Dr. Kankan Ch. Rabha,MD(Ay)Tamulpur
MICROBIOLGY : Malaria is caused by four species of pathogenic Malaria parasites of the genus plasmodium introduced in the human body by the bite of female anopheles mosquito.
This are
1. Plasmodium Vivax
2. Plasmodium Falciparum
3. Plasmodium Malaria
4. Plasmodium Ovalae.
PF and PV is more common in NE region, of course malaria is widely distributed through out the world ic Adrica,New Guinea, Central America, Indian Subcontinent, Eastern Asia.

EPIDEMILOGY : Malaria is the most important parasite disease in humans causing about 1 million death each year/

PATHOGENESIS : After introduction of sporozoits into the bloodstream by female anopheles mosquitoes, the parasite travels to the liver and reproduces asexually to form merozoites that infect RVCS. The merozoites transform into trophozoites, feed on intracellur proteins(Principally Hemoglobin), multiply 6-20 fold every 48-72 hours and cause the RBCS to rupture, releasing daughter merozoitys .the process then repeats.
Some Parasites’ develop into long lived  sexual forms called gametocytes, which can be taken up by another female anopheles mosquito, allowing transmission.
In Plasmodium Vivex Or  Plasmodium Ovale infaction, dormant forms called hypnozoites remain in liver cells and may cause dises 3 weeks to more then 1 year later.
RBCS infected with Plasmodium Falciparum may exhinit cytoadherenmce ( attachment to venular and capillary endothelium), resetting ( adherence to uninfected, RBCS ), and agglutination (adherence to other infected RBCS). The result is sequestration of Plasmodium Faciparum in vital organs with consequent underestimation(through parasititemia determination)of parasite numbers in the body.

CLINICAL MANIFESTATIONS : Pts Initially devlop nonspecific symptoms (Eg, Headache, Fatigue, Moialgias that are followed by fever)
Febril paroxysms at regular intervels are usual and suggest infaction with Plasmodium vivax or Plasmodium ovale
Spleenomegalym Hepatomegaly mild anemia and Jaundicew may devlop
The diagnosis of severe fulciparum malaria requires one of the following impaired conscious ness/Coma.,sever normocytic anemia renal failure, pulmonary edema, circulatory shok, spontaneous bleeding, acidoaiosis hemoglobinuria, Jaundice, Repeated generalized convulsions, and a parasitemia level of >5%
-  Cerebral malaria manifests as diffuse symmetric encephalopathy, typically without focal neurologic signs.
-        Coma is an ominous sign associated with mortality rates of more than 20%.
Pregnant women have unusually severe illness. Premature labour fetal distress stillbirth, and delivery of low-birth Wight infants are common.
Tropical spleenomegaly may result as a chronic complication of malaria and is characterized by massive spleenomegaly, Hepatomegaly and an abnormal immunologic response to infection.

DIGNOSIS: Although antibody-based diagnostic test are being used with increasing frequency demonstration of asexual forms of the parasite on peripheral blood smears is required for diagnosis.
Ticked and thin smears should be examined.
If the level of clinical suspicion is high and smear are initially negative, they should be repeated 12-24 hours for 2 days .
Other laboratory findings generally include norm chromic, normocytic anemia thrombocytopenia

TREATMENT OF MALARIA : Bed rest is advice during paroxysm. Plenty of fluid by mouth or I.V. route may be given if vomiting, purging or circulatory collapse are present. Antianaemic therapy should also be done. When high fever is present ice pack, Ice sponging,etc. may helpful.

SPECIFIC TREATMENT : In chloroquin sensitive P.F Malaria chloroquin phosphate: 1gm followed by 500 gm at 6 hours ,24 hours and 48 hours,
In Chloroquin resistant uncomplicated cases of PF malaria: quine sulphate 650 mgm thrice daily for 7days.In severe complicated P.F. : Quinidine may be given. QDH 500 mgm is dissolved in  2CC Normal Saline by IM route or same salt 500 mgm dissolved in 50 CC Normal Saline can be given slowly I.V.

Other drugs in chloroquin resistant PF malaria.
Mefloquin: 15 mgm /kg once or 750 mgm stat and then 500 mgm in 6-8 hours.
Artisunate or Artemether: Single daily dose of 4 mgm/kg on 1st day & 2mgm /kg on 2nd and 3rd day and then one mgm /kg on day 4th to 7th.
Artemether 20 mgm + Lumefantrine 120 mgm: 4 tab twice daily for 3 days.
Inj artisunate 2.4 mgm/kg IV or IM and then 1.2 mgm 12 hours daily.
Inj Artimether 3.2 mgm /kg IM and then Mgm /kg per    day IM

PREVENTION OF MALARIA : This is achieved by undertaking measures to prevent the breeding of mosquito by spraying D.D.T. in breeding places and protecting the  humen beings from mosquito bite by applying repellent lotion to the exposed parts and by sleeping under mosquito nets.

MALARIA OF TRIBES OF TAMULPUR : Tamulpur is Malaria prone area since long. Majority of people victims malaria. Amongs them tribal people are victims more due to superstitious beliefs,food habits (Bed Food).Lack of awareness, education, Low-Socioeconomic condition and Lack of Hygienic  conditions. Still there are some area if anybody suffers fever (Malaria,S.typh etc) they donot visit to Doctor,only they prefers to Ojja, Who advice them for Jaundice medicine & tantra Mantra , even the ojja adviced to the patint not to take Doctors treatment. Ultimatly duer to delayed treatment patint goes to more complicated I.E Jaundice , anemia renel dailure coma wihich may leads to death.
So, my Suggestion is that First come to Doctor for proper treatment & get relive very soon. Ethically. But now a days tribes people are also becomes more awareness regarding health higine ,I think thet wil overcome very soon from superstitious belief in time.

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