the wings of the nose or other parts of the face. Sometimes language can be involved in this process. The duration of this stage most often does not exceed 24 hours. These symptoms may occur due to overheating or hypothermia of the body. Often, herpes on the lips is a harbinger of a cold. In women, this phenomenon can develop during menstruation.

Bubble Formation
On at this stage the inflammatory process begins to develop. The areas where tingling was felt swell and small transparent bubbles form on their surface. The vesicles are located tightly to each other, forming small clusters. These formations are filled with a clear liquid, which becomes more cloudy as they grow. The pressure in the blisters increases and they become very painful. The location of the bubbles is the upper or underlip, as well as areas under the nose.

Formation of ulcers
After 2–3 days, the bubbles with liquid begin to burst. During this period, the patient is most contagious, since the fluid contains a large number of viruses. An ulcer forms at the site of the burst vesicle.

Formation of scabs
At this stage, the ulcers begin to become covered with a brown crust. All affected areas are involved in the process, and within one day dried scabs form in place of the blisters. When removing the crust, bleeding wounds and a feeling of itching or burning may occur.

Healing
Within 4–5 days, wound healing and skin restoration occur. During the process of the scab falling off, the patient may be bothered by mild peeling and itching, which often provokes patients to peel off the crust of the ulcers on their own. This leads to the healing process being delayed. Such interference can lead to the addition of a bacterial infection.

General manifestations herpes on lips
Along with rashes in the lip area, herpes simplex type 1 can be manifested by a deterioration in general condition, weakness, and headache. Often, patients have enlarged lymph nodes located in the lower jaw. Body temperature may also rise, muscle pain may develop, and salivation may increase.

What types of malaria are there?

There are four main types of malaria. Each type is caused by a specific type of malarial plasmodium, which determines the specificity of the disease.

The types of malaria are:

• tropical malaria;
• three-day malaria;
• malaria ovale;
• quartan.

Tropical malaria
Tropical or, as it is also called, comatose malaria has the most severe course. It accounts for about 95–97 percent of all deaths. The clinic is dominated by severe toxic syndrome. The changes in the phases of “chills,” “heat,” and “sweat,” characteristic of other forms of malaria, are not expressed.

The disease begins with the appearance of fever, diffuse headache and myalgia ( severe muscle pain). After a couple of days, symptoms of toxic syndrome appear - nausea, vomiting, low blood pressure. Tropical malaria is characterized by the appearance of a rash on the body ( allergic exanthema), cough, feeling of suffocation. During the first week, hemolytic anemia develops, which is accompanied by the development of jaundice. Anemia develops due to increased destruction ( hemolysis – hence the name anemia) red blood cells. Enlargement of the liver and spleen is observed only in the second week, which significantly complicates the early diagnosis of malaria.

Many people with weakened immune systems may develop toxic shock, malarial coma, or acute renal failure already in the first or second week of the disease. Patients who develop a malarial coma become lethargic, sleepy, and apathetic. After a few hours, consciousness becomes confused, inhibited, and convulsions may also appear. This condition has an unfavorable outcome.

Due to massive destruction of red blood cells, acute renal failure most often develops. So, from destroyed red blood cells, hemoglobin enters first into the blood and then into the urine. As a result, the processes of urine formation in the kidneys are disrupted and diuresis decreases ( daily urine). Due to oliguria, metabolic products that are normally excreted in the urine remain in the body. A condition called uremia develops.

Three-day malaria
Three-day malaria is a benign type of malarial invasion. As a rule, it is not accompanied by severe complications and does not lead to death.

Its onset is preceded by a short prodromal period, which is absent in the tropical species. It manifests itself as weakness and muscle pain, after which a sudden fever appears. The difference between three-day malaria is that temperature rises occur every 48 hours, that is, every third day. This is where the name of this type of malaria comes from. During the period of rising temperature, patients are excited, breathing heavily, their skin is hot and dry. Heart rate is sharply increased ( up to 100 – 120 beats per minute), blood pressure drops, and urinary retention develops. The phases of “chills,” “heat,” and “sweat” become more distinct. Average duration the attack varies from 6 to 12 hours. After two to three attacks ( respectively on days 7 – 10) an enlarged liver and spleen appear, and jaundice develops.

However, it can also happen that attacks of fever occur every day. This phenomenon is due to the entry into the blood of several generations of malarial plasmodium at once. Several months after the illness, the patient may continue to have periodic rises in temperature.

Malaria oval
This type of malaria is in many ways similar to tertian malaria, but has a milder course. The difference between malaria ovale is that attacks of fever occur every other day. The temperature rises mainly in the evening hours, which is not typical for previous types of malaria.

Quartan
This type of malaria, like the previous one, belongs to the benign forms of malarial invasion. It develops acutely, without any prodromal phenomena. Fever attacks occur every 72 hours. The temperature rises to 39 - 40 degrees. During attacks, the patient is also in serious condition - consciousness is confused, the skin is dry, the tongue is coated, blood pressure drops sharply.

In addition to the classic types of malaria, there is also a schizont type. It develops as a result of ready-made schizonts entering the human blood ( plasmodia that have undergone an asexual development cycle). Schizont malaria mainly develops as a result of blood transfusions or through the transplacental route. Therefore, this type is also called syringe or graft. Its difference is the absence of the development phase of plasmodium in the liver, and the clinical picture depends entirely on the volume of blood administered.

Mixed malaria also occurs, which develops as a result of simultaneous infection with several types of malarial plasmodia.

What are the features of tropical malaria?

The main features of tropical malaria are the severity of the developing symptoms, the nature of which is similar for all forms of the disease. There are also some differences between the complications, duration and outcome of tropical malaria from other types of disease.

Onset of the disease
Malaria is characterized by a prodromal period ( mild course of the disease), which is characterized by general malaise and mild headaches. Feverish states typical for this disease, followed by periods of calm ( paroxysms), occur after 2–3 days. In tropical malaria, the onset of the disease is more acute. From the first days, patients begin to experience nausea, vomiting, and indigestion in the form of diarrhea. Headaches vary in intensity. These symptoms are accompanied by a persistent fever that can last for several days. Subsequently, the fever acquires an intermittent course with other phases of paroxysms.

Features of tropical malaria from other forms

All forms of malaria except tropical	Criteria	Tropical malaria
The attacks are characterized by a clear change in phases of chills, heat and sweat. The duration of the second stage rarely exceeds 12 hours. After the end of the heat, body temperature drops sharply and increased sweating begins. Seizures occur according to a certain pattern. So, with three-day malaria, paroxysm bothers the patient once every 3 days, with four-day malaria - once every four days.	Paroxysms	The difference between paroxysms in this form is the short duration and weak severity of the first phase ( chills). In some cases, attacks begin to develop from the fever stage, bypassing the chills. In this case, the temperature suddenly reaches high values ​​( above 40 degrees) and can last all day. There is no specific systematic pattern in the occurrence of attacks. They can occur every other day, daily or twice a day. A decrease in temperature can occur without heavy sweating.
The patient may not feel anemia and this symptom is in most cases detected during laboratory testing. Sometimes blood changes are manifested by pale skin and weakness.	Anemia	With tropical malaria, anemia is more pronounced. Blood tests can detect pathologies from the first days of the disease. Patients experience lethargy and apathy due to a reduced amount of hemoglobin. There is a bluish tint to the extremities.
The spleen increases in size after several attacks. In this case, the abdomen becomes large and palpation can reveal a twofold increase in this organ.	Enlarged spleen	This form of malaria is characterized by a rapid enlargement of the spleen, which can be detected by ultrasound as early as 2–3 days. In this case, patients complain of pain in the area of ​​the right hypochondrium, which becomes stronger with a deep sigh.
With malaria, there is an enlargement of the liver, which entails nausea and pain, which is localized in the right hypochondrium. Liver functions are not significantly impaired, but yellowness of the skin and mucous membranes is present. A change in the size of this organ occurs after the first attacks and leads to a 10–15 percent increase in the total mass of the organ.	Liver enlargement	In tropical malaria, liver enlargement is more progressive. Also, this form is characterized by liver damage, which entails damage to the hepatic lobules ( liver functional units).
With malaria infection, there is a decrease in blood pressure during the fever phase and a slight increase during the chills stage. Patients also complain of rapid heartbeat and pain in the heart area, which are stabbing in nature.	Pathologies of the cardiovascular system	Tropical malaria is manifested by severe hypotension ( decreased blood pressure). In addition, there are severe heart pains, murmurs, and tachycardia.
During attacks, patients experience headaches and motor agitation. Feverish delirium may occur. In most cases, these symptoms go away as the temperature normalizes.	Nervous system disorders	Tropical malaria is characterized by more pronounced defeat nervous system. Severe headaches, feelings of anxiety and restlessness, convulsions, and confusion are often observed.
Malaria may be accompanied by a disorder such as albuminuria ( increased protein excretion in urine). Often, kidney dysfunction provokes edema. Such violations are quite rare - in 2 percent of cases.	Kidney dysfunction	With this form, kidney dysfunction is diagnosed in 22 percent of patients.

Complications
Severe complications, which often result in the death of the patient, most often develop with tropical malaria.

Complications of tropical malaria are:

• malarial coma– the patient’s unconscious state with a complete lack of reaction to any stimuli;
• algid– toxic-infectious shock, in which the patient retains consciousness, but remains in prostration ( severely depressed and indifferent state);
• hemoglobinuric fever– development of acute renal and liver failure.

Duration of the disease
The duration of this form of malaria differs from other types of the disease. Thus, the total duration of three-day malaria varies from 2 to 3 years, four-day malaria - from 4 to 5 years, oval malaria - approximately 3 - 4 years. The duration of tropical malaria does not exceed, in most cases, one year.

What are the signs of malaria in adults?

The main symptom of malaria in adults is attacks of fever ( paroxysms) giving way to a state of rest. They are characteristic of all forms of the disease, except tropical malaria. Before the first attack, the patient may experience a headache, pain in the muscles and joints, and general malaise. Body temperature may also rise to subfebrile levels ( no higher than 38 degrees). This condition continues for 2–3 days, after which febrile paroxysms begin. Malarial attacks are characterized by the presence of phases that develop and replace each other in a certain sequence. At first, the attacks may be irregular in nature, but after a few days a clear pattern of development of this symptom is established. The duration of pauses between attacks depends on the form of the disease. With three-day malaria, the attack repeats once every 3 days, with four-day malaria - once every 4 days. Attacks develop at the same time, most often between 11 and 15 hours.

The phases of a malarial attack are:

• chills;

Chills
This stage can be manifested by both mild trembling and severe chills, from which the patient’s whole body shakes. At the same time, the patient’s hands, feet and face become cold and acquire a bluish tint. The pulse quickens and breathing becomes shallow. The skin turns pale, becomes rough and takes on a bluish color. Chills can last from half an hour to 2 – 3 hours.

Heat
This phase is accompanied by a sharp increase in temperature, which can reach above 40 degrees. The patient's condition noticeably worsens. The face becomes red, the skin becomes dry and hot to the touch. The patient begins to experience severe headaches, muscle heaviness, and rapid, painful heartbeat. The tongue is covered with a grayish coating and is not sufficiently moist. Often the fever stage is accompanied by vomiting and diarrhea. The patient is in a state of excitement, convulsions and loss of consciousness may occur. The heat provokes an unquenchable thirst. This condition can last from 5 – 6 to 12 hours.

Sweat
The heat stage is replaced by the final phase, which manifests profuse sweating. The temperature drops sharply to normal values, sometimes can reach 35 degrees. The patient feels relief, calms down and falls asleep.

Other signs of malaria
Along with seizures among the most characteristic features malaria includes anemia ( anemia), splenomegaly ( enlarged spleen) and hepatomegaly ( liver enlargement). This disease also has a number of symptoms that manifest themselves both on the physical and mental levels.

Signs of malaria include:

• anemia;
• splenomegaly;
• hepatomegaly;
• urinary disorders;
• dysfunction of the cardiovascular system;
• icteric staining of the skin and mucous membranes;
• skin hemorrhages;
• herpetic rashes ( manifestations of herpes);
• nervous disorders.

Anemia
Patients with malaria rapidly develop anemia, which is characterized by a deficiency of hemoglobin and red blood cells. It develops due to massive destruction of red blood cells, due to the presence of malarial plasmodium in them ( so-called hemolytic anemia). Signs of anemia are most obvious between attacks. However, anemia may persist for a long time after recovery. The patient's skin becomes yellowish or sallow in color, weakness is noted, increased fatigue. With anemia, body tissues experience severe oxygen deficiency, because hemoglobin is an oxygen carrier.

Splenomegaly
An enlarged spleen is observed after 3–4 attacks of fever and persists for a long time. In tropical malaria, the spleen may enlarge immediately after the first paroxysm. Along with the increase, pain in this organ is observed. The spleen becomes denser, which is determined by palpation. In the absence of adequate treatment, the spleen enlarges so much that it begins to occupy the entire left side of the abdomen.

Hepatomegaly
The enlargement of the liver occurs faster than the change in the spleen. In this case, the edge of the liver drops below the costal arch and becomes denser and more painful. The patient complains of painful discomfort in the area of ​​the right hypochondrium.

Urinary disorders
Against the background of ongoing processes in the body, during attacks during chills, patients experience frequent urination. In this case, the urine has an almost transparent color. With the onset of fever, the volume of urine becomes more scanty, and the color becomes darker.

Dysfunction of the cardiovascular system
The most severe disturbances of the cardiovascular system are expressed during malarial paroxysms. Characteristic signs of this disease are an increase in blood pressure during chills and a drop during fever.

Jaundice staining of the skin and mucous membranes
It is an early sign of malaria in adults. When red blood cells are destroyed, not only hemoglobin is released from them, but also bilirubin ( bile pigment). It gives the yellow color to the skin and mucous membranes. In people with dark skin color, it is sometimes difficult to detect icteric discoloration. Their jaundice is determined by the color of the visible mucous membranes, namely the sclera ( outer shell eyes). The yellowish color of the sclera or their icterus may appear long before the icteric discoloration of the skin, and therefore is an important diagnostic sign.

Skin hemorrhages
Due to vascular spasms, a hemorrhagic rash forms on the patient’s body ( subcutaneous hemorrhages). The rash has no specific localization and spreads unevenly throughout the body. Externally, this sign looks like star-shaped spots of blue, red or purple.

Herpetic rashes
If a patient with malaria is a carrier of the herpes virus, it worsens during a febrile state. Bubbles with clear liquid characteristic of the virus appear on the lips, wings of the nose, and less often on other areas of the face.

Nervous disorders
The most obvious disorders of the nervous system are manifested in three-day and tropical malaria. Patients experience constant headaches, insomnia, and lethargy in the morning and throughout the day. The psyche of patients undergoes negative changes during attacks. They are depressed, have poor orientation, and answer questions asked in a confused manner. Often during a fever, patients become delirious and experience hallucinations. Tropical malaria is characterized by a violent state of the patient, which can continue even after an attack.

What are the signs of malaria in children?

In children, the signs of malaria vary widely, depending on the child’s age and immune system.

Signs of malaria in children include:

• fever;
• anemia;
• rash;
• disorders of the gastrointestinal tract;
• disorders of the nervous system;
• convulsions;
• enlargement of the spleen and liver.

Fever
It is the main symptom of childhood malaria. It can be either constant or in the form of attacks. Classic attacks, which are typical for adults, are rare. Such attacks occur in several stages. The first stage is chills; the second is heat ( heat); the third is pouring sweat. Children are characterized by high temperature rises of up to 40 degrees or more. The younger the child, the stronger the fever. During the second stage, children are excited, they experience rapid breathing, dry and red skin. A drop in temperature is accompanied by heavy sweating and severe, debilitating weakness. Such classic seizures are rare in children. More often, the temperature is variable, and in 10–15 percent of children, malaria occurs without fever at all. It is more common in infants constant temperature, drowsiness, lethargy. The equivalent of an attack in infants is a sharp pallor of the skin, turning into cyanosis ( bluish discoloration of the skin). In this case, the skin becomes sharply cold, and tremors of the limbs are observed.

Anemia
As a rule, malaria in children occurs with severe anemia. It appears from the first days of the disease and is often an early diagnostic sign. It develops due to massive destruction of red blood cells. The number of red blood cells sometimes drops to 30–40 percent of normal.

A distinctive sign of malarial invasion in children is changes in the blood not only in red blood cells and hemoglobin, but also in other blood elements. Thus, very often there is a general decrease in leukocytes ( leukopenia), platelets. At the same time, the erythrocyte sedimentation rate increases. Despite severe anemia, jaundice in children with malaria is observed only in 15 to 20 percent of cases.

Rash
The rash is especially common in young children. It first appears on the abdomen, then spreads to the chest and other parts of the body. The nature of the rash can be very diverse - petechial, macular, hemorrhagic. The development of the rash is caused by a decrease in the number of platelets and increased permeability of the vascular wall.

Gastrointestinal disorders
Disorders of the digestive system are almost always observed. The younger the child, the more varied these disorders are. They manifest themselves in the form of diarrhea, repeated vomiting, and nausea. Loose stools mixed with mucus are often observed, which is accompanied by bloating and pain. In infants, this may be the first sign of malarial infestation. Repeated vomiting also occurs, which does not bring relief.

Nervous system disorders
They can appear both at the height of febrile attacks and during the temperature-free period. These disorders manifest themselves in the form of meningeal symptoms, which are characteristic of all types of malaria. Photophobia, stiff neck, and vomiting appear. Such symptoms disappear simultaneously with a drop in temperature. Motor agitation, delirium, and confusion may also occur. This variety of nervous system disorders is explained by the effect of malaria toxin on nerve cells.

Convulsions
Seizures or convulsions are also very common in children with malaria. Basically, cramps appear at the height of fever. They can be clonic or tonic. Their appearance is explained by high temperature, and not by the presence of any disease. These seizures belong to the category of febrile seizures, which are characteristic of childhood. The younger the child, the more likely he is to have seizures.

Enlarged spleen and liver
It is a common but inconsistent symptom. The spleen and liver enlarge only after several repeated attacks of fever.

A separate type of malarial infection in children is congenital malaria. In this case, malarial plasmodium enters the child's body in utero through the placenta. This malaria is extremely severe and often ends in death. Children with congenital malaria are born prematurely, with low weight and abnormalities of internal organs. The skin of such children is pale, with a waxy or jaundiced tint, and a hemorrhagic rash is often observed. The spleen and liver are sharply enlarged. When born, children do not make their first cry, they are usually lethargic, with reduced muscle tone.

Why is malaria dangerous during pregnancy?

The danger of malaria during pregnancy is the increased risk of developing malignant forms diseases. Physiological changes that accompany the process of bearing a child make a woman more susceptible to infection. The nature of the consequences is determined by the stage of pregnancy at which malaria infection occurred. The outcome of the disease is also influenced by the condition of the woman’s body and the timing at which treatment was started. Infectious agents can have a negative impact both on the pregnant woman and directly on the fetus itself.

Consequences of malaria for women
Greatest danger infection represents when infected with it on early stages carrying a child. Most a common consequence is a spontaneous abortion. Termination of pregnancy occurs due to irreversible changes that have occurred in a woman’s body under the influence of malarial plasmodia. If pregnancy continues, children are often born prematurely, of which 15 percent die during childbirth and 42 percent die in the first days after birth. Among full-term children born to women infected with malaria, the percentage of stillbirths is an order of magnitude higher than among other mothers. Often, children of patients with malaria are born with low birth weight and are often ill during the first years of life.

Complications of malaria during pregnancy are:

• anemia (there is anemia among the people);
• nephropathy (a form of late toxicosis caused by kidney dysfunction);
• eclampsia (critical complications due to brain damage);
• hypoglycemia (decreased blood sugar).

Anemia
Lack of hemoglobin in the blood provokes multiple pathological processes in a woman’s body. The liver stops producing the necessary amount of protein to form new cells, which can result in intrauterine developmental delay of the embryo. Toxins are no longer excreted in full, which can lead to insufficient oxygen supply to the fetus.

Other consequences of malaria due to anemia are:

• premature placental abruption;
• stillbirth;
• weakness of labor.

Nephropathy
Nephropathy develops after the 20th week of pregnancy and is manifested by increased blood pressure, swelling of the hands and face, insomnia and headaches. Lab tests for this disorder is determined in urine increased content protein and uric acid. The consequences of nephropathy can be intrauterine growth retardation, pregnancy loss, and fetal death.

Eclampsia
This disorder develops due to damage to brain cells caused by malaria infection. Eclampsia manifests itself as convulsive seizures, after which the patient falls into a coma. After some time, the patient returns to consciousness. In some cases, a prolonged coma may develop, from which the woman cannot emerge. Vascular spasms that occur during seizures can lead to asphyxia ( suffocation) or hypoxia ( oxygen starvation) embryo. Eclampsia often causes intrauterine fetal death. In a pregnant woman, this complication of malaria can cause stroke, heart or lung failure, liver or kidney dysfunction. Often, against the background of this disorder, premature placental abruption occurs. All these pathologies can lead to the death of both the fetus and the woman herself.

Hypoglycemia
This syndrome can develop in pregnant women infected with tropical malaria. Hypoglycemia manifests itself in attacks, the repeated repetition of which can harm both the fetus and the expectant mother. The lack of the required amount of glucose can cause heartbeat disturbances or retardation in physical and mental development in the embryo. For women this state is fraught with depression of cognitive functions, depressed state, and attention disorder.

Also the consequences of congenital malaria include:

• jaundice;
• epileptic seizures;
• anemia ( often in severe form);
• enlarged liver and/or spleen;
• increased susceptibility to infections.

The consequences of intrauterine infection can be detected immediately or some time after birth.

What drugs are there against malaria?

Against malaria, there is a wide range of different drugs that act on various stages development of malarial plasmodium. First of all, etiotropic drugs are used, the action of which is aimed at destroying the malarial plasmodium from the body. Drugs whose action is aimed at eliminating symptoms ( symptomatic treatment).

There are the following main groups of drugs against malaria:

• drugs that act on malarial plasmodia in the liver and that prevent their further penetration into red blood cells - proguanil, primaquine;
• drugs that act on erythrocyte forms of plasmodium, that is, those that are already in erythrocytes - quinine, mefloquine, atovaquone;
• drugs that act on the sexual forms of Plasmodium falciparum - chloroquine;
• drugs to prevent relapses of malaria - primaquine;
• drugs used to prevent malaria - plasmocide, bigumal.
• drugs that are used to both treat and prevent malaria are antifolates.

Main drugs used in the treatment and prevention of malaria

A drug	Characteristic
Chloroquine	Mainly used for the prevention of all types of malaria. The drug should be taken a week before entering an endemic zone ( country or region with a high incidence of malaria).
Mefloquine	Used to prevent malaria in cases where chloroquine is ineffective.
Quinine	It is used in the treatment of malignant forms of malaria, for example, in the tropical form. The drug may be contraindicated due to individual intolerance.
Proguanil	They are used in the treatment of malaria in combination with other drugs, such as atovaquone. Also used for prevention.
Pyrimethamine	Possesses wide range action and is effective against malarial plasmodium and toxoplasma. Rarely used in monotherapy, as it quickly causes resistance.
Atovaquone	Used in the treatment of malaria, but not registered in most CIS countries. Highly effective against all types of malaria, used in the treatment of malaria in AIDS patients.
Galfan	It is a reserve drug and is used in extreme cases with forms of malaria resistant to other drugs. It also has great cardiotoxicity.

There are other drugs used in the treatment of malaria:

• antihistamines – clemastine, loratadine;
• diuretics – furosemide, diacarb, mannitol;
• colloidal and crystalloid solutions - refortan, 20 and 40% glucose solution;
• cardiotonic drugs – dopamine, dobutamine;
• glucocorticoids – Avamis, beclazone;

Thus, for malarial coma, mannitol is used; for renal failure - furosemide; for vomiting - cerucal. In severe cases, when severe anemia develops, transfusion is used donated blood. Also, in case of renal failure, methods of blood purification such as hemosorption and hemodialysis are used. They allow you to remove toxins and metabolic products from the body.

What anti-malaria pills are there?

There are different anti-malaria tablets depending on the main active ingredient.

Name of tablets	Characteristic
Quinine sulfate	Take 1 - 2 grams per day, lasting 4 - 7 days. They can be found in the form of 0.25 gram and 0.5 gram tablets. The daily dose is divided into 2 – 3 doses. The tablets should be taken with acidified water. It is best to use water with lemon juice. The dose and duration of taking the tablets depends on the type of malaria. Children's doses depend on age. Up to the age of ten years, the daily dose is 10 milligrams per year of life. Children over ten years old are prescribed 1 gram per day.
Chloroquine	Adults are prescribed 0.5 grams per day. On the first day, the daily dose was increased to 1.5 grams in two doses - 1.0 and 0.5 grams. Children's doses are 5 – 7.5 milligrams per kilogram. Treatment with chloroquine lasts 3 days.
Hydroxychloroquine	Adults are prescribed 0.4 grams per day. On the first day, the daily dose was increased to 1.2 grams in two doses - 0.8 and 0.4 grams. Children's doses are 6.5 milligrams per kilogram. Treatment with hydroxychloroquine tablets lasts 3 days.
Primaquin	Available in 3 and 9 milligrams. They are taken at 27 milligrams per day for two weeks. The daily dose is divided into 2 – 3 doses. Proguanil is prescribed not only for therapy, but also for the prevention of malaria. The dosage depends on the type of malaria. On average, the daily therapeutic dose is 0.4 grams, and prophylactic dose– 0.2 grams. Treatment lasts 3 days, and prophylaxis lasts the entire period of stay in an area with a high risk of infection, plus another 4 weeks. Children's doses do not exceed 0.3 grams per day. Diaminopyrimidine group of drugs Pyrimethamine tablets are prescribed in complex treatment and prevention of tropical malaria. They are usually used together with drugs of the sulfonamide group. Adults are prescribed 50–75 milligrams at a time. The pediatric dose ranges from 12.5 to 50 milligrams depending on age. IN for preventive purposes Pyrimethamine tablets are taken 25 milligrams per week in one dose during the period of stay in the “dangerous” zone. Sulfanilamide group of drugs The sulfanilamide group of anti-malaria drugs is effective in combating erythrocyte forms of plasmodium only in combination with biguanides. Sulfadoxine tablets are prescribed as a single dose of 1.0 - 1.5 grams, in accordance with the severity of malaria. The pediatric dose is 0.25 - 1.0 grams, depending on the child’s age. Sulfones Sulfones are reserve group drugs in the treatment of malaria. They are prescribed for tropical malaria resistant to conventional treatment. The tableted drug dapsone is used in combination with drugs of the diaminopyrimidine group ( pyrimethamine). The adult dose is 100 – 200 milligrams per day. The length of time you take the tablets depends on the severity of the malaria. Children's doses correspond to the child's weight - up to 2 milligrams per kilogram. Tetracycline group of drugs and lincosamides The tetracycline group of drugs and lincosamides are prescribed for malaria only if other drugs are ineffective. They have a weak effect against Plasmodium, so the course of treatment is long. Name of tablets Characteristic Tetracycline Available in 100 milligram quantities. For malaria, they are taken 3 to 5 tablets 4 times a day. The duration of therapy can vary from 2 to 2.5 weeks. Children's doses are calculated according to the child's weight. The daily dose is up to 50 milligrams per kilogram. Clindamycin Prescribe 2 - 3 tablets 4 times a day. One tablet contains 150 milligrams of active substance. Children are advised to take 10–25 milligrams per kilogram per day. Treatment with clindamycin tablets for malaria can last 1.5 - 2 weeks. What tests for malaria need to be taken? For malaria, it is necessary to take a general urine test, as well as general and specific blood tests that will help diagnose this disease. General urine analysis If you suspect malaria, you must undergo a general urine test. The test results may indicate the appearance of blood in the patient's urine. Hemoleukogram All blood tests begin with a hemoleukogram. In malaria, red blood cells are destroyed in large numbers, which leads to shifts in the overall ratio of cellular elements in the blood. The main deviations in the hemoleukogram in malaria are: decrease in red blood cell count ( less than 3.5 - 4 trillion cells per liter of blood); decrease in hemoglobin level ( less than 110 - 120 grams per liter of blood); decrease in average erythrocyte volume ( less than 86 cubic micrometers); increase in platelet count ( more than 320 billion cells per liter of blood); increase in leukocyte count ( more than 9 billion cells per liter of blood). Blood chemistry For malaria, it is also necessary to take a biochemical blood test, which confirms the active destruction of red blood cells in the vascular bed. Immunological blood test For detection of malaria antigens ( special proteins) it is necessary to donate blood for an immunological analysis. There are several rapid tests for various types of Plasmodium that allow you to diagnose the disease right at the patient’s bedside. Performance immunological tests takes 10 – 15 minutes. This assay is widely used for epidemiological studies in countries with a high risk of malaria infection. Polymerase chain reaction based on a drop of blood PCR for malaria must be taken only if previous tests have not confirmed the disease. PCR is performed on a drop of peripheral blood from a sick person. This type of analysis is highly specific. He gives positive result and detects the pathogen in more than 95 percent of cases of the disease. What are the stages of malaria? The clinical picture of malaria is divided into several stages. The stages of malaria are: incubation stage; stage of primary manifestations; stage of early and late relapses; recovery stage. Incubation stage The incubation period is the period of time from the moment the malarial plasmodium enters the body until the first symptoms appear. The duration of this period depends on the type of malarial plasmodium. The duration of the incubation period depending on the type of malaria The length of the incubation period may vary if inadequate prevention has previously been taken. Stage of primary manifestations This stage is characterized by the appearance of classic febrile attacks. These attacks begin with a stunning chill that permeates the entire body. This is followed by a heat phase ( maximum temperature rise). During this phase, patients are excited, rushing around the bed or, conversely, are inhibited. The temperature during the hot phase reaches 40 degrees or even more. Patients' skin becomes dry, red and hot. The heart rate increases sharply and reaches 100 – 120 beats per minute. Blood pressure decreases to less than 90 millimeters of mercury. After 6–8 hours, the temperature drops sharply, and is replaced by drenching sweat. During this period, patients feel better and fall asleep. Further, the development of primary manifestations depends on the type of malarial invasion. With three-day malaria, febrile attacks occur on every third day, with four-day malaria - on every fourth. The difference between tropical malaria is the absence of such paroxysms. Also during this stage the liver and spleen enlarge. During periods of no fever, symptoms such as muscle pain, headaches, weakness, and nausea persist. If malaria develops in children, then during this period symptoms of gastrointestinal disorders predominate. These symptoms are vomiting, diarrhea, and bloating. As the liver enlarges, a dull pain in the right hypochondrium increases and jaundice develops, as a result of which the patients’ skin acquires a jaundiced tint. One of the most formidable symptoms of this period is rapidly developing anemia ( decrease in the number of red blood cells and hemoglobin in the blood). Its development is caused by the destruction of red blood cells by the malarial plasmodium. Red blood cells are destroyed, and hemoglobin comes out of them ( which subsequently appears in the urine) and bilirubin, which gives the skin its yellow color. Anemia, in turn, leads to other complications. This is, firstly, oxygen deficiency that the body experiences. Secondly, hemoglobin released from red blood cells enters the kidneys, disrupting their functionality. Therefore, acute renal failure is a common complication of this period. It is also the main reason fatal outcome malaria. This stage characterizes the main clinical picture of malaria. In case of untimely diagnosis and treatment, conditions such as malarial coma, toxic shock, and hemorrhagic syndrome develop. Toxic syndrome at this stage is moderate, complications are rare. As in stage early manifestations anemia develops, the liver and spleen are moderately enlarged. Three-day and four-day malaria are also characterized by late relapses. They occur 8 to 10 months after early relapses have ended. Late relapses are also characterized by periodic rises in temperature to 39 - 40 degrees. Phase changes are also well defined. Recovery stage It occurs when the stage of late relapses passes. Thus, the total duration of the disease is determined by the type of invasion. The total duration for three-day and four-day malaria is from two to four years, for oval malaria - from one and a half to three years, for tropical - up to a year. Sometimes a latent stage may occur between the periods of early and late relapses ( complete absence of symptoms). It can last from two to ten months and is mainly characteristic of three-day malaria and malaria ovale. What are the consequences of malaria? There are multiple consequences of malaria. They can occur both in the acute period of the disease ( that is, in the stage of early manifestations), and after. The consequences of malaria are: malarial coma; toxic shock; acute renal failure; acute massive hemolysis; hemorrhagic syndrome. Malarial coma As a rule, it is a complication of tropical malaria, but can also be a consequence of other forms of malarial invasion. This complication is characterized by a staged, but at the same time, rapid course. Initially, patients complain of severe headache, repeated vomiting, dizziness. They experience lethargy, apathy and severe drowsiness. Over the course of several hours, drowsiness worsens and a soporous state develops. During this period, convulsions and meningeal symptoms are sometimes observed ( photophobia and muscle stiffness), consciousness becomes confused. If there is no treatment, a deep coma develops, during which blood pressure drops, reflexes disappear, and breathing becomes arrhythmic. During a coma, there is no reaction to external stimuli, vascular tone changes and temperature regulation is disrupted. This condition is critical and requires resuscitation measures. Toxic shock Toxic shock is also a consequence that is life-threatening. In this case, damage to vital organs such as the liver, kidneys, and lungs is noted. During shock, blood pressure first drops, sometimes reaching 50–40 millimeters of mercury ( at a rate of 90 to 120). The development of hypotension is associated both with a violation of vascular tone ( blood vessels dilate and pressure drops), and with cardiac dysfunction. In shock, patients' breathing becomes shallow and erratic. The main cause of mortality during this period is developing renal failure. Due to a sharp decrease in blood pressure, hypoperfusion occurs ( insufficient blood supply) renal tissue, resulting in renal ischemia. Since the kidneys remove all toxins from the body, when they lose their function, all metabolic products remain in the body. The phenomenon of autointoxication occurs, which means that the body is poisoned by its own metabolic products ( urea, creatinine). Also, with toxic shock, damage to the nervous system occurs, which is manifested by confusion, psychomotor agitation, and fever ( due to a violation of temperature regulation). Acute renal failure This consequence is due to the massive destruction of red blood cells and the release of hemoglobin from them. Hemoglobin begins to appear in the urine ( this phenomenon is called hemoglobinuria), giving it a dark color. The condition is complicated by low blood pressure. Renal failure in malaria is manifested by oliguria and anuria. In the first case, the daily amount of urine is reduced to 400 milliliters, and in the second - to 50 - 100 milliliters. Symptoms of acute renal failure are rapid deterioration of the condition, decreased diuresis, and dark colored urine. In the blood there is a disturbance in the water-electrolyte balance, a shift in the alkaline balance, and an increase in the number of leukocytes. Acute massive hemolysis Hemolysis is the premature destruction of red blood cells. Normally, the life cycle of an erythrocyte is about 120 days. However, in malaria, due to the fact that the malarial plasmodium develops in them, the destruction of red blood cells occurs much earlier. Hemolysis is the main pathogenetic link in malaria. It causes anemia and many other symptoms. Hemorrhagic syndrome In hemorrhagic syndrome, due to numerous violations of hemostasis, an increased tendency to bleeding develops. More often a hemorrhagic rash develops, which manifests itself as multiple hemorrhages in the skin and mucous membranes. Cerebral hemorrhages develop less frequently ( found in malarial coma) and other organs. Hemorrhagic syndrome can be combined with disseminated intravascular coagulation syndrome ( DIC syndrome). It, in turn, is characterized by the formation of numerous blood clots. Thrombi are blood clots that fill the lumen of blood vessels and prevent further blood circulation. Thus, in the brain, blood clots form the formation of Durk granulomas, which are specific to malarial coma. These granulomas are capillaries filled with blood clots, around which swelling and hemorrhages form. These blood clots are formed due to enhanced thrombocytopoiesis, which, in turn, is activated due to the destruction of red blood cells. Thus, it is formed vicious circle. As a result of hemolysis of red blood cells, numerous breakdown products are formed, which enhance the formation of blood clots. The more intense the hemolysis, the stronger the hemorrhagic and DIC syndrome. Is there a vaccine against malaria? A vaccine against malaria exists, but it is not currently universal. Its routine use is not approved in European countries. The first malaria vaccine was created in 2014 in the UK by the pharmaceutical company GlaxoSmithKline. British scientists have created the drug mosquirix ( moskirix), which is intended to vaccinate populations most at risk of contracting malaria. Since 2015, this vaccine has been used to vaccinate children in many countries in Africa, where malaria is most common. Moskirix vaccination is given to children from one and a half months to two years. It is at this age that African children are most susceptible to malaria. According to scientists, as a result of vaccination, not all children developed immunity against malaria. In children aged 5 to 17 months, the disease was prevented in 56 percent of cases, but in children under 3 months it was prevented in only 31 percent of cases. Thus, the currently created malaria vaccine has a number of negative qualities, which suspends its large-scale use. New developments are currently underway to create a more universal malaria vaccine. According to scientists, the first mass vaccinations should appear by 2017.

The causative agent of malaria is various types of protozoan pathogenic microorganisms. Malaria - what is this disease? It is an infectious recurrent disease in which blood cells are affected, the liver and spleen become enlarged, and become inflamed.

Malaria is a term of Italian origin meaning "bad air". The causative agent of three-day malaria, tropical malaria, four-day malaria and the causative agent of oval malaria are distinguished. The classification of malaria can also be supplemented by a mixed form, when infection is caused simultaneously by several types of microorganisms.

Together with the blood, the germ cells of plasmodium enter the female’s digestive tract. After fertilization and further transformations, sporozoites are formed, which pose a danger to humans. Sporozoites can remain in the salivary glands of a mosquito for up to 2 months.

In addition to the main route of transmission - mosquito bites, there are others. The infection can be acquired during a blood transfusion. A child can become infected with malaria through the placenta during pregnancy from a sick mother. In countries with an increased risk of an outbreak of a malaria epidemic, for example, in Africa, Asia, and South America, children and visitors are most susceptible to infection. The activity of malaria mosquitoes increases in summer and autumn.

A sick person is not contagious. Plasmodium is not transmitted from an infected person to a healthy person by airborne droplets, contact or sexual contact. But people become infected through direct contact with the blood of a patient. You can catch the infection during a blood transfusion or using unsterilized medical instruments.

Dangerous signs of the disease

Signs of malaria depend on the type of plasmodium that caused the disease:

1. The three-day form of malaria differs from other types in that the prognosis of the disease is quite favorable. With the right therapy, the disease can be quickly cured. The minimum incubation period is 2 weeks, but can last up to 6 months from the moment of the mosquito bite. The symptoms are standard, described above. Complications such as nephritis and hepatitis rarely develop.
2. The symptoms of malaria ovale are no different from the three-day form: the only difference is the duration of the incubation period. It lasts no more than 14 days.
3. Quadrennial malaria is successfully treated and rarely results in complications. An additional sign in adults is the presence of daily fever. The patient looks tired, exhausted, the internal organs do not increase in size. A distinctive feature is the occurrence of relapse after many years. Liver failure may be a complication.
4. Symptoms of tropical malaria are characterized by a sharp rise in temperature, chills, fever, weakness, pain in the head and muscles. The disease is severe and can lead to death.

How malaria manifests itself depends on the stage of the pathological processes.

The duration of the latent period in the human body depends on the type of pathogen. With three-day and oval malaria, on average it lasts about 14 days. With a four-day form, the asymptomatic period can last up to one month. With tropical malaria, the first signs may appear no later than 2 weeks. All these types of disease are characterized by enlargement of internal organs, fever and anemia.

The first signs may be accompanied by weakness, drowsiness, a slight increase in temperature, increased blood pressure, heavy breathing, pain in the head, and increased sweating.

The acute period is accompanied by fever in the body, chills, and severe sweating. Nausea, muscle pain, skin turns pale, and limbs become cold. These symptoms are more disturbing in the first half of the day.

But already in the second half of the day, the chills are replaced by a temperature reaching 40. A patient in this state may become delirious, lose consciousness, and convulsions may occur.

This condition can last up to 7 hours. After this, the temperature drops sharply, and profuse sweating is noted. The frequency of attacks depends on the type of malaria. For example, with a three-day form, attacks can recur every three days. By the second week of acute manifestations of the disease, hemolytic anemia develops.

Complications caused by the disease

If you pay attention to the symptoms of malaria in time and start treatment in a timely manner, then the attacks can be stopped. Otherwise, attacks can last for years. The disease is dangerous due to complications that can lead to death.

Another complication is malarial algid. The condition is accompanied by a decrease in blood pressure, a decrease in heart rate, a decrease in body temperature, the skin turns pale, and the body becomes covered in cold sweat. Diarrhea may be a concern.

Splenic rupture is often diagnosed; the main symptom is sharp pain in a stomach. If surgery is not performed in time, the patient dies.

Brain swelling most often develops during infection child's body. The temperature rises, the head hurts severely, convulsions and loss of consciousness are observed.

Acute liver failure may develop. Violation of the normal functioning of the liver occurs as a result of high hemoglobin in the blood and circulatory disorders. Severe pain in the upper abdomen and nausea are felt.

Malaria during pregnancy leads to unfavorable outcomes. Frequent complications are miscarriage and premature birth. There is a high risk of death of children in the first days after birth. Sometimes it turns out that a woman became infected a long time ago, but the acute stage was caused by pregnancy or childbirth.

Diagnostic measures

To know how to cure malaria, you need to go through additional examination. Indications for examination may be as follows:

1. A person who has recently visited countries with a high epidemiological threshold is sent for examination. At the same time, he experiences a periodic rise in temperature, weakness, pain in the head or upper abdomen, and other warning symptoms of malaria.
2. The patient is examined if a high rise in temperature continues after medical therapy in accordance with the diagnosis.
3. Living in a country where there is an outbreak of an epidemic with the slightest increase in temperature and deterioration of the condition.

Laboratory diagnosis of malaria first means testing blood from a vein or capillaries. A general blood test shows a decrease in the level of hemoglobin and red blood cells.

to install accurate diagnosis, the indirect immunofluorescence reaction (IDIF) method may be useful. A blood test helps detect antibodies to the pathogen.

Differential diagnosis of malaria allows you to distinguish it from other diseases. External signs may be similar to influenza, sepsis, typhoid fever, pyelonephritis, meningitis or pneumonia.

Other malaria tests may be needed. You need to submit your urine for testing and undergo an ultrasound abdominal cavity, ECG.

Treatment tactics

How to treat malaria? The patient must be left in hospital (any clinic has a special infectious diseases department). Only doctors in the inpatient department know how to get rid of malaria.

Treatment of malaria depends on the form of plasmodium, the stage of its development, and the presence of concomitant diseases. How to quickly get rid of the disease? There are many medications. The tissue forms of malarial plasmodium are affected by drugs such as Quinocid, Primaquine. The erythrocyte stage can be cured by the following: Pyrimethamine, Quinine.

Common. The active ingredient is chloroquine. The drug has a pronounced antimalarial effect. Additionally, it has immunosuppressive and anti-inflammatory effects. The standard treatment regimen involves taking a dosage of 1500 g on the first day, divided into two doses. You should drink 1 g in the morning, 500 mg in the evening. Take 750 mg for another two days.

Delagil tablets are contraindicated for pregnant and lactating women, as well as patients with severe cardiac, renal and hepatic disorders. Children are allowed to give the drug only from the age of six. On the first day, the dosage can be equal to 0.25 g, in the next two days it is reduced to 0.125 m.

In the treatment of tropical malaria with the appearance of complications, intravenous drip infusion of the drug Quinine is used. Start with a dosage equal to 20 mg per kg of patient body weight. Subsequently, the dosage is reduced to 10 mg. After a person recovers from a serious condition, they switch to oral administration of the medicine.

Other groups of drugs also help fight malaria. Immunomodulators, vitamin complexes that can increase the body's defenses, and enterosorbents that remove toxins are prescribed. Antihistamines, choleretic agents, and enzyme preparations may be prescribed. It is recommended to drink plenty of fluids.

Preventive actions

Prevention of malaria includes measures aimed at killing mosquitoes, taking medications, and using products that repel insects and prevent bites.

Anyone planning to visit countries with a high risk of a malaria outbreak should take a course of chemoprophylaxis 2 weeks before travel. For this purpose, the drugs Delagil, Proguanil, Mefloquine are prescribed.

In the fight against insects, special local remedies against mosquitoes in the form of spray, cream, ointment. Special mosquito nets must be installed on windows and doors, and electric fumigators must be turned on in the room. When staying outdoors in areas where there is a high risk of infection, you should choose clothing made from light, thick fabric.

With timely provision of qualified assistance, it is possible to quickly get rid of acute symptoms and completely cure the disease.