User:Manum56/malaria

Malaria is a mosquito borne infectious disease of humans. It is characterized by periodic cycles of high fever followed by chills. It is caused by the parasitic protists of the genus Plasmodium, which infect and cause the destruction of red blood cells resulting in the symptoms. Treatment involves administration of antimalarial drugs like Chloroquine and artemisin. Severe forms of the disease like Cerebral Malaria require intravenous administration. The disease is endemic to tropical and subtropical countries especially in Africa. The disease is transmitted by female anopheles mosquito which are the primary hosts of the parasite. Most preventive methods involve interruption of disease transmission using mosquito repellants, nets and prevention of mosquito reproduction.

Signs and Symptoms
Classical symptoms of Malaria is periodic or recurrent episodes of fever followed by chills. Each episode typically lasts four to six hours. The duration in between the spikes is determined by the infecting parasite species. Fever spikes after every two days in P. vivax and P. ovale infections(Benign tertian malaria), every three days for P. malariae(Quartan malaria). In P. falciparum infection the disease is more severe and occurs every two days (Malignant tertian malaria). As the disease progresses, it results in a major decrease of circulating RBCs resulting in hemolytic anemia and jaundice. Other symptoms include headache, joint pain, muscle pain, hemoglobinuria and vomiting. However these classical symptoms are rarely seen nowadays as a result of mixed parasite infection and early treatment. Based on the severity of the disease Malaria is classified into two, uncomplicated and complicated.

Complicated Malaria
In severe cases it can cause seizures, and even death. Complications are more common with Plasmodium falciparum. With prompt treatment malaria does not result in complications.

Parasitology
Details of Malarial parasite as a separate article

Treatment
When properly treated, a patient with malaria can expect a complete recovery. Treatment depends mainly on the severity of the disease and the infecting parasite type. Quinine, chloroquine and primaquine were the standard of care about a decade ago. Other drugs include sulfonamides and newer compounds like artemisinin derivatives.

Uncomplicated malaria
When treating uncomplicated malaria, the goals are to provide rapid cure of the infection. Cure is indicated by disappearance of the symptoms and clearance of the parasite from blood. It is also necessary to follow up the patients for a sufficient period of time to detect recrudescence,　recurrence and relapses. Prompt treatment ensures prevention from disease progression, morbidity, treatment failure and transmission from person to person. Use of single medication for treating malaria is not advised due to the high incidence of resistance to single agent.

Current evidence favors the use of artemisinin based combination therapies for uncomplicated malaria. Amodiaquine and sulfadoxine-pyrimethamine combination is effective, compartively cheaper but less efficacious than Artemisinin combinations.

Falciparum malaria: Because Chloroquine resistance is becoming increasingly common and is already a significant problem especially in Africa, Artemisinin based combination therapies for at-least 3days is recommended. Single dose primaquine may be used additionally to quickly remove Plasmodium gametocytes and reduce the transmission rates. Six doses of a combination of Artemether-Lumefantrine appears to be the best available combination.

Complicated malaria
When treating Complicated Malaria, the primary goal is to prevent death and neurological sequelae especially in the case of pregnancy.

Falciparum Malaria: WHO recommends the use of Intravenous artesunate for the treatment of artesunate. The recommendations