Bicol University College of Nursing Legazpi City

S ubmit ted b y : Rec el y n Ca ndace D. Fa u sti no B SN I I C Gr oup 8

S ubmit ted to : Pro fe ssor . Brigi da Lo bet e

Octo ber 17, 2011

What i s malaria ?
Malaria is an infectious disease caused by a parasite, Plasmodium, which infects red blood cells. Malaria is characterized by cycles of chills, fever, pain, and sweating. Historical records suggest malaria has infected humans since the beginning of mankind. The name "mal ar ia" (meaning "bad air" in Italian) was first used in English in 1740 by H. Walpole when describing the disease. The term was shortened to "malaria" in the 20th century. C. Laveran in 1880 was the first to identify the parasites in human blood. In 1889, R. Ross discovered that mosquitoes transmitted malaria. Of the four common species that cause malaria, the most serious type is Plasmodium falciparum malaria. It can be life-threatening. However, a n o t h e r r e l a t i v e l y n e w s p e c i e s , P l a s m o d i u m k n o wl e s i , i s a l s o a d a n g e r o u s species that is typically found only in long -tailed and pigtail macaque monkeys. Like P. falciparum, P. knowlesi may be deadly to anyone infected. T h e o t h e r t h r e e c o m m o n s p e c i e s o f m a l a r i a ( P . v i v a x , P . m a l a ri a e , a n d P . ovale) are generally less serious and are usually not life -threatening. It is possible to be infected with more than one species of Plasmodium at the same time. Wh at ar e mal ar i a sy mpt o ms an d s i g n s? The symptoms characteristic of malaria include flulike illness with fever, chills, muscle aches, and headache. Some patients develop nausea, vomiting, cough, and diarrhea. Cycles of chills, fever, and sweating that repeat every one, two, or three days are typical. There can sometimes be vomiting, diarrhea, coughing, and yellowing ( jaundice) of the skin and whites of the eyes due to destruction of red blood cells and liver cells. People with severe P. falciparum malaria can develop bleeding problems, shock, liver or kidney failure, central nervous system problems, coma, and can die from the infection or its complications. C erebral malaria (coma, or altered mental status or seizures) can occur with severe P. falciparum infection. It is lethal if not treated quickly; even with treatment, about 15%-20% die.

How i s malaria tra nsmitt ed?

The life cycle of the malaria parasite ( Plasmodium) is complicated and i n v o l v e s t w o h o s t s , h u m a n s a n d A no p h e l e s m o s q u i t o e s . T h e d i s e a s e i s t r a n s m i t t e d t o h u m a n s w h e n a n i n f e c t e d A no p h e l e s m o s q u i t o b i t e s a p e r s o n and injects the malaria parasites (sporozoites) into the blood. This is shown in Figure 1, whe re the illustration shows a mosquito taking a blood meal (circle label 1 in Figure 1).

Figure 1: CDC illustration of the life cycles of malaria parasites, Plasmodium spp. SOURCE: CDC Sporozoites travel through the bloodstream to the liver, mature, and eventually infect the human red blood cells. While in red blood cells, the parasites again develop until a mosquito takes a blood meal from an infected human and ingests human red blood cells contai ning the parasites. T h e n t h e p a r a s i t e s r e a c h t h e A no p h e l e s m o s q u i t o ' s s t o m a c h a n d e v e n t u a l l y i n v a d e t h e m o s q u i t o s a l i v a r y g l a n d s . W h e n a n A no p h e l e s m o s q u i t o b i t e s a human, these sporozoites complete and repeat the complex Plasmodium life cycle. P. ovale and P. vivax can further complicate the cycle by producing dormant stages (hypnozoites) that may not develop for weeks to years.

What i s the trea tme nt for ma laria?

Three main factors determine treatments: the infecting species of Plasmodium parasite, the clinical situation of the patient (for example, adult, child, or pregnant female with either mild or severe malaria), and the drug susceptibility of the infecting parasites. Drug susceptibility is determined by the geographic area where the infection was acquired. Different areas of the world have malaria types that are resistant to certain medications. The correct drugs for each type of malaria must be prescribed by a doctor who is familiar with malaria treatment protocols. Since people infected with P. falciparum malaria can die (often because of delayed treatment), immediate treatment for P. falciparum malaria is necessary. Mild malaria can be treated with oral medication; severe malaria (one or more symptoms of either impaired consciousnes s/coma, severe anemia, renal failure, pulmonary edema , acute respiratory distress syndrome , shock, disseminated intravascular coagulation, spontaneous bleeding, acidosis, hemoglobinuria [hemoglobin in the urine], jaundice, repeated generalized convulsions, and/or parasitemia [parasites in the blood] of >

5%) requires intravenous (IV) drug treatment and fluids in the hospital. Drug treatment of malaria is not always easy. Chloroquine phosphate (Aralen) is the drug of choice for all malarial parasites except for chloroquine-resistant Plasmodium strains. Although almost all strains of P. malariae are susceptible to chloroquine, P. falciparum , P. vivax, and even some P. ovale strains have been reported as resistant to chloroquine. Unfortunately, resistance is usually noted by drug -treatment failure in the individual patient. There are, however, multip le drug-treatment protocols for treatment of drug -resistant Plasmodium strains (for example, quinine sulfate plus doxycycline [Vibramycin, Oracea, Adoxa, Atridox] or tetracycline [Achromycin], or clindamycin [Cleocin], or atovaquoneproguanil [Malarone]). There are specialized labs that can te st the patient's parasites for resistance, but this is not done frequently. Consequently, treatment is usually based on the majority of Plasmodium species diagnosed and its general drug -resistance pattern for the country or world region where the patient b ecame infested. For example, P. falciparum acquired in the Middle East countries is usually susceptible to chloroquine, but if it's acquired in sub -Sahara African countries, it's usually resistant to chloroquine. The WHO's treatment policy, recently established in 2006, is to treat all cases of uncomplicated P. falciparum malaria with artemisinin-derived combination therapy (ACTs). ACTs are drug combinations (for example, artesunate -amodiaquine, artesunatemefloquine, artesunate-pyronaridine, dihydroartemis inin-piperaquine, and chlorproguanil-dapsoneartesunate) used to treat drug -resistant P. falciparum. Unfortunately, as of 2009, a number of P. falciparum-infected individuals have parasites resistant to ACT drugs. New drug treatments of malaria are currentl y under study because Plasmodium species continue to produce resistant strains that frequently spread to other areas. One promising drug class under investigation is the spiroindolones, which have been effective in stopping P. falciparum experimental infections.

How do p eopl e a voi d g etti ng malar ia?

If people must travel to an area known to have malaria, they need to find out which medications to take, and take them as prescribed. Current CDC recommendations suggest individuals begin taking antimalarial drugs about one to two weeks before traveling to a malaria infested area and for four weeks after leaving the area (prophylactic or preventative therapy). Doctors, travel clinics, or the health department can advise individuals as to what medicines to take to keep from getting malaria. Currently, there is no vaccine available for malaria, but researchers are trying to develop one. Avoid travel to or through countries where malaria occurs if possible. If people must go to areas where malaria occurs, they sho uld take all of the prescribed preventive medicine. In addition, the 2010 CDC international travel recommendations suggest the following precautions be taken in malaria and other disease -infested areas of the world; the following CDC recommendations are no t unique for malaria but are posted by the CDC in their malarial prevention publication.

Av o i d o u t b r e ak s : T o t h e e x t e n t p o s s i b l e , t r a v e l e r s s h o u l d a v o i d traveling in areas of known malaria outbreaks. The CDC Travelers' Health web page provides alerts and i nformation on regional disease transmission patterns and outbreak alerts (http://www.cdc.gov/travel). B e aw ar e o f p e ak e x po su r e t i m e s an d pl ac e s : E x p o s u r e t o a r t h r o p o d bites may be reduced if travelers modify their patterns of activity or behavior. Although mosquitoes may bite at any time of day, peak biting activity for vectors of some diseases (for example, dengue, chikungunya) is during daylight hours. Vectors of other diseases (for example, malaria) are most active in twilight periods (for example, dawn and dusk) or in the evening after dark. Avoiding the outdoors or focusing preventive actions during peak hours may reduce risk. W ea r a pp r o p r i a t e c l o t h i n g : T r a v e l e r s c a n m i n i m i z e a r e a s o f e x p o s e d skin by wearing long -sleeved shirts, long pants, boots, and hats. Tucking in shirts and wearing socks and closed shoes instead of sandals may reduce risk. Repellents or insecticides such as permethrin can be applied to clothing and gear for added protection; this measure is discussed in detail below. C h ec k f o r t i ck s : T r a v e l e r s s h o u l d b e a d v i s e d t o i n s p e c t t h e m s e l v e s and their clothing for ticks during outdoor activity and at the end of the day. Prompt removal of attached ticks can prevent some infections. B e d n et s: W h e n a c c o m m o d a t i o n s a r e n o t a d e q u a t e l y s c r e e n e d o r a i r conditioned, bed nets are essential to provide protection and to reduce discomfort caused by biting insects. If bed nets do not reach the floor, they should be tucked under mattresses. Bed nets are most effective when they are treated with an insecticide or repellent such as permethrin. Pretreated, long -lasting bed nets can be purchased prior to traveling, or nets can be treated after purchase. The permethrin will be effective for several months if the bed net is not washed. (Long-lasting pretreated nets may be effective for much longer.) I n s ec t i c i de s : A e r o s o l i n s e c t i c i d e s , v a p o r i z i n g m a t s , a n d m o s q u i t o c o i l s can help to clear rooms or areas of mosquitoes; however, some products available internationally may contain pesticides that are not registered in th e United States. Insecticides should always be used with caution, avoiding direct inhalation of spray or smoke. O pt i mu m pr o t ect i o n ca n b e pr o v i de d by ap pl y i n g r e pe l l e n t s. T h e C D C recommended insect repellent should contain up to 50% DEET (N,N diethyl-m-toluamide), which is the most effective mosquito repellent for adults and children over 2 months of age.

Source: http://www.medicinenet.com/malaria/index.htm

What i s de ng ue fev er?

Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness of sudden onset that usually follows a benign course with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularl y characteristic of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles. Dengue (pronounced DENG-gay) can affect anyone but tends to be more severe in people with compromised immune systems. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever multiple times. However, an attack of dengue produces immunity for a lifetime to that par ticular serotype to which the patient was exposed. Dengue goes by other names, including " breakbone" or "dandy fever." Victims of dengue often have contortions due to the intense joint and muscle pain, hence the name breakbone fever. Slaves in the West Indies who contracted dengue were said to have dandy fever because of their postures and gait. Dengue hemorrhagic fever is a more severe form of the viral illness. Symptoms include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red or purple splotches or blisters under the skin), bleeding in the nose or gums, black stools, or easy bruising are all possible signs of hemorrhage. This form of dengue fever can be life -threatening a nd can progress to the most severe form of the illness, dengue shock syndrome.

What ar e de ng ue f ev er symptom s and sig ns?

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear in stages. Dengue starts with chills, headache, pain upo n moving the eyes, and low backache. Painful aching in the legs and joints occurs during the first hours of illness. The temperature rises quickly as high as 104 F (40 C), with r elatively low heart rate (bradycardia) and low blood pressure (hypotension). The eyes become reddened. A flushing or pale pink rash comes over the face and then disappears. The glands (lymph nodes) in the neck and groin are often swollen. Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature ( defervescence) with profuse sweating. This precedes a period with normal temperature and a sense of well -being that lasts about a day. A second rapid rise in temperature follows. A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face. The palms and soles may be bright red and swollen.

What i s the trea tme nt for de ngu e f ev er?

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. For typical den gue, the treatment is purely concerned with relief of the symptoms. Rest and fluid intake for a d e q u a t e h y d r a t i o n i s i m p o r t a n t . A sp i r in a nd n on st e ro id al ant i - i nfl amm at o ry

d ru g s s hou l d onl y b e t ak en u n d er a do ct o r' s su p erv i s ion be c au s e o f t h e p o ss i b il it y o f wo rse n ing bl ee d ing com pl ic at ion s. A c e t a m i n o p h e n ( T y l e n o l )
and codeine may be given for severe headache and for joint and muscle pain (myalgia).

How ca n de ng ue fev er be prev e nted?

The transmission o f the virus to mosquitoes must be interrupted to prevent the illness. To this end, patients are kept under mosquito netting until the second bout of fever is over and they are no longer contagious. The prevention of dengue requires control or eradication o f the mosquitoes carrying the virus that causes dengue. In nations plagued by dengue fever, people are urged to empty stagnant water from old tires, trash cans, and flower pots. Governmental initiatives to decrease mosquitoes also help to keep the disease in check but have been poorly effective. To prevent mosquito bites, wear long pants and long sleeves. For personal protection, use mosquito repellant sprays that contain DEET when visiting places where dengue is endemic. There are no specific risk factors for contracting dengue fever, except living in or traveling to an area where the mosquitoes and virus are endemic. Limiting exposure to mosquitoes by avoiding standing water and staying indoors two hours after sunrise and before sunset will help. The Aedes aegypti mosquito is a daytime biter with peak periods of biting around sunrise and sunset. It may bite at any time of the day and is often hidden inside homes or other dwellings, especially in urban areas. There is currently no vaccination available for dengue fever. There is a vaccine undergoing clinical trials, but it is too early to tell if it will be safe or effective. Early results of clinical trials show that a vaccine may be available by 2015.

So ur c e : http : // www.me dici ne net. com /de ng ue_ fev er/ artic le .htm