Must read!! Diagnosis and Management of Malaria

Introduction
Malaria is a dangerous disease that spreads when an infected female Anopheles mosquito bites a human. Four types of malarial parasites infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. Among the four types, Plasmodium falciparum is the parasite responsible for almost every case of severe malaria. When an infected female mosquito bites, it injects malaria parasites into the person’s bloodstream. Malaria symptoms include fever, severe headache, myalgia (muscle pain), vomiting, and shaking chills. Malaria is uncommon in the United States, although widespread in tropical regions such as Africa and Asia. Prevention and treatment of malaria are possible due to advances in medical sciences. However, malaria can cause serious health problems, including jaundice, convulsions, brain injury, breathing problems, organ failure, and death if not diagnosed and treated correctly.

How is malaria diagnosed?
The healthcare professionals check and inquire about the symptoms and travel history of the patient as the initial step to diagnose the disease. Therefore, it’s essential to tell your healthcare provider about the countries you’ve recently been to or the locality of your stay so that they can accurately assess your risk of getting malaria.
The different diagnostic tests for malaria are:

1. Microscopic Diagnosis
   The physician takes a sample of your blood and sends it to a lab to check for malaria parasites under the microscope. Before the examination, the specimen is stained (usually with the Giemsa stain) to give the parasites a distinct appearance. This technique is still the gold standard for laboratory confirmation of malaria and aids doctors in determining the best course of action.
   Malaria blood tests can reveal the following:
   1. First, confirm that malaria parasites are present in the blood.
   2. Second, which form of the malaria parasite is producing the symptoms you’re experiencing?
   3. Whether a drug-resistant parasite is responsible for malaria infection?
   4. Whether or not the condition is driving any significant side effects.
2. Antigen Detection Test
   Immunochromatographic tests are available to detect the presence of antigens of malaria parasites in the host’s blood. The antigen detection tests are “Rapid Diagnostic Tests” (RDT) as they provide the results within 15 minutes. These tests are also considered an alternative to microscopy tests under circumstances where the microscopic diagnosis is unreliable. The USFDA approved the first RDT for use in the US on June 13, 2007. However, individual physicians and patients are not permitted to utilize the RDT, which is only certified for use by hospital and commercial laboratories. The USFDA also stated that all RDTs should be followed up with microscopy to verify the results and, if positive, to confirm the species and quantify the amount of infected red blood cells.
3. Serology Test
   The Serology Diagnostic Test is used to measure the past exposure of a person to malaria. It detects the presence of specific antibodies against specific malaria parasites. The techniques used in the serology test can be indirect immunofluorescence (IFA) or enzyme-linked immunosorbent assay (ELISA).
4. Molecular Diagnosis
   The molecular diagnosis technique is only helpful after confirming malaria from either microscopic diagnosis or Antigen Detection Test. After that, it is used to diagnose the malaria parasite or parasite nucleic acids present in the host body with the help of PCR. However, it is less common in use as it is sensitive.

How is malaria treated?
The treatment for malaria is done by the use of antimalarial drugs prescribed by a medical practitioner. Different antimalarial drugs have a different mode of action, and their use depends on the following factors:

1. The type of malaria parasite you have
2. The severity of your symptoms
3. Your age
4. Whether you’re pregnant
5. Medications

Treatments of Malaria:

• Chloroquine phosphate is one of the most often used antimalarial medicines. For every parasite that is sensitive to the medicine, chloroquine is the favored treatment. However, parasites have developed resistance to chloroquine in many regions and are no longer effective against malaria parasites.
• Artemisinin-based combination therapy of two or more medications combats the malaria parasite. Chloroquine-resistant malaria is frequently treated with such combination therapy. Artemether-lumefantrine (Coartem) and artesunate-mefloquine are two such examples of combination therapy.
  
  Other common antimalarial drugs include:
  • Atovaquone-proguanil (Malarone, Mepron®).
  • Quinine sulfate (Qualaquin) with doxycycline (Oracea, Vibramycin, others)
  • Primaquine phosphate
  • Artemisinin drugs (artemether and artesunate).
  • Chloroquine.
  • Doxycycline (Doxy-100®, Monodox®, Oracea®).
  • Mefloquine.

Side effects of the Antimalarial Drugs
Antimalarial medications can have adverse side effects. Antimalarial drugs can interact with other medicines, so tell your doctor about any you’re taking. The following are possible side effects associated with antimalarial drugs:

1. Gastrointestinal (GI) problems like Nausea and diarrhea
2. Headaches.
3. Sensitivity to sunlight has increased.
4. Insomnia
5. Psychological issues as well as eyesight issues.
6. Ringing ears or Tinnitus
7. Seizures.

How can malaria be prevented?
To prevent getting infected with malaria, people have to follow necessary guidelines and precaution measures. These include:

1. Apply insect repellent on your skin and wear full sleeve shirts and pants when moving out of the house.
2. Always use mosquito nets on your bed before going to sleep.
3. Cover windows and doors with nets to prevent the entry of mosquitoes.
4. Permethrin is an insect repellent used on clothing, mosquito nets, tents, sleeping bags, and other materials to prevent the bite from mosquitoes.
5. Keep your nearby environment clean and get rid of old tyres, cups, plates, and other things where rainwater gets stored and becomes stagnant.
6. Spray DDT on stagnant water and near the drains to prevent the breeding of the mosquitoes.

Prevention medicine
If you’re traveling to a place where malaria is frequent, talk to your doctor a few months ahead of time about whether you need to take drugs to protect yourself from malaria parasites before, during, and after your trip.
Malaria prevention medicines are often the same as those used to treat the disease. However, the drug you take is determined by where you’re going, how long you’ll be gone, and your health conditions.

Vaccine
A malaria vaccine by the name RTS, S/AS01 ( brand name Mosquirix), was approved by the World Health Organization in 2021 to treat malaria caused by the P.falciparum parasite. According to the WHO, the RTS, S/AS01 malaria vaccine should be given to children starting at five months in a four-dose schedule to reduce malaria disease and burden. However, malaria vaccines are still being developed and studied by researchers to avoid infection.

Conclusion
Malaria parasites are still infecting youngsters all over the world. A patient can avoid delay in diagnosis by paying attention to the risk of malaria and using laboratory tests appropriately. As more diagnostic and therapeutic technologies and approaches become accessible, the possibility of preventing the high morbidity and mortality associated with malaria grows. However, in the end, an efficient and safe vaccination is required to avoid the immense suffering and untimely deaths caused by this disease, which affects millions of children each year.

References

1. William Stauffer, Philip R. Fischer, Diagnosis and Treatment of Malaria in Children, Clinical Infectious Diseases, Volume 37, Issue 10, 15 November 2003, Pages 1340–1348, https://doi.org/10.1086/379074
2. Malaria. Accessed at
   https://www.mayoclinic.org/diseases-conditions/malaria/symptoms-causes/syc-20351184
3. Malaria. Accessed at https://my.clevelandclinic.org/health/diseases/15014-malaria
4. Malaria Diagnosis. Accessed at https://www.cdc.gov/malaria/diagnosis_treatment/diagnosis.html
5. WHO recommends groundbreaking malaria vaccine for children at risk. Accessed at https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk