Malaria - symptoms, treatment and prevention. Treatment of malaria with traditional methods Etiotropic drugs for the treatment of malaria

Accompanied by fever, chills, an increase in the size of the spleen and liver, and anemia. A characteristic feature of this protozoal invasion is the cyclical clinical course, i.e. periods of improved well-being are followed by periods of sharp deterioration with a high rise in temperature.

The disease is most common in countries with hot climates. These are South America, Asia and Africa. According to the World Health Organization, malaria is a serious health problem in 82 countries where the mortality rate from this infection is very high.

The relevance of malaria for Russian people is due to the possibility of infection during tourist trips. Often the first symptoms appear upon arrival home, when a person’s temperature rises.

It is imperative that if this symptom appears, you should inform your doctor about your trip, because this will make it easier to establish the correct diagnosis and save time.

Causes, clinical picture of the disease

The causative agent of malaria is Plasmodium falciparum. It belongs to the class of protozoa. The causative agents can be 4 types of plasmodia (although there are more than 60 species in nature):

• P. Malariae – leads to malaria with a 4-day cycle;
• P.vivax – causes malaria with a 3-day cycle;
• P. Falciparum – causes tropical malaria;
• R. Ovale - causes the oval form of tertian malaria.

The life cycle of malarial plasmodia includes a successive change of several stages. At the same time, a change of owners occurs. At the stage of schizogony, pathogens are found in the human body. This is the stage of asexual development, it is replaced by the sporogony stage.

It is characterized by sexual development and occurs in the body of a female mosquito, which is the carrier of the infection. The causative mosquitoes belong to the genus Anopheles.

Penetration of malarial plasmodia into the human body can occur at different stages in different ways:

1. When bitten by a mosquito, infection occurs at the sporozontal stage. Penetrated plasmodia after 15-45 minutes end up in the liver, where their intensive reproduction begins.
2. Penetration of plasmodiums of the erythrocyte cycle at the schizont stage occurs directly into the blood, bypassing the liver. This route is realized when donated blood is administered or when using non-sterile syringes that can be contaminated with plasmodia. At this stage of development, it passes from mother to child in utero (vertical route of infection). This is the danger of malaria for pregnant women.

In typical cases, division of plasmodia that enter the body through a mosquito bite occurs in the liver. Their number is increasing many times over. At this time, there are no clinical manifestations (incubation period).

The duration of this stage varies depending on the type of pathogen. It is minimal in P. falciparum (from 6 to 8 days) and maximum in P. malariae (14-16 days).

The characteristic symptoms of malaria are described by the well-known triad:

• paroxysmal (crisis-type) increase in temperature, repeated at certain intervals (3 or 4 days);
• enlargement of the liver and spleen (hepatomegaly and splenomegaly, respectively);
• anemia.

The first symptoms of malaria are nonspecific. They correspond to the prodromal period and are manifested by signs characteristic of any infectious process:

• general malaise;
• severe weakness;
• lower back pain;
• joint and muscle pain;
• slight increase in temperature;
• decreased appetite;
• dizziness;
• headache.

A specific increase in temperature develops due to the release of plasmodium into the blood. This process is repeated several times, reflected in the temperature curve. The cycling time is different - in some cases it is 3 days, and in others - 4.

Based on this, the corresponding types of malaria are distinguished (three-day and four-day). This is the period of obvious clinical manifestations when the patient consults a doctor.

Fever in malaria has a characteristic appearance, due to the sequential change of three phases. At the beginning there is a stage of chills (a person cannot warm up, despite warm wrappings), which is replaced by fever (the second stage). The temperature rises to high values ​​(40-41°C).

The attack ends with excessive sweating. It usually lasts from 6 to 10 hours. After an attack, a person immediately falls asleep due to severe weakening that develops as a result of intoxication and muscle contractions.

Enlargement of the liver and spleen is not determined from the very beginning of the disease. These symptoms can be identified after 2-3 febrile attacks. Their appearance is due to the active reproduction of malarial plasmodia in the liver and spleen.

When infected, anemia immediately appears in the blood, associated with the destruction of red blood cells (malarial plasmodia settle in them).

At the same time, the level of leukocytes, mainly neutrophils, decreases. Other hematological signs are an acceleration of ESR, a complete absence of eosinophils and a relative increase in lymphocytes.

These signs indicate activation of the immune system. She fights the infection, but fails. The disease progresses, and the risk of complications increases.

With a certain degree of probability, they can be predicted based on unfavorable prognostic signs. These are considered:

• fever that occurs every day, and not cyclically (every 3-4 days);
• absence of an interfebrile period between attacks (an elevated temperature is constantly determined, which corresponds to subfebrile values ​​between attacks);
• severe headache;
• widespread convulsions observed 24-48 hours after the next attack;
• a critical decrease in blood pressure (70/50 mm Hg or less), approaching a state of shock;
• high level of protozoa in the blood according to microscopic examination;
• the presence of plasmodia in the blood, which are at different stages of development;
• progressive increase in the number of leukocytes;
• decrease in glucose below 2.1 mmol/l.

Main complications malaria are:

• malarial coma, which most often affects pregnant women, children and young people;
• acute kidney failure when diuresis decreases to less than 400 ml per day;
• hemoglobinuric fever, which develops with massive intravascular destruction of red blood cells and the formation of a large amount of toxic substances;
• malarial algid, which resembles brain damage in this disease, but differs from it in the preservation of consciousness;
• pulmonary edema with acute onset and course (often fatal);
• rupture of the spleen associated with torsion of its legs or congestion;
• severe anemia caused by hemolysis;
• intravascular coagulation as part of DIC syndrome, followed by pathological bleeding.

Complications of tropical malaria may be specific:

• corneal damage;
• vitreous opacification;
• choroiditis (inflammatory damage to the capillaries of the eye);
• optic neuritis;
• paralysis of the eye muscles.

Laboratory diagnosis of malaria is carried out according to indications. These include:

1) Any increase in body temperature in a person located in an endemic geographic area (countries with increased incidence).

2) Increased temperature in a person who has received a blood transfusion within the last 3 months.

3) Repeated episodes of fever in a person receiving therapy in accordance with the final diagnosis (established diagnosis is any disease other than malaria).

4) Fever persists for 3 days during the epidemic period and more than 5 days at other times.

5) The presence of certain symptoms (one or more) in people who have visited endemic countries within the last 3 years:

• fever;
• malaise;
• chills;
• liver enlargement;
• headache;
• enlarged spleen;
• decrease in hemoglobin;
• yellowness of the skin and mucous membranes;
• the presence of herpetic rashes.

To verify the diagnosis, various laboratory examination methods can be used:

1. Microscopic examination of blood smears (allows direct detection of malarial plasmodium).
2. Express test.
3. (the study of genetic material by repeatedly obtaining copies of the DNA of the malarial plasmodium when it is present in the blood).
4. A biochemical analysis is performed to determine the severity of the disease (determines the severity of liver damage, which is always observed with malaria).

All patients with a confirmed diagnosis of malaria are recommended to undergo a number of instrumental studies. Their results help the doctor identify possible complications and begin their treatment in a timely manner.

• ultrasound scanning of the abdominal cavity (particular attention is paid to the size of the liver, kidneys and spleen);
• electrocardiogram;
• X-ray of the lungs;
• echocardioscopy;
• neurosonography;
• electroencephalography.

Treatment of patients with malaria is carried out only in a hospital. The main goals of therapy are:

• prevention and elimination of acute attacks of the disease;
• prevention of complications and their timely correction;
• prevention of relapse and carriage of malarial plasmodia.

Immediately after diagnosis, all patients are recommended to undergo bed rest and be prescribed antimalarial drugs. These include:

• Primaquine;
• Chloroquine;
• Mefloquine;
• Pyrimethamine and others.

At the same time, the use of antipyretic and symptomatic drugs is indicated. They are quite diverse due to the multiorgan nature of the lesion. Therefore, doctors of various specialties are often involved in treatment, and not just infectious disease specialists.

In cases where this does not happen, a change in antimalarial drug is required. It is also indicated when plasmodia are detected in the blood on the 4th day. This may indicate possible pharmacological resistance. It increases the risk of distant relapses.
If everything goes smoothly, then special criteria are determined to finally confirm cure. These include:

• normalization of temperature;
• reduction of the spleen and liver to normal sizes;
• a normal blood picture - the absence of asexual stages of malarial plasmodia in it;
• normal biochemical blood test values, indicating restoration of liver function.

Prevention of malaria

Map of malaria distribution in the world

Tourists should pay close attention to malaria prevention. Even before traveling, you should find out from a travel agency whether the country poses a danger for this disease.

If yes, then you should visit an infectious disease specialist in advance. He will recommend taking antimalarial drugs that will protect the person from infection.

There is no specific vaccine against malaria.

• Avoid being on the street after 17.00, because this is the time when mosquito activity peaks;
• If you need to go outside, cover your body with clothes. Pay special attention to the ankles, where mosquitoes most often bite, as well as the wrists and hands, where the skin is very thin;
• use of repellents.

If the child is small, then parents should refrain from traveling to dangerous countries. In childhood, taking antimalarial drugs is not advisable due to the frequent development of side effects and hepatotoxicity. Therefore, parents should weigh the possible risks.

World Malaria Day

The World Health Organization established International Malaria Day in 2007 (at its 60th session). It falls on April 25th.

The prerequisite for the establishment of the date was disappointing statistical data. Thus, new infections occur annually in 350–500 million cases. Of these, death occurs in 1-3 million people.

The main objective of World Malaria Day is to promote preventive measures against the disease.

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru/

State educational institution of higher professional education "Orenburg Medical Academy" of the Federal Agency for Health and Social Development.

Department of Infectious Diseases and Epidemiology

Test

on infectious diseases

Malaria, diagnosis and treatment principles

Completed:

Silnova M.G.

Checked:

Kalinina T.N.

Orenburg

Plan

Introduction

1. Etiology and pathogenesis

2. Epidemiology

3. Clinic

4. Diagnostics

5. Principles of treatment

6. Organization of patient care

7. Prevention

Literature

Introduction

Malaria is a protozoal anthroponotic disease in which febrile attacks and periods of apyrexia alternate, with enlargement of the liver and spleen, anemia with the possible development of hemolytic jaundice. The disease has a tendency to relapse.

Currently, malaria is common in 90 countries around the world, half of which are in Africa. More than 2 billion people, or 41% of the planet's population, are still at risk of infection, and 300-500 million fall ill with this dangerous disease every year. On the territory of the former Soviet Union, there are active outbreaks in Tajikistan, Uzbekistan, and Azerbaijan. In most European countries (including Russia), there are cases of malaria imported from abroad. The spread of malaria in endemic areas is zonal and focal and is determined by the interaction of natural and socio-economic factors prevailing in each specific territory. The prevalence of infection in different age groups of the population is clearly visible. In countries of tropical Africa, for example, the risk of infection is highest for children aged 5 months to 6 years, as well as for young pregnant women, especially first-time mothers. In countries of South and Southeast Asia, as well as South America, young adults who are actively involved in economic activities have the highest risk of contracting malaria. Immigrants, especially refugees and seasonal agricultural workers, are at risk of contracting malaria. The risk of infection, morbidity and even mortality from malaria have increased significantly among non-immune persons visiting malarial countries due to the nature of their activities (sailors, air crew members, businessmen, etc.), or for the purpose of tourism and pilgrimage. Disorderly movements of large groups of people contribute to the massive spread of drug-resistant strains of malaria over vast territories. Post-infectious immunity is not stable, reinvasion and cross-infestation are possible.

1. Etiology andpathogenesis

There are four known species of Plasmodium that cause human malaria: Pl. vivax, Pl. malariae, Pl. falciparum, Pl. ovale, causing three-day, four-day, tropical and oval malaria, respectively.

Erythrocyte schizogony in Pl. malariae lasts 72 hours, in other types of malarial plasmodia it lasts 48 hours. The duration of the first cycle of erythrocyte schizogony corresponds to the end of the incubation period.

Primary malarial paroxysms after long-term incubation and late relapses in three-day and oval malaria are associated with the activation of bradysprozoids.

2. Epidemiology

The transmission mechanism is transmissible; more than 400 species of Anopheles are known, of which only 60 are known carriers and 30 species are the main carriers of human malaria pathogens. The possibility of infection through blood transfusion or the use of infected equipment (syringes, needles) cannot be ruled out.

3. Clinic

The malaria clinic has several consecutive periods.

The incubation period lasts 1-3 weeks, with four-day malaria up to 6 weeks. In the inactive state of bradysporozoites in the liver (in the case of tertian and oval malaria), it can extend to 2 years or more.

The period of initial fever (up to 3-5 days at the first infection) is manifested by general malaise, headache, myalgia, arthralgia, and lower back pain. As the temperature rises, chills of varying severity are observed, and when the maximum fever is reached, a feeling of heat is observed. Subsequently, a decrease in temperature to subfebrile levels is accompanied by sweat, sometimes profuse. After 2-3 days of fever, enlargement of the liver and spleen, their thickening and pain on palpation can be detected.

Next comes a period of primary malarial paroxysms with phases of chills, heat and sweat of varying intensity; rises in temperature alternate with periods of apyrexia. Feverish attacks last for 2-16 hours, their duration is longest in tropical malaria. Attacks are repeated every other day, with four-day malaria - after 2 days of normal temperature. At the height of the attack, headache, dizziness, myalgia and arthralgia intensify, often lower back pain, and vomiting is possible. At high temperatures and severe toxicosis, delusions, hallucinations, and psychomotor agitation are possible. The patient's face is hyperemic, the sclera is injected, the skin is hot and dry. Tachycardia, decreased blood pressure, and oliguria are noted. With tropical malaria, exanthema, bronchospasm, abdominal pain, and diarrhea are also possible. After several attacks, anemia and jaundice may develop. In the apyrectic intervals between attacks of fever, the patients’ well-being improves, but asthenia remains.

After several malarial paroxysms, a secondary latent period begins without clinical manifestations of the disease; it can last from 1 to 3 months.

Early relapses of malaria occur with the main clinical signs of the period of primary malarial paroxysms. They are distinguished by the absence of initial fever, manifestations of hepatolienal syndrome from the first day of relapse, the patient tolerates them more easily, and the number of febrile attacks is less.

4. Diagnostics

Differential diagnosis is carried out with other diseases with paroxysmal fevers and hepatolienal syndrome: leptospirosis, brucellosis, sepsis, visceral leishmaniasis, etc.

5. Principles of treatment

In endemic areas, in all cases of malaria, hospitalization of patients is advisable.

Following the course of treatment with hematoschizontocidal drugs, histioschizontocidal drugs are prescribed that act on bradysporozoites and simultaneously on gametocytes: primaquine 9 mg 3 times a day or quinocide 30 mg/day for 10-14 days.

For malaria caused by Plasmodium strains with chloroquine resistance of degrees II and III, mefloquine (Lariam) is used according to appropriate regimens. The use of Fansidar and Fansimef is increasingly limited due to low efficacy and toxicity. In complicated and severe forms of the disease (mainly tropical malaria), treatment is carried out in intensive care units. After taking smears and a thick drop of blood, emergency measures begin: intravenous drip administration of quinine with hemodez, saline solutions (total infusion volume up to 1-1.5 l), corticosteroids, ascorbic acid. For convulsions, agitation, and oligoanuria, seduxen, Lasix, mannitol, sodium bicarbonate, and antihistamines are prescribed.

6. Organization of patient care

Care for uncomplicated disease consists of monitoring patients and providing assistance to them during a malarial attack. A typical attack of malaria occurs with alternating phases of chills, fever and profuse sweating. The attack most often begins in the first half of the day with a stunning chill. During the period of chills, it is necessary to additionally cover the patient with one or two blankets and place heating pads at the feet. The duration of chills ranges from 30 minutes to 2 hours, then it gives way to fever. During the hot period, the temperature rises to 39-40 ° C, the patient's headache intensifies, vomiting, delirium, and impaired consciousness may appear. When the temperature rises, remove blankets and heating pads; at this time the patient feels very thirsty and needs to be given water. To relieve headaches, use an ice pack wrapped in a towel. After a few hours, the patient’s body temperature drops sharply, and a period of sweating begins. When sweat first appears, the bubble should be removed from the head immediately.

Medical personnel must not allow the patient to become hypothermic: the temperature in the room must be maintained at least 20 °C in the absence of drafts; It is necessary to change linen in a timely manner and ensure that the patient does not lie uncovered in bed. After the end of the attack, the patient’s well-being noticeably improves, but severe weakness and drowsiness remain - the patient usually falls asleep, and after sleep his condition may be satisfactory until the next attack.

Patients with malaria require bed rest during the entire febrile attack and the subsequent period of sleep. Patients outside of an attack are on a general regimen. A special diet for this disease is not prescribed; patients receive general diet No. 15. During a malarial attack, patients become thirsty and must be given water often.

7. Prevention

Prevention consists of carrying out measures aimed at identifying and sanitizing sick people and carriers and combating pathogen vectors. Identifying the source of infection remains one of the decisive measures in the fight against infection and its prevention. Contingents suspected of having malaria include those living in endemic areas or arriving from such areas with fever, chills, malaise, enlarged liver and spleen, yellowness of the sclera and skin, herpes, anemia, and those who have had a disease with such symptoms. Early and complete identification of patients in malaria-prone regions is possible through regular door-to-door visits in populated areas during the malaria transmission season with thermometry, population surveys, and blood collection from those suspected of malaria. These activities should be combined with health education of the population, which helps to increase the appeal and timely identification of patients with malaria. All patients undergo radical treatment.

Seasonal chemical prophylaxis with tindurin is carried out from the moment of detection of a local outbreak of three-day malaria until the end of the transmission season, primarily in conditions of insufficient effectiveness of anti-mosquito measures. It helps reduce mosquito infestation.

In foci of three-day malaria, when a significant layer of infected individuals has formed, in whom the pathogen is in the latent stage, mass preventive treatment with primaquine (interseasonal prophylaxis) of the entire population is carried out before the beginning of the next season. To protect people traveling to areas unfavorable for this infection, individual chemoprophylaxis is used: delagil (0.25 g 2 times a week), chloridine (0.025 g 1 time a week) for 1 week before departure, during their stay there and in within 4-6 weeks after return. In foci of tropical malaria, individual chemoprophylaxis with mefloquine 250 mg once a week is recommended. It is the main method of personal protection.

Reducing the number of mosquito vectors is achieved by carrying out hydraulic engineering measures, anti-larval treatment of reservoirs (breeding sites), and treating livestock living quarters with insecticides. Mosquito breeding sites are destroyed by draining swamps and cleaning and draining water bodies. It is necessary to monitor the irrigation system and prevent stagnation of water. The use of repellent preparations, protective clothing, nets, and canopies is an integral part of a set of preventive measures aimed at protecting the population from mosquito attacks. You can protect your room from mosquitoes by installing nets on windows, ventilation holes, installing vestibules, and locking doors.

Literature

V. I. Pokrovsky, S. G. Pak Infectious diseases and epidemiology M. Geotar medicine 2000.

T. M. Zubik, K. S. Ivanov Differential diagnosis of infectious diseases L. Medicine 1991.

E. P. Shuvalova Tropical diseases M. Medicine 1989.

N. D. Yushchuk, M. A. Zhogova Epidemiology M. Medicine 1993.

N. P. Paleeva Nurse's Guide to Nursing M. Medicine 1989.

Posted on Allbest.ru

Similar documents

presentation, added 01/08/2015


Malaria is an acute infectious disease. Malarial plasmodia. History of scientific discoveries in malariology. Ways of transmission of infection. Damage to organs and systems due to malaria. Malaria in children, indigenous residents of endemic malaria foci. Disease prevention.

abstract, added 12/14/2008


An infectious disease caused by malarial plasmodia. The source of malaria pathogens is carried by female mosquitoes of the genus Anopheles. Four forms of the disease. Complications of tropical malaria. Clinical observation and examination for Plasmodium carriage.

abstract, added 10/21/2009


Causative agents of three-, four-day and tropical types of malaria. Developmental cycles of malarial plasmodium occurring in humans (schizogony) and mosquitoes (sporogony). Incubation period and symptoms of the disease. Its diagnosis, prevention and treatment.

abstract, added 10/09/2015


presentation, added 07/01/2015


General characteristics of the disease. Life cycle. Pathogenesis. Symptoms and course of the disease. Three-day malaria. Tropical malaria. Quartan. Ovale malaria. Cerebral form. Diagnosis and treatment. Immunity. Control. Historical reference.

abstract, added 11/01/2003


Use of blood for medicinal purposes. The first human-to-human blood transfusion. Indications for blood transfusion and its components. Typology of blood groups. Diagnosis of HIV infection. Comparison of the number of blood transfusions in Nakhodka and other cities.

course work, added 10/26/2015


Classification of blood components and products. Characteristics of blood substitutes and infusion-transfusion agents. General principles of component hemotherapy. Basic blood products: plasma, albumin, protein. Infectious safety of donor blood.

abstract, added 10/21/2015


The causative agent of mumps infection. Mechanism and routes of transmission. Reservoir and sources of infection. Symptoms, lesions and complications. Diagnosis of mumps. Clinical picture and treatment. Basic preventive and anti-epidemic measures.

presentation, added 03/03/2016


Analysis of the epidemic situation regarding meningococcal infection. The presence of meningococci in the human nasopharynx. Reasons for the development of pathological inflammatory processes. Clinical manifestations and microbiological diagnosis of meningococcal infection.

Malaria is a disease of the African continent, South America and Southeast Asia. Most cases of infection occur in young children living in West and Central Africa. In these countries, malaria leads among all infectious pathologies and is the main cause of disability and mortality in the population.

Etiology

Malaria mosquitoes are ubiquitous. They breed in stagnant, well-warmed bodies of water, where favorable conditions remain - high humidity and high air temperature. That is why malaria was previously called “swamp fever.” Malaria mosquitoes differ in appearance from other mosquitoes: they are slightly larger, have darker colors and transverse white stripes on their legs. Their bites also differ from ordinary mosquitoes: malaria mosquitoes bite more painfully, the bitten area swells and itches.

Pathogenesis

There are 2 phases in the development of Plasmodium: sporogony in the mosquito body and schizogony in the human body.

In more rare cases, this occurs:

1. Transplacental route - from sick mother to child,
2. Blood transfusion route - during blood transfusion,
3. Infection through contaminated medical instruments.

The infection is characterized by high susceptibility. Residents of the equatorial and subequatorial zones are most susceptible to malaria infection. Malaria is the leading cause of death among young children living in endemic regions.

malaria regions

The incidence is usually recorded in the autumn-summer period, and in hot countries - throughout the year. This is an anthroponosis: only people get sick from malaria.

Immunity after an infection is unstable and type-specific.

Clinic

Malaria has an acute onset and is characterized by fever, chills, malaise, weakness and headache. rises suddenly, the patient shakes. Later, dyspeptic and pain syndromes are added, which are manifested by pain in muscles and joints, nausea, vomiting, diarrhea, hepatosplenomegaly, and convulsions.

Types of malaria

Three-day malaria is characterized by paroxysmal course. The attack lasts 10-12 hours and is conventionally divided into 3 stages: chills, fever and apyrexia.

During the interictal period, body temperature normalizes, patients experience fatigue, weakness, and weakness. The spleen and liver become denser, the skin and sclera become subicteric. A general blood test reveals erythropenia, anemia, leukopenia, and thrombocytopenia. During attacks of malaria, all systems of the body suffer: reproductive, excretory, hematopoietic.

The disease is characterized by a long-term benign course, attacks are repeated every other day.

In children, malaria is very severe. The pathology clinic for children under 5 years of age is unique. Atypical attacks of fever occur without chills and sweating. The child turns pale, his limbs become cold, general cyanosis, convulsions, and vomiting appear. At the beginning of the disease, the body temperature reaches high numbers, and then a persistent low-grade fever persists. Intoxication is often accompanied by severe dyspepsia: diarrhea, abdominal pain. Sick children develop anemia and hepatosplenomegaly, and a hemorrhagic or macular rash appears on the skin.

Tropical malaria is much more severe. The disease is characterized by less severe chills and sweating, but longer bouts of fever with an irregular fever curve. During a drop in body temperature, chilling occurs again, a second rise and a critical decline. Against the background of severe intoxication, patients develop cerebral signs - headache, confusion, convulsions, insomnia, delirium, malarial coma, collapse. The development of toxic hepatitis, respiratory and renal pathology with corresponding symptoms is possible. In children, malaria has all the characteristic features: febrile paroxysms, a special type of fever, hepatosplenomegaly.

Diagnostics

Diagnosis of malaria is based on the characteristic clinical picture and epidemiological data.

Laboratory research methods occupy a leading place in the diagnosis of malaria. Microscopic examination of a patient's blood allows one to determine the number of microbes, as well as their type and type. For this, two types of smears are prepared - thin and thick. A thick drop of blood is examined if malaria is suspected, to identify Plasmodium and determine its sensitivity to antimalarial drugs. The type of pathogen and the stage of its development can be determined by examining a thin drop of blood.

A general blood test in patients with malaria reveals hypochromic anemia, leukocytosis, and thrombocytopenia; in a general urine test - hemoglobinuria, hematuria.

PCR is a fast, reliable and reliable method for laboratory diagnosis of malaria. This expensive method is not used for screening, but only as an addition to the main diagnosis.

Serodiagnosis is of auxiliary value. An enzyme immunoassay is performed, during which the presence of specific antibodies in the patient’s blood is determined.

Treatment

All patients with malaria are hospitalized in an infectious diseases hospital.

Etiotropic treatment of malaria: “Hingamin”, “Quinine”, “Chloridine”, “Chloroquine”, “Akrikhin”, sulfonamides, antibiotics - “Tetracycline”, “Doxycycline”.

In addition to etiotropic therapy, symptomatic and pathogenetic treatment is carried out, including detoxification measures, restoration of microcirculation, decongestant therapy, and the fight against hypoxia.

Colloidal, crystalloid, complex salt solutions are administered intravenously,"Reopoliglyukin", isotonic saline solution, "Hemodez". Patients are prescribed Furosemide, Mannitol, Eufillin, and undergo oxygen therapy, hemosorption, and hemodialysis.

To treat complications of malaria, glucocorticosteroids are used - intravenous Prednisolone, Dexamethasone. According to indications, plasma or red blood cells are transfused.

Patients with malaria should strengthen their immunity. It is recommended to add nuts, dried fruits, oranges, and lemons to your daily diet. During illness, it is necessary to avoid eating “heavy” foods, and prefer soups, vegetable salads, and cereals. You should drink as much water as possible. It lowers body temperature and removes toxins from the patient's body.

Persons who have had malaria are monitored by an infectious disease specialist and undergo periodic examinations for plasmodium carriage for 2 years.

Folk remedies will help speed up the healing process:

Timely diagnosis and specific therapy shorten the duration of the disease and prevent the development of severe complications.

Prevention

Preventive measures include timely identification and treatment of patients with malaria and carriers of malarial plasmodium, conducting epidemiological surveillance of endemic regions, extermination of mosquitoes and the use of remedies for their bites.

A vaccine against malaria has not yet been developed. Specific prevention of malaria involves the use of antimalarial drugs. Persons traveling to endemic areas must undergo a course of chemoprophylaxis with Hingamin, Amodiaquine, and Chloridine. For greatest effectiveness, it is recommended to alternate these drugs every month.

You can use natural or synthetic repellents to protect yourself from mosquito bites. They are collective and individual and are available in the form of spray, cream, gel, pencils, candles and spirals.

Mosquitoes are afraid of the smell of tomatoes, valerian, tobacco, basil oil, anise, cedar and eucalyptus. A couple of drops of essential oil are added to vegetable oil and applied to exposed areas of the body.

Video: life cycle of falciparum plasmodium

From a public health perspective, the goal of treatment is to reduce transmission of infection to others by reducing the reservoir of infectious agents and preventing the emergence and spread of antimalarial drug resistance.

Importance of Diagnostic Testing

Treatment of uncomplicated cases of malaria

Treatment of infection P. falciparum

ACTs are the main recommended treatment for P. falciparum malaria and their effectiveness must be maintained as alternative drugs to artemisinin derivatives are not expected to reach the market for several years. WHO recommends regular monitoring of the effectiveness of antimalarial drugs used in national malaria control programs to ensure that the chosen treatments remain effective.

In areas of low transmission, antimalarial treatment should be supplemented with a single low dose of primaquine to prevent transmission. However, testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency is not required because a single low dose of primaquine effectively blocks transmission and rarely causes serious toxicity in patients with any form of G6PD deficiency.

Oral monotherapy and artemisinin resistance

Artemisinin and its derivatives should not be used as oral monotherapy, as this contributes to the development of artemisinin resistance. In addition, it is strongly recommended to favor fixed-dose dosage forms (combining two different active ingredients combined in one tablet) over combinations of different tablets placed in the same blister, same or different packaging, as this makes it easier to adhere to the dosing schedule and reduces the possibility of using individual components as monotherapy.

• Additional information about discontinuation of oral artemisinin monotherapy

Treatment of P. vivax infection

Treatment of P. vivax infections should be with ACT or chloroquine in areas where P. vivax does not have resistance to chloroquine. In areas where P. vivax has been shown to be resistant to chloroquine, infections should be treated with an ACT, preferably one where the co-drug has a long half-life. With the exception of the combination of artesunate with sulfadoxine-pyrimethamine (AS+SP), all ACTs are effective against the spread of P. vivax infection in the bloodstream.

In order to prevent relapses, primaquine should be prescribed in addition to the main treatment; the dose and frequency of administration should be determined taking into account the enzyme activity of glucose-6-phosphate dehydrogenase (G6PD) in a particular patient.

Treatment of severe cases of malaria

To treat severe cases of malaria, artesunate injections (intramuscular or intravenous) should be given for at least 24 hours, followed by a full three-day course of ACT as soon as the patient is able to tolerate oral medications. If injectable drugs are not available, children under 6 years of age with severe malaria should be given prehospital treatment with artesunate suppositories, after which they should be immediately referred to a health facility where they can receive adequate treatment.

It is extremely important not to use either injectable artemisinin-based drugs or artesunate suppositories as monotherapy - the initial course of treatment of severe forms of malaria with these drugs must be supplemented with a three-day course of ACT. This is necessary to ensure complete cure and prevent the development of resistance to artemisinin derivatives.

Expanding access to ACT

Access to ACT has expanded significantly in recent years. By the end of 2016, ACT had been accepted as first-line treatment in 80 countries. An estimated 409 million courses of artemisinin combination therapy (ACT) were administered in countries in 2016, up from 311 million courses in 2015. More than 69% of such courses were distributed through the public sector. The number of ACT courses distributed through the public sector increased from 192 million in 2013 to 198 million in 2016, with the majority (99%) distributed in the WHO African Region.

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 a fifth species, Plasmodium knowlesi, also causes malaria in humans in Southeast Asia. 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
Under 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, the proliferation of 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 latent period begins. If treatment is incorrect or ineffective, immediate (3 months), late or distant (6-9 months) relapses occur after several weeks or months.

Three-day malaria. Duration of 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 abdominal syndrome is expressed (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 also be severe and, in the absence of timely treatment, have 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 of laboratory blood tests.

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.

If indirect signs of a malarial infection are detected in a patient (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 the thick drop more carefully and not two, but a series - 4 - 6 at 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 a large number of schizonts are used as an antigen for diagnosing three-day and four-day malaria.

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 (Artemisia annua), which contain the substance artemisinin and its synthetic analogues, are highly effective, 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 medications are typically used by people visiting areas at risk of contracting malaria and are not used much by the local population due to the high cost and side effects of 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. Prior to this time, its widespread use had 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. 04/25/2019

The long weekend is coming, and many Russians will go on holiday outside the city. It's a good idea to know how to protect yourself from tick bites. The temperature regime in May contributes to the activation of dangerous insects...

How to protect yourself and your loved ones from whooping cough? 05.04.2019

The incidence of whooping cough in the Russian Federation in 2018 (compared to 2017) increased almost 2 times 1, including in children under the age of 14 years. The total number of reported cases of whooping cough for January-December increased from 5,415 cases in 2017 to 10,421 cases for the same period in 2018. The incidence of whooping cough has been steadily increasing since 2008...

20.02.2019

Chief children's phthisiatricians visited school No. 72 in St. Petersburg to study the reasons why 11 schoolchildren felt weak and dizzy after they were tested for tuberculosis on Monday, February 18

18.02.2019

In Russia, over the past month there has been an outbreak of measles. There is a more than threefold increase compared to the period a year ago. Most recently, a Moscow hostel turned out to be a hotbed of infection...

Medical articles

Almost 5% of all malignant tumors are sarcomas. They are highly aggressive, rapidly spread hematogenously, and are prone to relapse after treatment. Some sarcomas develop for years without showing any signs...

Viruses not only float in the air, but can also land on handrails, seats and other surfaces, while remaining active. Therefore, when traveling or in public places, it is advisable not only to exclude communication with other people, but also to avoid...

Regaining good vision and saying goodbye to glasses and contact lenses forever is the dream of many people. Now it can be made a reality quickly and safely. The completely non-contact Femto-LASIK technique opens up new possibilities for laser vision correction.

Cosmetics designed to care for our skin and hair may actually not be as safe as we think