Research Paper on "Malaria Medical Information Description of Malaria Classification"

Research Paper 13 pages (3454 words) Sources: 12

[EXCERPT] . . . .

Malaria

Medical Information

Description of malaria

Classification of malaria

Etiology of malaria

Prognosis of malaria 1 B. Natural History

Stages

Symptoms

Diagnostic Procedures

Physical examination

Laboratory Test

Drugs

Surgery

Epidemiology

Descriptive Epidemiology

Prevalence

Incidence

Mortality

Geographic Distribution

International

Regional (within U.S.)

Rural vs. Urban

Risk Factors

Known malaria risk factors

Distribution of risk factors among subpopulations

Prevention and Control

Disease Prevention

Primary

Secondary

Tertiary

Public Health Intervention

Policy Development

Intervention Program

Fig1.1. The spread of malaria against the age groups in South africa

Current Research

References

LIST of ACRONYMS

CDC

Centre for Disease Control

WHO

World Health Organization

ORD

Office of Rare Diseases

NIH

National Institute of Health

SP

Sulphadoxine-pyrimethamine

CQ

Chloroquine

FGR

Fetal Growth Restriction

RBM

Roll Back Malaria

LLINs

Long Lasting Insecticide Impregnated Nets

DDT

Dichlorodiphenyltrichloroethane

IRS

Indoor Residual Spraying

Malaria

Section I. Medical information

A. Description of malaria

(1). Definition

Malaria is an ancient and deadly parasitic infection that is transmitted by the female anopheles mosquito since they drink blood while laying eggs. It is caused by four species of the plasmodium genus of protozoa collectively known as malaria parasites.

Malaria is common in the tropical regions around the world with devastating effects. It is estimated that currently malaria kills around 3,000 people every day, majority being the children, across the world. Despite the fact that it is prevalent in the tropical countries and the third world, its presence is also noted in the U.S.A. particularly along the boundaries among the returning travelers as it was noticed in the year 2000 recording up to 1400 cases according to Medical Dictionary.1

(2). Classification of malaria

Malaria can be classified into two major categories and the symptoms that characterize each outlined according to CDC2 as below;

i. Uncomplicated malaria: it is caused by plasmodium vivax and is less serious with mild symptoms as headaches, fever, muscle pains, chills, vomiting, sweats and nausea.

ii. Complicated or severe malaria; is generally caused by plasmodium falciparum and is more acute and can cause death if not well handled. The symptoms include confusion, focal neurologic signs, coma, respiratory difficulties and severe anemia. It is also characterized by poor prognosis.

(3). Etiology of malaria

Malaria infection is triggered by the injection of sporozoites into the blood stream by the female anopheles mosquito, which in turn spread to the liver thereafter multiplying in the hepatocytes (liver cells). Once in the hepatocytes sporozoites will develop into thousands of merozoites which will transcend into the second stage where they will enter the blood stream and cause infection of the erythrocytes (red blood cells). It is at this stage that the patient will start feeling some joint pains, fever and nausea. The merozoites will systematically undergo haemolysis or reproduction in the erythrocites which leads to the destruction of the red blood cells.

(4). Prognosis of malaria

Most malaria patients will display mild joint pain, fever and nausea. On the severe malaria cases it will begin with febrile illness with a 20% of the cases accompanied by increasing respiratory effort. The remaining 80% will have severe disease, impaired consciousness and anemia. There will also be slight increase of depth of breathing, though this can pass unnoticed.

Respiratory distress accompanied by anemia carries a 20% chance of mortality among malaria patients. If the respiratory distress is accompanied by impaired consciousness, then the chances of mortality rise to 30% as Parry O.H.E.3, 292-293 Most of malaria symptoms subside once the patient takes doses of anti-malarial dugs.

B. Natural History

(1). Stages

There are basically three stages in the development of the infection of the malaria infection as noted by Sweet L. & Gibbs S.4, 370.

i. Cold Stage: the patient undergoes terrible coolness, chills and shivers. This may last for between 15 minutes to 2 hours.

ii. Hot stage: is characterized by high temperatures of up to 40°C yet little or to the very minimum diaphoresis. It is the most dangerous stage for children. In addition to the sweating and high temperatures, this stage might display headache, tachypnea, backaches, abdominal pains, tachycardia, vomiting and delirium are evident here.

iii. Sweating stage: this comes in after 2 to 6 hours of the hot stage. It sets in when the fever in stage two sets to reduce and it comes with the patient sweating profusely and feeling extremely weak and sleepy.

(2). Symptoms

The symptoms do vary as noted above. The CDC2, outlines the symptoms ranging from fever, sweating, rise in temperature, headache, tachypnea, backache, abdominal pains, tachycardia, vomiting and delirium. On the severe cases it can manifest symptoms such as convulsions, hypoglycemia, circulatory collapse, hyperparasitaemia, renal failure, haemoglobinuria, hepatic dysfunction and bleeding abnormalities.

C. Diagnostic Procedures

(1). History

For quite some time now malaria has presented a challenge in its diagnosis due to the population movement, endemic malaria, and frequent travelers. The other factor is the drug resistance and the generic variations that have altered the known and widely accepted morphology of the malaria parasites as per American Society for Microbiology.5, 66-78

A complete history should be obtained of the patient including the previous immunosuppressive treatment or disorders, diagnostic testing, other medications, surgery, trauma and the use of anesthesia. It would be significant to ask of any recent cross-border travels as proposed by the Travel Med.6.

(2). Physical examination

Physical examination of malaria includes recording of the temperature, ask the patient when the fever began and whether it has been fluctuating. Enquire of other symptoms like chills, pain or fatigue.6.

(3). Laboratory Test

The best known test for malaria is known as the blood smear test where the parasites can be identified by closely examining the patients' blood under the microscope having been stained so as to give the parasites a distinctive appearance as stated in Travel Med.6, 117

D. Treatment

(1). Drugs

There are several drugs that have been used to treat malaria over the years like Sulphadoxine-pyrimethamine (SP) and chloroquine (CQ), though these have been rendered ineffective due to growing resistance in the parasites, though there is still a wide use of SP as observed by Ranjitkar S., et.al.7, 75. Other drugs for combating and preventing malaria include Mefloquine, doxycycline primaquine Malarone among others, suggests Parry.3.

(2). Surgery

If there is prevalence of malaria in patients due for surgery, the malaria infection should be treated first and in any case it was accompanied by anemia then it should be handled first. It is apparent that trauma precipitates malarial relapse and that is why most patient up for surgery and have been to malaria prone areas are most likely to relapse into malarial attack. American Society for Microbiology5 indicates that Malaria can affect the healing of wounds since it increases anemia and visceral changes which lowers the immunity, hence must be cleared before one goes for surgery.

Section II. Epidemiology

A. Descriptive Epidemiology

(1). Prevalence

According to Malis S., et.al.,8,914 the CDC received 1,298 cases of malaria in the U.S.A. In the year 2008 which was a decrease by 13.8% from the year 2007 where 1,505 cases were reported. The World Tourism Organization further indicated that the bulk of the number of patients were travelers coming back from West African countries. Among them were 790 immigrants and 508 U.S. civilians of which 344 did not follow the chemoprophylactic drug regimen as recommended by CDC.9. There were 14 cases reported in pregnant women of whom none of them had adhered to the chemoprophylactic prescription.

Of the reported 1,298 cases, there were a total of 1,274 from whom their age was obtained. Of these 1,274 patients, 241 (18.9%) were found among the age of 18 years and below, 995 (78.1%) among patients of 18-64 years, 38 (3.0%) among those of 65 years and above. Among the American population most of the malaria infection was among those who had travelled to Africa as found in Morbidity and Mortality Weekly Report.10, 10-11.

(2). Incidence

Currently, the Office of Rare Diseases (ORD) under the National Institute of Health (NIH) has categorized malaria as a rare disease, which means it affects at most 1 person in every 2,000 people. Direct extrapolation will indicate that less than 2000,000 Americans (or those within the borders of USA) are affected by malaria as shown by Malis S.8. There is a continued campaign however, particularly among those going out of the U.S.A. And those coming back to ensure the rates of infections drop even further.

(3). Mortality

Malaria severity was observed to be more common among the returnees from East African, central and Southern Africa countries that those from the West African countries according to Lewis S.J. et.al.11, 741-3. The WHO17 indicates that in the United States, the death rate is so low and as noted above it is considered to be a rare disease with the death rate pinned at 0.0 representing 0 deaths out of 100,000 Americans.

B. Geographic Distribution

(1). International

Malaria has a higher prevalence rate in areas that are conducive for the malaria parasite in the vector to rapidly multiply. These are the tropical areas and… READ MORE

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