Malaria: diagnosis, treatment and prevention

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There's a high incidence of malaria in our country. Read through this article for handy information on prevention, diagnosis and treatment of this infectious disease. 

[caption id="attachment_3247" align="alignleft" width="200" caption="An insect repellent spray can offer some protection against mosquito bites"]Malaria: diagnosis, prevention and treatment [/caption]

Diagnosing Malaria

Two tests microscopy and /or Rapid Diagnostic Test (RDT) should be done in all clinically suspected malaria cases.

  • Microscopy includes stained, thick and thin blood smears and this test remains the gold standard for confirmation of diagnosis of malaria. It is highly sensitive and can also quantify the parasite load. It also allows for distinguishing the various species of malaria parasite and their different stages.
  •  Rapid Diagnostic Tests (also known as Dipsticks or Malaria Rapid Diagnostic Devices (MRDDs) assist in the diagnosis of malaria by detecting evidence of malaria parasites in human blood. They tend to be expensive and temperature sensitive.

Treatment for malaria

Three factors play a deciding role in treatment for malaria: i) The infecting species of the Plasmodium parasite. ii) The patient’s clinical situation of the patient such as the age of the patient, pregnant female, mild or severe malaria. iii) The drug susceptibility of the infecting parasites.
Those infected the Plasmodium species P. falciparum malaria can die if not treated immediately. Mild malaria can be treated with oral medication; severe malaria will require intravenous (IV) drug treatment and fluids in the hospital.

Chloroquine phosphate (Aralen) is the drug of choice for all malaria parasites except for chloroquine-resistant Plasmodium strains. Unfortunately, resistance is usually noted by drug treatment failure in the individual patient.

According to the World Health Organisation’s treatment policy -- established in 2006 -- all cases of uncomplicated P. Falciparum malaria are to be treated with artemisnin-derived combination therapy (ACTs).
The ACT used in the national programme in India is artesunate+sulfadoxine-pyrimethamine (SP). Currently, a fixed dose combination of the drugs artemether+lumefantrine and a blister pack of artesunate+mefloquine are also available in the country.
Unfortunately, as of 2009, a number of P. falciparum-infected individuals have parasites resistant to ACT drugs.

Prevention of malaria

  • Malaria transmission can be reduced largely by preventing mosquito bites through the use of mosquito nets and insect repellents, or by mosquito-control measures such as spraying insecticides and draining standing water (where mosquitoes breed).
  • Chemoprophylaxis (administration of a medication given to prevent infections) is recommended for travellers, migrant labourers and military personnel exposed to malaria in highly endemic areas.
  • The drug, doxycycline can be used for short-term chemoprophylaxis (less than 6 weeks). The drug should be started 2 days before travel and continued for 4 weeks after leaving the endemic area. This drug is contraindicated in pregnant women and children less than 8 years.
  • For long-term chemoprophylaxis (more than 6 weeks) mefloquine weekly should be administered two weeks before, during and four weeks after leaving the area. However, it is contraindicated in cases with history of convulsions, neuropsychiatric problems and cardiac conditions.
  • Several vaccines that may provide a high level of protection for a sustained period are under development and this challenge is still to be met.

Also read: Malaria - introduction, causes and symptoms

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