Padama, Michael P

BSN 4-M

Definition

Malaria is a mosquito-borne infectious disease caused by a eukaryotic protist of the genus

Plasmodium. It is widespread in tropical and subtropical regions, including parts of the
Americas, Asia, and Africa. Each year, there are approximately 350–500 million cases of
malaria, killing between one and three million people, the majority of whom are young children
in sub-Saharan Africa. Ninety percent of malaria-related deaths occur in sub-Saharan Africa.
Malaria is commonly associated with poverty, and can indeed be a cause of poverty and a major
hindrance to economic development.

Five species of the plasmodium parasite can infect humans; the most serious forms of the disease
are caused by Plasmodium falciparum. Malaria caused by Plasmodium vivax, Plasmodium
ovale and Plasmodium malariae causes milder disease in humans that is not generally fatal. A
fifth species, Plasmodium knowlesi, is a zoonosis that causes malaria in macaques but can also
infect humans.

Malaria is naturally transmitted by the bite of a female Anopheles mosquito. When a mosquito

bites an infected person, a small amount of blood is taken, which contains malaria parasites.
These develop within the mosquito, and about one week later, when the mosquito takes its next
blood meal, the parasites are injected with the mosquito's saliva into the person being bitten.
After a period of between two weeks and several months (occasionally years) spent in the liver,
the malaria parasites start to multiply within red blood cells, causing symptoms that
include fever, and headache. In severe cases the disease worsens leading to hallucinations, coma,
and death.

Signs and Symptoms

Typical

Sudden onset of High Fever with rigors and sensation of extreme colds followed by feeling of
burning, leading to profuse sweating and remission of fever by crisis thereafter. The febrile
paroxsyms occur every alternate day. Headache, body ache, nausea etc. may be associated
features
Atypical

In atypical cases, classical presentation as mentioned above may not manifest. Hence, any fever
case until unless proved otherwise, may be considered as malaria in the endemic areas during
transmission season

In most of the cases, the first symptoms are not specific and similar to those of a minor viral
illness with malaise, headache, fatigue, abdominal discomfort and muscle aches followed by
fever and chills. Repeated infections lead to anaemia, enlargement of spleen, and chronic ill
health with bouts of fever. Most patients with uncomplicated acute infection have few abnormal
physical findings other mild anaemia and in some cases a palpable spleen. None of the clinical
features of malaria is pathognom

Pathognomonic Signs of malaria

fever and chills.

Severe & Complicated Malaria

Children
The signs & symptoms in children are a history of high fever plus at least one of the following.
1. Prostration (inability to sit), altered consciousness lethargy or coma,
2. Breathing difficulties,
3. Severe anaemia,
4. Convulsions,
5. Inability to drink/ vomitting.

Adults
The same symptoms & signs in children are valid for adults, with addition of dark and/or limited
production of urine.
1. Hypoglycaemia
2. Shock
3. Hyperpyrexia (Rectal temperature above 390c)
4. Dehydration
5. Acute Renal failure with anuria or oliguria and black water fever.
6. Hyperkalaemia/Hypo kalaemia
7. Pulmonaty Oedema
8. GAstro intestinal complications.
9. Bleeding (Pulmonary oedema)
10. Jaundice & lever damage.
11. Hyperparasitaemia
 Incubation period:
1. 12 days for P. Falciparum
2. 14 days for P. vivax and ovale
3. 30 days for P. malariae

Mode of Transmission:
1. The disease is transmitted mechanically through the bite of an infected female anopheles
mosquito
2. It can be transmitted parenterally through blood transfusion.
3. On rare occasions, it is transmitted from shared contaminated needles.
4. However, transplacental transmission of congenital malaria is a rare case
 Clinical Manifestations:
1. Paroxysms with shaking chills
2. Rapidly rising fever with severe headache
3. Profuse sweating
4. Myalgia, with feeling of well-being in between
5. Splenomegally, hepatomegally
6. Orthostatic hypotension
7. Paroxysms may last for 12 hours, then, maybe repeated daily or after a day or two.
8. In children:
a. Fever maybe continuous
b. Convulsions and gastrointestinal symptoms are prominent
c. Splenomegally
9. In cerebral malaria
a. Changes in sensorium, severe headache, and vomiting
b. Jacksonian or grand mal seizure may occur

Diagnostic Procedure:
1. Malarial smear – In this procedure, a film of blood is placed on a slide, stained, and
examined microscopically.
2. Rapid diagnostic test (RDT) – This is a blood test for malaria that can be conducted
outside the laboratory and in the field. It gives a result within 10 to 15 minutes. This is done
to detect malarial parasite antigen in the blood.

Nursing Management:
1. The patient must be closely monitored.
a. Intake and output should be closely monitored to prevent pulmonary edema.
b. Daily monitoring of patient’s serum bilirubin, BUN creatinine, and parasitic count
2. If the patient exhibits respiratory and renal symptoms, determine the arterial blood gas and
plasma electrolyte
3. During the febrile stage, tepid sponges, alcohol rubs, and ice cap on the head will help
bring the temperature down.
4. Application of external heat and offering hot drinks during chilling stage is helpful.
5. Provide comfort and psychological support.
6. Encourage the patient to take plenty of fluids.
7. As the temperature falls and sweating begins, warm sponge bath maybe given.
8. The bed and clothing should be kept dry.
9. Watch for neurologic toxicity (from quinine infusion) like muscular twitching, delirium,
confusion, convulsion, and coma.
10. Evaluate the degree of anemia.
11. Watch for any signs especially abnormal bleeding.
12. Consider severe malaria as medical emergency that requires close monitoring of vital
signs.
 Treatment and Medications:
Anti-Malarial Drugs
 Artemether-lumefantrine (Therapy only, commercial names Coartem and Riamet)
 Artesunate-amodiaquine (Therapy only)
 Artesunate-mefloquine (Therapy only)
 Artesunate-Sulfadoxine/pyrimethamine (Therapy only)
 Atovaquone-proguanil, trade name Malarone (Therapy and prophylaxis)
 Quinine (Therapy only)
 Chloroquine (Therapy and prophylaxis; usefulness now reduced due to resistance)
 Cotrifazid (Therapy and prophylaxis)
 Doxycycline (Therapy and prophylaxis)
 Mefloquine, trade name Lariam (Therapy and prophylaxis)
 Primaquine (Therapy in P. vivax and P. ovale only; not for prophylaxis)
 Proguanil (Prophylaxis only)
 Sulfadoxine-pyrimethamine (Therapy; prophylaxis for semi-immune pregnant women in
endemic countries as “Intermittent Preventive Treatment” – IPT)
 Hydroxychloroquine, trade name Plaquenil (Therapy and prophylaxis)

Prevention and Control:

1. Malaria cases should be reported.
2. A thorough screening of all infected persons from mosquitoes is important.
3. Mosquito breeding places must be destroyed.
4. Homes should be sprayed with effective insecticides which have residual actions on the
walls.
5. Mosquito nets should be used especially when in infected areas.
6. Insect repellents must be applied to the exposed portion of the body.
7. People living in malaria-infested areas should not donate blood for at least three years.
8. Blood donors should be properly screened.