m d in d ia healthcare services (tpa) private limited iso 9001:2000 certified

MDIndia Healthcare Services (TPA) Private Limited

ISO 9001:2000 Certified

Pre Insurance Medical

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MDI Confidential Proprietary Information

Malaria ……Malaria ……Health Checkups & Pre Insurance

Medical Services Team

Dr. Sachin KasatMBBS, AIII, FIII

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• Malaria is an infectious disease caused by a parasite(Plasmodium) that's

transmitted by mosquitoes.

• The illness results in recurrent attacks of chills and fever, and it can be deadly in

some cases

• Malaria is usually a 'rainy season disease'; coinciding with increased

mosquito abundance

What is it ?

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Malaria remains the world's most devastating human parasitic infection. Malaria affects over 40% of the world's population. WHO, estimates that there are 350 - 500 million cases of malaria worldwide, of which 270 - 400 million are falciparum malaria, the most severe form of the disease. Malaria kills in one year what AIDS kills in 15 years. For every death due to HIV/AIDS there are about 50 deaths due to malaria. To add to the problem is the increasing drug resistance to the established drug.Every 30 seconds, a child dies from malaria.Nearly one million people die from malaria every year.About one half of the world’s population is at risk of malaria.Malaria also hurts the economyIn India we have a medical dictum

Any fever unless proved otherwise has to be considered to be of Malaria and treated accordingly

Deforestation, population migration and changes in agricultural practice have profound effect on malaria transmission. Urban malaria is becoming an increasing problem in many countries.Epidemics are caused by migration (i.e. Introduction of susceptible hosts), the introduction of new vectors, or changes in the habits of the mosquito vector in the human host. Epidemics have occurred in North India.

Problem Statement

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Spread ….

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Where do mosquitoes breed?

Tire tracks Irrigation water

Rice paddies

Any place there is water!

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Malaria spread depends on:•Rainfall pattern•Types of Mosquito in the area•Proximity of residential area to mosquito breeding sites•Young children and pregnant women are at highest risk in these areas•With frequent exposure, adults develop some immunity to malaria

Risk Factors !

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Signs & Symptoms ….

Main Symptoms:

•Fever

•Headache

•Chills

•Vomiting

These usually start about 10 to 15 days after the mosquito bite.

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Signs & Symptoms ….

Initially symptoms resemble those of a minor viral illness. These include:

Lack of sense of well being Headache Fatigue Abdominal discomfort Muscle aches followed by fever Nausea/ vomiting

These may be followed by typical malaria picture:

Fever spikes (sudden rise and fall in temperature) Chills Rigors

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Disease progress….COLD STAGE:As the temperature begins to rise, there is intense headache and muscular discomfort. The patient feels cold, clutches blankets, and curls up shivering and uncommunicative. (The chill) . Within minutes the limbs begin to shake and teeth chatter, and the temperature climbs rapidly to a peak. The rigor usually lasts 10-30 minutes but can last upto 90 minutes.

HOT STAGE:By the end of rigor there is peripheral vasodilatation and the skin feels hot and dry. The temperature is high.

SWEATING:Profuse sweat then breaks out. It lasts for 2-4 hours. The patient is soaked in sweat and the temp falls. The blood pressure is relatively low. The patient feels exhausted and may sleep. Defervescence usually takes 4-8 hours. Fever is irregular at first with temperature exceeding 39 degrees centigrade. It may rise upto 40 C

If the infection is left untreatedFever recurs every third day in P.vivax and ovale infection establishing a 2-day cycle (tertian) Spike occurs every three days (Quartan) in P.malariae infection i.e. fever recurs every fourth day The pattern of fever in P. falciparum infection is erratic Paroxysms with rigors are more common in P. vivax & P. ovale than in P. falciparum and P. malariae malaria. True rigors are unusual in naturally acquired falciparum malaria. As the infection continues the spleen and liver enlarge and anemia develops. The patient loses weight. If no treatment is given the natural infection stabilizes for several weeks or months and then gradually resolves IF No complications arise and immunity is good

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Complications

Malaria can give rise to following complications:ComaBreathing problemsAnemiaJaundice Kidney failureShockDeath

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DiagnosisThe diagnosis of malaria rests on the demonstration

of asexual forms of the parasite in peripheral blood smears stained with Giemsa’s stain.

Clinically, any patient suffering from fever with rigors in an endemic area should arouse a suspicion of malaria

Malaria is diagnosed by microscopic examination of the blood. Thick and thin blood films are made on clean, grease – free glass slides.

Rapid Malaria Test is a newer test which enables to look for malaria antigens directly.

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Care of Malaria PatientPatients with severe malaria or those unable to take oral drugs should receive parenteral antimalarial therapy.

If there is any doubt about the resistance status of the infecting organism, then quinine or quinidine should be given.

If the temperature is high on admission (greater than 38.5oC) then symptomatic treatment with antipyretics and tepid sponging brings symptomatic relief, and also reduces the likelihood that the patient will vomit the oral antimalarials. This is particularly important for young children.

Several drugs are available for oral treatment, and the choice of drug depends on the likely sensitivity of the infecting parasites.

Chloroquine remains the treatment of choice for the benign human malarias.

Patients should be monitored for vomiting for 1 hour after the administration of any oral antimalarial drug. Symptom based treatment with tepid sponging and acetaminophen administration lowers fever and thereby reduces the patient’s propensity to vomit these drugs

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The main strategy for malaria control:

Attack the adult mosquitoes, or prevent them from biting people.

Some risks:1. Toxicity of DDT2. Resistance of

mosquitoes

Indoor residual spraying work

Control …..

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Prevent mosquito bites?

Use mosquito repellants.Wear long pants and long sleeves.Use bed nets..

Wear light-colored clothes.Use window screens

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Chloroquine alone is used to prevent malaria for travelers going to specific geographical regions where malaria is rampant.

The adult dosage is 500 mg once weekly.

The drug should be taken one week before entering a malarious area, weekly while there, and weekly for 4 weeks after leaving a malarious area.

Rare side effects to chloroquine include upset stomach, headache, dizziness, blurred vision, and itching. Generally these effects do not require the drug to be discontinued.

Travellers ….

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(Third Party Administration) Services Financially Stable since inception, with FYE 2009: 4.6+ million

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About MDIndia

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m d in d ia healthcare services (tpa) private limited iso 9001:2000 certified

Documents

risk of malaria

malaria transmission

falciparum malaria

urban malaria

cases of malaria

typical malaria picture

mosquito vector

worlds population