Malaria

Malaria is an acute febrile illness that can cause a wide variety of symptoms, ranging from no symptoms in the early course of infection to severe symptoms and even death. After a bite from the infected Anopheles mosquito, it usually takes around a week to a month for the first symptoms to appear. This period is known as the incubation period. The incubation period for an infection with P. falciparum (a type of malarial parasite, Plasmodium) is shorter compared to that of P. malariae (another malarial parasite). The symptoms usually appear 10–15 days after the infective mosquito bite. The initial symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death. Some individuals with malaria experience cycles of "attacks," which typically start with shivering and chills, followed by high fever and sweating before returning to normal temperature. These attacks (malarial paroxysm) occur in three stages:

• Cold stage – sudden feeling of cold and shivering
• Hot stage – high fever
• Sweating stage – before the temperature returns to normal

Other symptoms include:

• Headache
• Nausea and vomiting
• Body pain, especially in the muscles and joints
• Loss of appetite

In severe cases, symptoms may include:

• Anemia
• Bleeding
• Jaundice
• Convulsions

Malaria is caused by a bite from a female Anopheles mosquito infected with the Plasmodium parasite. The bite transfers the parasite (sporozoites) into the bloodstream, where it travels to the liver. In the liver, the parasites mature and multiply to form merozoites. This is followed by an invasion of red blood cells, resulting in malaria.

Since the malaria parasite is found in the red blood cells of an infected person, transmission can also occur, although rarely, through:

• Blood transfusions
• Organ transplants
• Shared use of contaminated syringes or needles

Another mode of transmission can occur from an infected mother to child during pregnancy or labor.

In humans, malaria is caused by five different species of the parasite:

• P. falciparum
• P. malariae
• P. ovale
• P. vivax
• P. knowlesi

Among these, P. falciparum is the most common species (~75%), followed by P. vivax (~20%).

In India, malaria is primarily caused by P. vivax and P. falciparum. Malaria due to P. vivax is more prevalent in plain areas, while P. falciparum is responsible for most malaria cases in hilly regions and forested areas.

The following factors are associated with high rates of malarial transmission:

• Staying or traveling to regions where malaria is endemic or highly prevalent, including tropical, subtropical, or areas of lower elevation.
• Areas with high mosquito breeding sites.
• Open air or tented accommodations.
• Wetter and hotter months of the year.
• Conditions that lead to lower immunity (immunosuppression).
• Age groups with low immunity (children under 5 years of age or the elderly).

Why do mosquitoes bite you more than others? Additionally, there might be times when you wonder why mosquitoes bite you more than others. This could be due to:

• 'O' blood type.
• Mosquito-attracting genes.
• Pregnancy.
• Consumption of alcohol.

The reason is that alcohol consumption, pregnancy, and even exercise increase your metabolic rate, leading you to exhale more CO2, which attracts mosquitoes.

The cyclical pattern of symptoms is a classical sign of malaria and prompts the doctor to suspect the disease. The symptoms are generally periodical and occur in cycles of 48 or 72 hours, depending on the type of malaria parasite one is infected with. Your doctor will examine the symptoms and check for an enlarged liver or spleen to make a diagnosis. He or she might also take medical history along with the symptoms.

Diagnosis involves identifying the type of parasite causing malaria. Tests include:

• Peripheral smear for Malaria: Also known as microscopy of thick blood smear, these blood smears allow for the visualization of malarial parasites under a microscope. It helps to detect and identify the malarial parasite.
• Antigen tests: Also known as rapid diagnostic tests, these blood tests help detect circulating parasite antigens. However, this test does not distinguish between the types of malarial parasites. In most cases, it is followed by a blood smear, which provides accurate information on the severity and type of the parasites. Rapid Diagnostic Tests (RDTs) offer a useful alternative to microscopy in situations where reliable microscopic diagnosis is not available.
• PCR test: The Polymerase Chain Reaction (PCR) test, or molecular test, is most useful for confirming the species of malarial parasite after the diagnosis has been established by either smear microscopy or RDT. It shows accurate results even if the parasite count is low or if the blood smear results are inconclusive.
• Antibody tests: This test detects the presence of antibodies in the blood, which usually occurs post-infection. It uses either indirect immunofluorescence (IFA) or enzyme-linked immunosorbent assay (ELISA) techniques. It does not detect current infection but rather identifies past exposure.
• Drug resistance test: Recommended in cases where malaria parasites are resistant to drugs, this test helps the doctor determine if certain drugs will be effective in treating your condition and guides treatment decisions accordingly.
• Other tests: In most cases, a complete blood count (CBC) is advised to check parameters such as hemoglobin and blood cell count. This can give your doctor an idea of the severity of the infection and whether you suffer from other conditions, such as anemia. Other tests that might be recommended (in rare cases) include tests to detect hypoglycemia, renal failure, hyperbilirubinemia, and acid-base disturbances.

Note: Malaria can be lethal and may lead to severe complications, requiring hospitalization if misdiagnosed or not treated in time.

Prevention of malaria can be achieved through public health and community-based programs aimed at controlling mosquito breeding and eliminating their breeding sites. On an individual level, the following measures can be practiced:

• Wear clothes that cover arms, legs, and feet.
• Avoid sleeping or staying long in open areas.
• Use mosquito repellents on your skin and clothing.
• Install mosquito screens on doors and windows to prevent entry into homes.
• Use bed nets for all family members during nighttime.
• Utilize mosquito zapping devices, such as electric bats.
• Invest in mosquito-repelling plants, like tulsi and lemongrass.

To prevent mosquito breeding, consider the following tips:

• Do not overwater potted plants and always empty the trays to prevent them from becoming breeding grounds.
• Change water regularly for indoor plants and decorative items where water can accumulate, such as bird baths, tabletop fountains, flower vases, and fish tanks.
• Empty water from air conditioning trays, refrigerator trays, and other containers, including pet or bird feeding bowls.
• Clean these tanks at least once every 15 days to disrupt the mosquito breeding cycle, which lasts about 15-20 days.
• Turn over empty pails and buckets when not in use and cover containers with proper lids to prevent mosquito breeding.
• Use dustbins with well-fitting lids and dispose of trash daily, as uncovered trash cans attract mosquitoes.
• Practice regular fogging with mosquito repellents or larvicides and spray pesticides like DDT in potential mosquito breeding areas.

The following mosquito repellent products can help prevent bites and thereby reduce the risk of malaria:

• Mosquito repellent bands can be worn on the wrist like a fitness band or watch. They are available in chemical forms, which are DEET-impregnated, and natural forms that contain essential oils like citronella, eucalyptus, or mint.
• Mosquito patches are stickers that can be applied to clothing, such as collars, sleeves, skirts, or shorts. They are available in both chemical and herbal forms.
• Body lotions or mosquito sprays containing synthetic repellents like DEET and permethrin or natural repellents like citronella offer protection against mosquitoes.
• Mosquito repellent sticks, similar to incense sticks, are loaded with mosquito repellents. These can be lit and placed in open areas such as gardens, terraces, or balconies.
• Mosquito nets are conventional options for fighting mosquitoes. The wire mesh of these nets should be extremely fine to prevent mosquito entry. An ideal mesh should have 18 x 18 strands per inch in both directions (length and width). Window screens can also be fitted with such wire mesh.

In addition to these repellents, products like blankets, floor cleaners, electric zappers, and table-top fumigator machines can help keep mosquitoes away.

The medicines prescribed depend on various factors such as the species of malarial parasite and the severity of the disease. Often, the doctor prescribes a combination of drugs.

In most cases, the treatment for malaria includes the administration of the medicine Chloroquine. For the severe form of the disease, IV Quinine or Quinidine may be given. Primaquine is used to kill dormant liver forms of P. vivax and P. ovale. Recently, chloroquine resistance has been observed in P. falciparum from some areas.

For chloroquine-resistant malaria, the following medications can be used:

• Mefloquine
• Halofantrine
• Lumefantrine
• Artemisinin-based combination therapies (ACTs), which include:
• Artemether-lumefantrine (Coartem)
• Artesunate-mefloquine

Other drugs that may be prescribed include:

• Atovaquone-proguanil combinations
• Quinine sulfate combinations
• Primaquine phosphate
• Doxycycline
• Tetracycline
• Clindamycin

Additionally, drugs like paracetamol are prescribed to provide relief from pain, fever, and body aches, which are commonly seen in people with malaria.

Try the following home remedies to bring down fever and treat other symptoms of malaria:

• Boil some basil leaves along with black pepper (kalimirch) in 2 glasses of water until reduced to half. Drink this decoction whenever you have a fever.
• Drink neem tea after meals to treat malaria. Boil a few neem leaves in water and use this decoction as tea.
• Eat grapefruit or drink its juice to combat the malaria parasite.
• Take half an inch of cinnamon (dalchini) stick and grind it. Boil in water. Drink it with honey and a pinch of black pepper.
• Eat citrus fruits such as orange, lime, and lemon to boost immunity and speed up recovery.

Diet for Malaria

In addition to taking medicines and using home remedies to treat malaria, eating a healthy and balanced diet can play a key role in improving your condition and speeding up your recovery.

During the Active Disease

A diet consisting of juices and very light foods like rice, dal, and vegetables with minimal fat content is highly recommended. Fresh seasonal fruits and fresh juices such as mangoes, apples, grapes, grapefruits, papaya, and pineapple should also be included.

During the Recovery Period

A diet of fresh fruits and vegetables, milk, paneer, whole grains, and nuts is advised. Tulsi is a natural anti-malarial, and a few leaves boiled in water may be given daily along with the allopathic medicines.

After Recovery

There are high chances that a person might feel weak even after recovery from malaria. Therefore, a diet rich in protein is recommended to help the body repair the damage caused by the infection. Cereals, pulses, nuts, and meats are great sources of protein. Dark leafy green vegetables rich in iron, rice, and whole grains should be consumed to help patients regain normal health.

Malaria is a serious condition that, if left unattended, may lead to death. Although malaria can be a deadly disease, illness and death from malaria can usually be prevented with proper diagnosis, timely treatment, and care. If left untreated, it can cause severe organ failure and other health complications such as:

• Cerebral malaria, which causes neurological abnormalities
• Severe anemia due to the destruction of red blood cells
• Blood in the urine or stools
• Acute respiratory distress syndrome (ARDS), which causes a severe inflammatory reaction in the lungs
• Abnormalities in blood coagulation
• Hypotension or low blood pressure
• Hypoglycemia or low blood glucose
• Difficulty in breathing
• Organ failure (lung, liver, or kidney failure)
• Rupture of the spleen leading to massive bleeding
• Meningitis, which may occur if malaria infects the brain

Some of the common alternative therapies for protection from mosquito bites and malaria include:

• Neem oil: Neem oil is an effective indoor mosquito repellent. Mix neem oil and coconut oil in equal portions and apply it to all exposed parts of your body. This will protect you from mosquito bites for at least eight hours.
• Eucalyptus and lemon oil: The mixture of lemon oil and eucalyptus oil is effective in repelling mosquitoes. Both contain cineole, which has antiseptic and insect-repellent properties when applied to the skin. Mix lemon oil and eucalyptus oil in equal proportions and use it on exposed areas of your body.
• Citronella oil: Citronella oil is an essential oil extracted from citronella grass. This oil has been known to prevent mosquito bites efficiently. Apply citronella oil all over the body. You can also add a few drops of this essential oil to a candle or vaporizer, or use it as a spray for mosquito-prone areas of the house.
• Camphor: Known as “kapura,” camphor is an effective mosquito repellent. Light a small piece of camphor in your room and close all doors and windows. Leave the room closed for 15 minutes.
• Tulsi: The Tulsi plant is effective in killing mosquito larvae and keeping mosquitoes away. Plant a few Tulsi shrubs near your windows and doors. Different varieties of basil, such as lemon basil and cinnamon basil, are particularly effective in warding off mosquitoes.
• Marigold: The marigold plant has a distinct smell that repels mosquitoes and other insects, primarily due to the compound pyrethrum, which is also found in certain insect repellents. It is easy to grow and maintain, and you can plant these in pots and place them in your garden.
• Geranium: Geranium is an attractive flowering plant that grows easily with basic care. It is commonly grown indoors in hanging pots, making it ideal for warding off mosquitoes inside the house. It requires plenty of light and well-drained soil.
• Lavender: The sweet aroma of lavender, highly sought after for perfumes, is effective in repelling mosquitoes. Although it is commonly grown in Europe, it can also be cultivated in India with minimal care. It can be grown indoors in pots with well-drained soil.