Malaria is one of the most common diseases found in the tropical and sub-tropical regions. It is basically caused by protozoan parasites of the genus Plasmodium. It is the female Anopheles mosquito that carries the malarial parasites. When it bites a person, the parasites enter the body, wherein they multiply and spread. Malaria mostly affects people with a weak immune system or those living in unhealthy living conditions. The most common symptoms of malaria include high fever - accompanied by chills, headache and shivering.
Fig 1. Malaria illustration of transmission of parasite- Medline plus
Among the malaria species that infect humans, P.vivax and P. ovale can develop dormant liver stages that can reactivate after symptomless intervals of up to 2 (P. vivax) to 4 years (P. ovale).
In general, malaria is a curable disease if diagnosed and treated promptly and correctly.All the clinical symptoms associated with malaria are caused by the asexual erythrocytic or blood stage parasites. The toxic factors stimulate macrophages and other cells to produce fever and rigors and probably influence other severe pathophysiology associated with malaria.
Plasmodium falciparum-infected erythrocytes, is believed to be a factor in causing the severe disease syndrome known as cerebral malaria, which is associated with high mortality.
Following the infective bite by the Anopheles mosquito, a period of time (the "incubation period") goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days. The shorter periods are observed most frequently with P. falciparum and the longer ones with P. malariae.
Antimalarial drugs taken for prophylaxis by travelers can delay the appearance of malaria symptoms by weeks or months, long after the traveler has left the malaria-endemic area.
Such long delays between exposure and development of symptoms can result in misdiagnosis or delayed diagnosis because of reduced clinical suspicion by the health-care provider. Returned travelers should always remind their health-care providers of any travel in areas where malaria occurs during the past 12 months.
Infection with malaria parasites may result in a wide variety of symptoms, ranging from absent or very mild symptoms to severe disease and even death. Malaria disease can be categorized as uncomplicated or severe (complicated).
The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of
a cold stage (sensation of cold, shivering)
a hot stage (fever, headaches, vomiting; seizures in young children)
and finally a sweating stage (sweats, return to normal temperature, tiredness).
Classically (but infrequently observed) the attacks occur every second day with the "tertian" parasites (P. falciparum, P. vivax, and P. ovale) and every third day with the "quartan" parasite (P. malariae).
More commonly, the patient presents with a combination of the following symptoms:
Nausea and vomiting
In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected. Conversely, in countries where malaria is frequent, residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation ("presumptive treatment").
Severe malaria occurs when infections are complicated by serious organ failures or abnormalities in the patient's blood or metabolism. The manifestations of severe malaria include
Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
Severe anemia due to (destruction of the red blood cells)
Hemoglobinuria (hemoglobin in the urine) due to hemolysis
Acute respiratory distress syndrome (ARDS), an inflammatory reaction in the lungs that inhibits oxygen exchange
Abnormalities in blood coagulation
Low blood pressure caused by cardiovascular collapse
Acute kidney failure
Metabolic acidosis, often in association with hypoglycemia
Hypoglycemia (low blood glucose). Hypoglycemia may also occur in pregnant women with uncomplicated malaria, or after treatment with quinine.
Severe malaria is a medical emergency and should be treated urgently and aggressively.
Other Manifestations of Malaria
Neurologic defects may occasionally persist following cerebral malaria, especially in children. Such defects include trouble with movements (ataxia), palsies, speech difficulties, deafness, and blindness.
Recurrent infections with P. falciparum may result in severe anemia. This occurs especially in young children in tropical Africa with frequent infections that are inadequately treated.
Malaria during pregnancy (especially P. falciparum) may cause severe disease in the mother, and may lead to premature delivery or delivery of a low-birth-weight baby.
On rare occasions, P. vivax malaria can cause rupture of the spleen.
Nephrotic syndrome (a chronic, severe kidney disease) can result from chronic or repeated infections with P. malaria infections (such as skin or respiratory infections).(2)
Diagnosis of malaria depends on the demonstration of parasites in the blood, usually by microscopy. Additional laboratory findings may include mild anemia, mild decrease in blood platelets (thrombocytopenia), elevation of bilirubin, and elevation of aminotransferases.
Malaria severely weakens the patient's immune system as it causes fever, headaches, nausea, loss of appetite and constipation. This severely weakens the individual leaving him vulnerable to other infections and diseases. All these symptoms are aggravated by strenuous activity or exertion. For this reason, patients are advised to refrain from any unnecessary physical activity and in severe cases, complete bed rest might be necessary. In most cases, however, extremely light exercise in the form of a small stroll after meals can be beneficial as this helps to combat fatigue and lethargy. In recent years, yoga has been gaining recognition as it requires very little energy and combats both the physical as well as the mental stress. Activities like swimming, dancing and aerobics are extremely strenuous and should be avoided at all costs. Walking (even strolling) for extended periods of time can leave you exhausted and is discouraged. ...more
Most people who live in areas where malaria is common have developed some immunity to the disease. Visitors will not have immunity and should take preventive medications.
It is important to see your health care provider well before your trip, because treatment may need to begin as long as 2 weeks before travel to the area, and continue for a month after you leave the area. Most travelers from the U.S. who contract malaria fail to take the right precautions.
Take plenty rest and fluids
Consume small meals with items easy to digest
Do only light activity as per your doctor's advice
Do not drink alcohol or smoke.
Prevent mosquito bites by wearing protective clothing over the arms and legs, using mosquito netting while sleeping, and using insect repellent.(3)
Drink plenty of fluids and water. Also during illness your appetite will be dampened hence allow yourself to eat "any" item you desire to have so as to gain calories. As soon as you feel better though alter your diet to a healthful one.
Extract some fresh lemon juice from one slice of half-cut lemon, and you need to add it into one cup of lukewarm water.
Consumption of this lemon treated water by slow sipping helps to control the rising of temperature in the initial period of fever.
Grapefruit in raw condition or in the form of juice helps to control the intensity of the infection;
it is an effective and useful easy herbal remedy for malaria. Other than grapefruits, orange and apples are other good options for the recovery of malaria patients.
Basil leaves are a good herbal remedy for malaria. You need to make some basil extracts [out of 12-15 leaves] and add 1-2 teaspoon of black pepper to it.
The patients who suffer from initial stages of malaria mostly obtain great relief from this remedy.
It is important to eat the right kind of food during illness especially. Try to incorporate 6-7 small meals/snacks during the day. Consume easy to digest, mildly spiced food as to gain maximum energy and not exert the body at the same time.
Generally, all food items can be classified into six major groups (3) as shown in the Healthy Food Pyramid.(4)
Immediate Diet Plan
Include lots of fresh, seasonal, local and if possible organic Fruits and Vegetables.
Add plenty of Whole Grains (whole wheat flour, brown rice, whole beans).
Say NO to all Sugary beverages and foods. Do not add any extra sugar to beverages like tea coffee etc. Especially important when diabetic.
Refined ingredients like white rice, white flour, maida should be completely omitted from diets. Especially important when diabetic.