Malaria and Associated Complications

Malaria is one of the most common type of febrile illness in India caused by the bite of female Anopheles mosquitoes and is caused by different species of plasmodium. It is one of leading cause of mortality all over the world, causing more than 2000 deaths each day. In India it leads to significant morbidity accounting for almost 13%, which is highest in the South East Asia region. In India around 20 million cases are reported each year with 15000-20000 death annually.

Malaria is mainly caused by four species of plasmodium out of which plasmodium vivax and falciparum are most important. Plasmodium vivax counts for 60-65% of infection where as 30-35% causes are due to P. falciparum. In India there are many areas in which malaria is endemic. Its incidence generally increases during rainy season due to increased mosquitoes breeding and transmission.

Signs and Symptoms associated with Malaria:

Malaria is usually present with nonspecific symptoms initially, like lack of sense of well being, headache, body ache, fatigability, abdominal discomfort followed by fever, similar to symptom of viral illness. Headache and body ache are usually severe in case of malaria, but other feature like photophobia, neck stiffened, arthralgia are absent which help it in differentiating it from other causes of fever like dengue, leptospira and meningitis.

Fevers of malaria is usually associated with chills and rigors, however typical periodic pattern may or may not be present. On the basis of severity malaria is defined as complicated or non complicated. Uncomplicated malaria is defined as symptomatic malaria without signs of vital organ dysfunction. In such cases a sudden rise of fever with chills may occur at regular interval. In complicated malaria symptoms of organ dysfunction are usually associated. It is generally caused by P. falciparum infection. It may present with altered mental status ranging from failure to localize or respond appropriately to external stimuli. Seizures may occur in such patients. Other features may include pulmonary oedema (fluid accumulation in the lungs and the air sacs making it difficult to breathe) manifesting with strenuous and labored breathing. Patient may be unable to maintain O2 saturation and may require ventilator support.

Episodes of Hypoglucemic (Blood sugar level < 40 mg/dl) are very common in such patients. Such patients may also go into renal failure with decreased urine output and hypotension. Significant bleeding from gums, nose and gastrointestinal tract may occur. Sign of hepatic dysfunction like Jaundice may also be seen in case of severe malaria.

In patient who were suffering from HIV/AIDS, malignancy, malnutrition feature are more aggravated. In pregnancy, malaria may cause early abortion, intrauterine growth retardation and consequent increased infant mortality rate. In children convulsion, coma, hypoglycemia, metabolic acidosis and sever anemia are more common.

How can malaria be transmitted?

Other than the bite if the female Anopheles mosquito, Malaria can also be transmitted by needle stick injury, blood transfusion, sharing of needles by drug abuser or organ transplantation.
Repeated or chronic infection of malaria may lead to massive splenomegaly (enlargement of the spleen) which may cause pancytopenia (deficiency of the cellular component of the blood – RBC, WBC and platelets) which lead to increased risk of bleeding susceptibility to infection.

How can malaria be prevented ?

Malaria may be contained by judicious use of insecticides to kill mosquito rapid diagnosis and management. Chemo prophylaxis may be given to patients who are high risk group such as pregnant women, young children and traveler from non endemic zone travelling to high risk area. Personal protection include avoidance of exposure to mosquito at their peak feeding time usually dusk to dawn, use of insect repellant suitable clothing & use of bed net during night.