Immunity to malaria is characteristic. Malaria. Severe attacks of Plasmodium falciparum malaria

Malaria is a disease that in our latitudes is usually confused with influenza and other acute respiratory viral infections. This is especially widespread in the winter: at this time of year, people often go on vacation to tropical countries, where malaria feels at home, because the tropics are the habitat of malaria pathogens.

What is malaria?

Difference between the Anopheles mosquito and other species

Getting infected with malaria in our latitudes, as in any others, is possible if a person infected with plasmodia is bitten by a mosquito of the genus Anopheles (only this one). The mosquito drank a certain amount of infected blood, after which, driven away, it flew to another poor fellow, to whom it had already transferred the brutal plasmodia along with its saliva. Or when injecting two people with the same syringe (as with HIV, hepatitis). There are no other ways of transmitting malaria. Also, if you caught Plasmodium in the tropics, it means that it was transmitted to you by a mosquito from some person with malaria. Malaria is not transmitted by airborne droplets or in any other way!

There are 5 types of malaria, each of which differs in the degree of danger:

Immunity to malaria occurs only partially, after a large number of infections over several years. It occurs only for a specific type (strain) of malaria and intensifies with each new time. Symptoms become weaker over time, and the possibility of death is practically reduced to a minimum. There is no vaccine for malaria! Development and clinical trials of a vaccine against the tropical form are underway, but it will not protect you from all types of plasmodiasis at once. However, it showed weak efficiency (about 35%).

Symptoms of malaria

When I traveled to Papua New Guinea, I was, of course, well aware that this region is very rich not only in natural resources, but also in Plasmodium falciparum. And before going to such a wilderness, I stocked up on a good anti-malarial drug. Those. I was prepared for this disease, I knew its symptoms and knew how to treat it. But theory is theory, but in practice everything often turns out to be completely different, because it is impossible to foresee everything.

When I first felt the symptoms of fever and chills, the first thing I immediately thought of was malaria and nothing else. Local residents in this endemic region get sick very often and malaria in New Guinea is the most common disease. I went to the local hospital to get a rapid test for malaria. The test showed a negative result. I asked the doctor what should I do about my symptoms, to which the doctor replied that I needed to take Panadol (Paracetamol) two tablets every 6 hours. Those. The usual, classic therapy for ARVI is to simply relieve unpleasant symptoms (temperature) with paracetamol and wait until the immune system itself cures you of the viruses. In addition, I also took the antibiotic amoxicillin, believing that cold symptoms could be caused by bacteria, i.e. I drank just in case, having no idea of ​​the realities.

Possible symptoms of malaria

• Fever- temporary increase in body temperature due to intoxication of the body with waste products of plasmodium. Fever has a cyclical appearance. As a rule, the temperature rises sharply, reaches its peak value (38-40°) and drops, down to normal body temperature (36.6-37°). Cycles can be 4 days, 3 days or permanent. The temperature can change several times within one day, even with three-day malaria (all types);
• Chills- feeling of cold when the temperature rises in the first stage of fever (all types);
• Heat- feeling of heat when the temperature drops, redness of the skin, after chills, the second stage of fever (all types);
• Sweating- during heat transfer, the third stage of fever (all types);
• Tingling in the skin- unpleasant sensations similar to weak mosquito bites (all types);
• Cramps, muscle tremors- if the temperature rises to 39-40° and above. The body begins to shake, the muscles contract. This arises from the fact that the body, feeling cold, begins to contract muscles (as in real cold, frost) in order to thereby release the necessary heat to warm the internal organs (all types);
• Dry cough- a frequent occurrence;
• Joint pain- not all types of malaria ( P. falciparum);
• Nausea, vomiting- sometimes, against the background of elevated temperature as a side effect;
• Diarrhea- sometimes with blood ( P. falciparum);
• Headache- does not always appear (mostly P. falciparum);
• Anemia- decreased hemoglobin in the blood, pale skin, does not appear immediately (all types);
• Low blood sugar- does not appear immediately;
• Hemoglobin in urine- does not appear immediately;
• Hepatosplenomegaly- enlargement of the spleen and liver in advanced forms (all types);
• Hepatitis nephroso-nephritis- renal-liver failure, jaundice ( P. falciparum);
• Hemorrhagic syndrome- bleeding of mucous membranes, leads to death ( P. falciparum);
• Coma- when the form is neglected, leads to death ( P. falciparum);
• Paralysis- rarely, with advanced form ( P. falciparum).
• Brain edema- manifests itself rarely; if the disease progresses lightning fast in the early stages, it can lead to death ( P. vivax);

Not all symptoms appear immediately and not in all forms of malaria. Main symptoms - fever, headache, anemia, enlarged liver and spleen. Death most often occurs from overheating when the temperature rises above 42°, as well as from encephalopathy - coma or cerebral edema. Malaria during pregnancy can cause fetal death, P. falciparum And P. vivax. The most susceptible to the disease are post-infant children (from 1 year to 5 years), pregnant women and adults who have not previously been ill (for example, tourists).

So I just lived, taking paracetamol whenever symptoms occurred. And the symptoms continued constantly. The temperature dropped and then rose again - cyclically. Then one day in Bangkok, instead of 2 paracetamol tablets, I took 1 - and then I started shaking! I didn’t have a thermometer, but I’m sure it was over 40 degrees, and I had a strong fever, with cramps, like after cold water.

Then I came home and lived at home for another week with these symptoms, which appeared and disappeared. I took paracetamol while taking them off. I would like to say that the daily dose of paracetamol is 1 g, but I took 3 g per day, i.e. 6 tablets (2 at a time). Sometimes 4. Why didn’t I see a doctor immediately upon arriving home? Because I thought that after constantly taking antibiotics, my immune system was slightly weakened, and therefore my body fought the flu virus more slowly.

P. falciparum under a microscope (Gametocyte)

Red blood cell infected with P. vivax

I would like to note that in such situations, many people attribute these symptoms to ARVI and exclude the possibility of malaria. Even when they go to the doctor, doctors often also make a diagnosis of ARVI, while sarcastically mocking ignorant patients. Even when they hint to them: maybe I have malaria?! However, whoever is ignorant here, this still needs to be established! It is not uncommon for such patients to die after an incorrect diagnosis by would-be therapists! People are treated for a cold and eventually die from malaria, when their body is no longer able to resist the huge number of malarial plasmodia, which have multiplied greatly in their body during this time.

About 100 years ago, malaria was used to treat syphilis. Patients with syphilis were specially infected with malaria in order to cause an increase in body temperature to 41-42°, at which the causative agent of syphilis dies. Malaria was then treated traditionally - with quinine.

And then one day, when I again felt a strong fever with shaking (muscle tremors), in which I could not even get out of bed, I realized that things were bad, and it was most likely not a cold. As soon as I felt better, I took my temperature: it was 40.2°. This is despite the fact that it was already on the decline, in accordance with its cycle. This means that during the trembling she was obviously higher. I decided to call an ambulance so that she would take me to the infectious diseases department of our city hospital (I had already been there), and there they could accurately diagnose me, without my ignorant amateur fortune-tellers, and I could receive appropriate therapy.

Bursting red blood cells release a new generation of plasmodia

I was admitted to the hospital with a preliminary diagnosis, which was made by ambulance workers - "Fever of unknown origin". This is the most adequate diagnosis for similar symptoms in a similar situation (the patient arrived from an endemic region), there was no talk of any ARVI or typhoid fever (often confused with malaria). The hospital took all the necessary tests and ruled out the presence of pneumonia, tuberculosis, and, of course, a cold. Before the first results of the blood test were ready, there were two versions of my diagnosis: sepsis (blood poisoning) and malaria. After the test for sterility (for sepsis) and the “Thick Drop” were ready, the exact diagnosis was established - malaria. That means I was wrong, that means the rapid test was wrong, and I still have malaria. However, some test strips can only detect antigens (proteins) of the causative agent of tropical malaria and not the other three types. So, perhaps I came across just such a test, for the tropical form.

Test strip: 1 - absence of plasmodium; 2 - P. falciparum; 3 - combined; 4,5 - spoiled test.

Treatment of malaria

was found in my blood Plasmodiumvivax - the causative agent of three-day malaria. Adequate therapy is to take drugs like Quinine. Quinine is a drug that is obtained from the bark of the cinchona tree. People have been treating malaria with this substance since time immemorial. In Russia, Chloroquine is used, which is produced under various names, the most popular is - Delagil. I also informed the doctors that I have Quinine purchased abroad. I drank it too, taking 4 tablets even before taking Delagil. After which I felt a clear improvement in my health, a drop in temperature - it no longer rose.

Treatment of malaria in Russia: Chloroquine (Delagil / Immard / Plaquenil)

• 4 days (P. malariae) - 1st day: 1.5 gr, 2nd day: 0.5 gr, 3rd day: 0.5 gr;
• 3 days (P. vivax, P. ovale) - 1st day: 1.5 gr, 2nd day: 0.5 , 3rd day: 0.5 , 4th day and onwards (within 2 weeks) + Primaquin(to prevent relapse);
• Tropical (P. falciparum) - 1st day: 1.5 gr, 2nd day: 0.5 gr, 3rd day: 0.5 gr, 4th day: 0.5 gr, 5th day: 0.5 gr, next + Primaquin. -

For treatment tropical malaria this therapy outdated due to the emergence of resistance in some strains P. falciparum to chloroquine!

Other drugs (adult dose)

• Fansidar(Sulfadoxine + Pirematamine) - once, 3 tablets;
• Primaquin- 3 tablets/day, for 2 weeks;
• Quinine- 500-700 mg, every 7-8 hours, for 7-10 days;
• Lariam(Mefloquine) - 1 g once;
• Coartem(Artemether + Lumefantrine) - 4 tablets, morning and evening, for 3 days;
• Malaron(Atovaquone + Proguanil) - 4 tablets per day, for 3 days.
• Bigumal(Proguanil) - 1.5 g for 4-5 days
• Quinocid- 300 mg, 1-2 times a day

For treatment tropical malaria (p. falciparum) Most often used: Lariam, Coartem and Malarone.

The World Health Organization recommends treating all types of malaria with artemisinin combination therapy (ACT). Artemisinin(or its derivatives) + Primaquin(for the treatment of relapses). Artemisinin is not a quinine derivative; it is isolated from Artemisia annua ( Artemisia annua). WHO.

The use of delagil for tropical malaria is now practically useless! As far as I know (the doctors themselves told me this), in our hospitals, except for Delagil, there are no more antimalarial drugs, but they can be purchased separately in city pharmacies. For example, the same Quinine is available in a form together with analgin, but the quinine content is very low. Chloroquine (Delagil), Primaquine are less harmful drugs than Quinine, but due to resistance Plasmodium falciparum to Chloroquine, Quinine, which kills all types of plasmodium, began to be used again. Primaquine is used to prevent relapses of malaria after primary recovery. Popular in Africa Coartem, which copes well with tropical malaria, which is widespread there.

IMPORTANT! In the Russian Federation, as well as in the CIS countries, you can only buy Delagil, Fansidar, Analgin with quinine among antimalarial drugs. Other drugs must either be ordered from abroad or brought with you from countries where malaria is endemic.

Typically, two types of drugs are used to treat malaria. First one, then the other (for example, first delagil, then primaquine). The fact is that different forms of plasmodium, sexual and asexual, can live in our blood. By killing some forms, we do not kill others, and the person still remains infected, which can lead to recurrence and infection of other people during the mosquito active season (summer).

In my case, for three-day malaria, delagil is a completely adequate medicine. After taking Delagil they started giving me an antibiotic doxycycline(in conjunction with suprastin), it is also possible to take tetracycline or clindamycin. In addition, I took one quinine tablet each while in Papua New Guinea and Bangkok - at the time of high fever, just in case. I believed in the test results and believed that it was not malaria, but the flu, complicated due to a weakened immune system, but I took quinine just in case. Why one tablet? Because I gave this medicine to local residents, and they always only needed one tablet, after which they said that they felt good. However, the locals are less susceptible to the disease than I, a newbie! They have a partial immune response, antibodies to this type of plasmodium.

Relapses of malaria

Malarial plasmodia can go into hibernation and remain in the human body for many years, after which symptoms of the disease may again appear. For the prevention of exoerythrocytic distant relapses, it is prescribed Primaquin or Quinocid. The catch is that it is impossible to buy primaquine and quinocide in the Russian Federation - they are not certified drugs. They can, for example, be brought from abroad. Therefore, it turns out that to prevent relapses, our doctors try the use of antibiotics doxycycline, tetracycline, etc. However, this therapy does not always show a positive effect, without killing the “dormant” forms of plasmodium.

As an option, you can use complex therapy with Quinine/Chloroquine (elimination of erythrocyte, blood forms) + fansidar(elimination of non-erythrocyte forms), it does not guarantee elimination of relapses, but can be used. Without the use of appropriate medications, there is a high risk of more and more new clinical manifestations of the disease occurring months and even years later. P. vivax, P. ovale can lie dormant in the body for up to 3 years, P. malariae- dozens.

I relapsed after 2 months from the end of treatment. The temperature rose, chills, fever, sweating, pain in the left side, tingling on the skin, like weak mosquito bites. I didn’t even have my blood tested, but immediately started taking delagil - it’s easy to buy in pharmacies.

Prevention of malaria

If you go traveling to the tropical wilderness, be sure to stock up on anti-malarial drugs in advance in the large cities that you will pass through. Take time, go to the pharmacy and buy a couple of packages of the drug. Tropical malaria is very common in Africa and India, so do not take delagil there, but stock up on quinine. If you don’t know how to use a particular drug, then drink according to maximum 0.5 g per day, do not drink any more because it may cause side effects.

In 2015, about 214 million people had malaria, of whom 438,000 died. 90% of them were in Africa. WHO

To prevent malaria, you can use all the same drugs as to treat it. But it is worth remembering that if you do get malaria, despite taking medications, you need to use a different type of medicine to treat it. For prophylaxis, the same quinine, primaquine, Lariam (mefloquine), malarone, etc. are used.

However, despite small doses of the drug taken as preventive measures ( 2 once a week, starting at 2 weeks before the trip, and 2 after), the drugs still have a harmful effect on the body due to side effects. It is best to treat malaria after it appears. You should start taking it immediately, at the first symptoms. As soon as you feel an increase in temperature, feel free to take your treasured tablets according to the previously selected dosage.

Life cycle of Plasmodium falciparum

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

Malaria- an infectious disease caused by malarial plasmodia; characterized by periodic attacks of fever, enlarged liver and spleen, anemia, and relapsing course. The spread of malaria is limited by the range of the carriers - mosquitoes of the genus Anopheles and the ambient temperature, which ensures the completion of the development of the pathogen in the mosquito's body, i.e. 64° north and 33° south latitude; The disease is common in Africa, Southeast Asia and South America. In Russia, mainly imported cases are registered.

Clinical picture The disease is largely determined by the type of pathogen, therefore four forms of malaria are distinguished: three-day malaria, caused by P. vivax; oval malaria, caused by P. ovale; four-day, caused by P. malariae; tropical, pathogen - P. falciparum. However, a number of clinical manifestations of the disease are common to all forms. The duration of the incubation period depends on the type of pathogen. With tropical malaria it is 6-16 days, with a three-day with a short incubation period - 7-21 days (with a long incubation - 8-14 months), with oval malaria - 7-20 days (in some cases 8-14 months) , four-day - 14 - 42 days. At the onset of the disease, there may be a prodrome period, manifested by malaise, drowsiness, headache, body aches, and remitting fever. After 3-4 days, an attack of malaria occurs, during which three periods are distinguished - chills, fever, and profuse sweating.

The first period can be expressed in varying degrees: from mild chills to stunning chills. The face and limbs become cold and bluish. The pulse is rapid, breathing is shallow. The duration of chills is from 30 - 60 minutes to 2 - 3 hours. During the period of fever, lasting from several hours to 1 day or more, depending on the type of pathogen, the general condition of patients worsens. The temperature reaches high numbers (40-41 °C), the face turns red, shortness of breath, agitation, and often vomiting appear. The headache gets worse. Sometimes delirium, confusion, and collapse occur. Diarrhea is possible. The end of the attack is characterized by a decrease in temperature to normal or subnormal numbers and increased sweating (third period), lasting 2 to 5 hours. Then deep sleep occurs. In general, the attack usually lasts 6-10 hours. Subsequently, for varying periods of time, depending on the type of pathogen (for example, one day, two days), normal temperature remains, but the patient experiences weakness, which gets worse after each attack. After 3 - 4 attacks, the liver and spleen enlarge. At the same time, anemia develops, the patient's skin acquires a pale yellowish or earthy tint. Without treatment, the number of attacks can reach 10 - 12 or more, then they stop spontaneously. However, complete recovery does not occur. After several weeks, a period of early relapses begins, which, according to clinical signs, differ little from the primary acute manifestations of malaria. After the cessation of early relapses in three-day malaria and oval malaria, after 8 - 10 months (and later), usually in the spring of the year following infection, late relapses may develop. They are milder than the primary disease. In individuals who have taken insufficient amounts of antimalarial drugs for prophylactic purposes, the clinical picture of the disease may be atypical, and the incubation period may last several months or even years.

Three-day malaria is usually benign. The attack begins during the day with a sudden rise in temperature and chills. The attacks occur within one day. Daily attacks are also possible.

Ovale malaria is similar to three-day malaria caused by P. vivax, but is milder. Attacks occur more often in the evening hours.

Four-day malaria, as a rule, does not have a prodromal period. The disease begins immediately with attacks that occur 2 days later on the third or lasts for two days in a row with one fever-free day. Chills are mild.

Tropical malaria is characterized by the most severe course, often beginning with prodromal phenomena: 2 - 3 days before the attack, headache, arthralgia, myalgia, lower back pain, nausea, vomiting, and diarrhea may appear. The fever may be constant or irregular for a few days. In residents of endemic areas with tropical malaria, the temperature is often intermittent. Unlike other forms of malaria, in this form the chills are less pronounced, and the febrile period is longer - 12 - 24 and even 36 hours. Periods of normal temperature are short, sweating is not sharp. Already in the first days of the illness, palpation reveals pain in the left hypochondrium; the spleen becomes accessible to palpation after 4-6 days of illness. The liver enlarges from the first days of the disease. Jaundice often develops, nausea, vomiting, abdominal pain, and diarrhea appear.

Complications

Diagnosis

Treatment

Treatment carried out in a hospital. Patients are hospitalized in rooms protected from mosquitoes. To eliminate attacks of malaria, hematoschizotropic drugs are prescribed, which have a detrimental effect on the asexual erythrocyte stages of plasmodium. These include chloroquine diphosphate and its analogues from the group of 4-aminoquinolines (chingamin, delagil, rezoquin, etc.), as well as plaquenil, quinine, bigumal, chloridine, mefloquine. Chloroquine (Delagil) is most often used. These remedies provide a radical cure only for tropical and four-day malaria. After eliminating attacks of three-day and oval malaria, it is necessary to carry out anti-relapse treatment with primaquine and quinocide.

Forecast favorable with timely treatment. In complicated forms of tropical malaria, deaths occur, especially often in children and pregnant women.

Prevention

Persons traveling to malaria-endemic areas are given personal chemoprophylaxis. A week before leaving for a malaria outbreak, give delagil (or hingamin) 0.25 g 2 times. Then the drug is taken in the same dose during the entire stay in the outbreak and 4 - 6 weeks after returning, 1 time per week.

Those who have recovered from malaria are under dispensary observation for 2 years, which includes clinical observation and examination for Plasmodium carriage.

All people can suffer from malaria, but due to individual characteristics, the clinical manifestations of the disease vary from person to person. Malaria is characterized by nonsterile immunity (see), due to the constant presence of a small number of plasmodia in the blood. Post-infectious immunity in malaria is short-lived and unstable.

Infection of Anopheles mosquitoes with plasmodia can occur if there are at least 1-2 gametocytes (macro- and microgametocytes) in 1 mm3 of the patient’s blood. Therefore, the timing of the appearance of gametocytes and their number at different stages of infection largely determine the course of the epidemic process.

Patients with various forms of malaria become sources of infection at different periods of the disease. Thus, with the primary manifestation of three-day malaria with a short incubation, the sick person can become a source of infection within 15 days after infection. With the initial manifestation of three-day malaria with a long incubation, the patient becomes a source of infection only after 9-11 months. after infection. With tropical malaria, full-fledged gametocytes capable of infecting the carrier appear in the blood of patients no earlier than 24-25 days after infection. With four-day malaria, an infected person can become a source of spread of the disease no earlier than the 40-45th day after infection.

No changes in the invasiveness of gametocytes in 3-day malaria are observed throughout the course of the disease. The causative agent of three-day malaria is distributed in various latitudes. The northern subspecies of the causative agent of three-day malaria (P. vivax hibernans), which causes the disease after a long incubation, during the epidemic season can perform sporogony once a year, since each newly infected person becomes ill and becomes a source of infection only the next year. The second subspecies (P. vivax vivax), which causes disease after a short incubation, includes three types of strains.

1. Strain S. Elizabeth (the most northern), described in the USA. After the initial manifestation of the disease, which creates the possibility of spreading the infection in the same season when the sick person himself became infected, a latent period begins (7-9 months), followed by almost all cases of distant relapses, creating the possibility of spreading the infection next year.

2. The James strain (Madagascar) after the initial manifestation often causes early relapses (during the first 2-3 months of the disease), then a latent period begins (4-6 months), followed by distant relapses, ensuring transmission of the infection in the next year. Similar strains were common in the southern regions of the USSR.

3. The Chesson strain is adapted to conditions of distribution throughout the year. It is characterized by early relapses, following one after another after short intervals, they are limited in a large number of patients to the first 4-6 months. illness; no latent period is observed.

Four-day malaria is characterized by poor production of gametocytes. The duration of the disease is often up to 3 years.

For the transmission of infection, the temperature regime is of particular importance, affecting the development of plasmodium in the vector (Table 2).

In the salivary glands of Anopheles females, sporozoites remain invasive for no longer than 40-50 days, but often after 3-4 weeks after the end of sporogony, mosquitoes cease to transmit the infection.

The population's susceptibility to malaria is universal. Only in recent years have noteworthy data appeared on the resistance of the population of some hyperendemic malaria areas to the causative agent of three-day and tropical malaria.

In hyperendemic areas, a picture of complete immunity, maintained by frequent repeated inoculations of sporozoites, is often observed. In these areas, only children, especially young children, are the source of infection that supports the spread of malaria.

Malaria is a group of vector-borne diseases that are transmitted by the bite of a malarial mosquito. The disease is widespread in Africa and the Caucasus countries. Children under 5 years of age are most susceptible to the disease. More than 1 million deaths are recorded every year. But, with timely treatment, the disease proceeds without serious complications.

Etiology

There are three ways of contracting tropical malaria:

• transmission type(through the bite of a malarial mosquito);
• parenteral(through unprocessed medical supplies);
• transplacental(mixed type).

The first route of infection is the most common.

General symptoms

The first and most sure sign of infection with the disease is fever. It begins as soon as the malaria pathogen has penetrated and reached a critical level. In general, the symptoms of malaria are:

• periodic fever;
• significant enlargement of the spleen;
• Possible liver hardening.

The general list may be supplemented with other signs, depending on the period of development and form of the disease.

Forms of malaria

In modern medicine, the disease is classified into four forms:

• three-day form;
• four-day;
• tropical infectious form;
• ovale malaria.

Each of these forms has its own characteristic, pronounced symptoms and requires an individual course of treatment.

Three-day form

Three-day malaria has a very favorable prognosis compared to other forms of the disease. The incubation period can last from 2 to 8 months from the moment of the mosquito bite.

The symptoms of malaria of this subform correspond to the list described above. In the absence of correct treatment or if the immune system is too weakened, complications such as nephritis or malarial hepatitis may occur. In the most complex clinical cases, peripheral nephritis may develop. But in general, three-day malaria occurs without significant complications.

Quartan

Just like three-day malaria, with correct and timely treatment it occurs without significant complications. General symptoms of the disease can be supplemented by the following signs:

• daily fever;
• There is practically no increase in internal organs.

It is worth noting that attacks of fever can be easily stopped if antimalarial drugs are used in a timely manner. However, relapse of the disease can occur even after 10–15 years.

In rare cases, a complication may develop in the form of renal failure.

Ovale malaria

In its symptoms and course, this form is similar to the three-day form of the disease. The incubation period can last on average up to 11 days.

Tropical malaria

Tropical malaria is the most common form of the disease. Harbingers of the development of the disease may be the following:

• sharply increased temperature;
• chills;
• weakness, malaise;
• muscle pain.

Unlike three-day malaria, this form of pathology is characterized by a severe course. Without appropriate treatment, even death can occur. The virus is transmitted from a sick person to a healthy person, or through a mosquito bite.

Periods of disease development

Since the disease is classified as a polycyclic infectious disease, its course is usually divided into four periods:

• latent (incubation period);
• primary acute period;
• secondary period;
• relapse of infection.

Clinical picture of periods

The initial period, that is, the incubation period, practically does not manifest itself at all. As the patient progresses to the acute stage, the following signs of the disease may appear:

• a sharp change from a period of chills to fever;
• increased sweating;
• partial cyanosis of the extremities;
• rapid pulse, heavy breathing.

At the end of the attack, the patient’s temperature can rise to 40 degrees, the skin becomes dry and red. In some cases, a mental state disorder may be observed - the person is either in an excited state or falls into unconsciousness. Convulsions may occur.

During the transition to the secondary period of development of the pathology, the patient calms down, his condition improves somewhat, and he can sleep peacefully. This condition is observed until the next attack of fever. It is worth noting that each attack and the development of a new period of the disease is accompanied by profuse sweating.

Against the background of such attacks, an enlarged condition of the liver or spleen is observed. In general, the incubation period includes up to 10–12 such typical attacks. After this, the symptoms become less pronounced and the secondary period of the disease begins.

Without treatment, relapse almost always occurs and death cannot be ruled out.

Diagnostics

Diagnosis of this disease is not particularly difficult, due to its specific symptoms. To clarify the diagnosis and prescribe the correct course of treatment, a laboratory blood test is performed (allows us to identify the pathogen).

With timely treatment, malaria proceeds without significant complications. In this case, any traditional methods or dubious pills purchased independently from a pharmacy are unacceptable. Delay can result not only in relapse of the disease and complications in the form of other diseases, but also in death.

The most effective is drug treatment. In this case, the patient must be hospitalized, since treatment should be carried out only inpatiently and under the constant supervision of medical specialists.

In the initial period, as a rule, they get by with tablets alone. The most commonly used is Hingamin. The doctor calculates the dosage and frequency of administration individually based on the general health condition, weight and age of the patient.

If the tablets do not bring the desired result and the condition of the infected patient does not improve, drugs are prescribed that are administered intravenously.

Other tablets based on artemisinin can also be used to treat the disease. But drugs based on this substance are very expensive, so they have not found widespread use in clinical practice for the treatment of malaria infection. However, such tablets are most effective for treatment even in the later stages of the development of the pathological process.

Possible complications

Unfortunately, malaria in any form can affect the condition of any organ or system in the human body. The disease most often affects the liver, spleen and cardiovascular system. Also, against the background of malaria, diseases of the nervous system, genitourinary and vascular systems can occur.

As medical practice shows, the disease is most difficult and fatal in southern countries, where there is no access to good drugs. Cheap pills can only temporarily stop attacks, but this does not kill the infectious agent. As a consequence of this, the transition to the last period of development of the disease begins and death occurs.

Prevention

Prevention of malaria requires taking special tablets. You should start taking them 2 weeks before your intended departure to the risk zone. An infectious disease doctor can prescribe them. It is worth continuing to take the prescribed pills after arrival (for 1–2 weeks).

In addition, to prevent the spread of infection in countries where the disease is not uncommon, measures are being taken to destroy malaria mosquitoes. The windows of the buildings are protected by special nets.

If you are planning to go to such a dangerous zone, you should get special protective clothing and do not forget to take preventive pills.

Such preventive measures almost completely eliminate infection with this dangerous disease. If you experience at least a few of the symptoms described above, you should immediately contact an infectious disease specialist. Timely treatment will allow you to almost completely get rid of the disease and prevent the development of complications.