Falciparum Malaria :
Malarial organisms are a part of the micro-organisms, but they are completely different from the virus and bacteria and belong to protozoa group.- These organisms are known as malarial parasites. There are basically four types of malarial parasites, but the main are vivax and falciparum. Before we discuss falciparum, we will study this widespread disease in detail.
1. The first cycle occurs in female anopheles mosquito. This part of the cycle is known as the reproductive stage.
2. The second part of-the cycle takes place in the cells of the human liver and in the red blood cells. This can be called the stage of development, division and growth.
When the Anopheles female mosquito bites a human, along with the sting the sporozoites of the malarial parasite enter the blood stream and within a short period enter the liver cells. Here their development, division and growth take place. Ultimately, the cells of the liver rupture and innumerable merozoites enter blood and then enter the red blood corpuscles. In this stage some of the merozoites get converted into gametocytes (Male and female). Gametocytes represent the stage of gametogeny. i.e. reproduction.
When a female Anopheles mosquito bites a malarial patient and sucks the blood, gametocytes also reach the stomach of the mosquito and there, in the stomach new sporozoites develop, which enter the blood stream of another person through the sting of the mosquito. The rest of the merozoites, which are present in the blood cells continue with the process of development, division and growth. Eventually, these red cells also rupture and innumerable merozoites are released in the blood stream and enter other red cells. In vivax malaria, this process continues for a long time. The falciparum malarial parasite goes through only one cycle in the human body.The fever and shivering occurs primarily because of the rupture of innumerable blood cells. This is also the cause of anemia (pallor or decrease in the hemoglobin levels) after frequent bouts of malaria.
Thus, malarial parasites continue their life cycle in female anopheles mosquito and humans and keep the disease as well as themselves alive. The symptoms of the disease occur only after 8 to 14 days of the mosquito bite.
i. In the initial phase, the patient experiences shivering.
ii. Once the shivering stops, the body temperature rises (fever) and the patient feels warm.
iii. After some time the patient perspires profusely and the fever subsides. The patient experiences extreme weakness.
The attack occurs again in a similar manner on the second or third day.
In addition to this headache, body ache, nausea, vomiting and dry cough may occur. In many cases boils erupt on the lips (herpes simplex, labialis).
Falciparum malaria can occur with many other unusual symptoms. These malarial parasites infect all the stages of the red blood corpuscles (Vivax infects only the newly formed blood cells) 1 to 2% of the total blood cells get infected. Thus the number of infected blood cells is considerably more and the resulting anemia is also more severe. These infected blood cells clog the capillaries causing unconsciousness (Cerebral malaria). Kidney disorders,diarrhoea, jaundice, respiratory problems, low blood pressure etc life threatening problems may also occur.
Usually, tablets of chloroquin are used in the cases of vivax malaria. Quinine is a very effective medicine for falciparum malaria. This is given in a dose of 10 mg/kg every 8 hours for 10 days. There are many side effects of the medicine, especially on the heart. Therefore, this drug should be taken under the supervision of a doctor. In serious cases, quinine is given intravenously along with glucose. When the patient is able to take the tablets orally, then the same is administered accordingly.
Sometimes this drug is not effective in falciparum malaria. For such drug resistant cases mefloquin, artisunate, artiether etc. are given. Besides this pyrimethamine, tetracycline, doxycycline can also be given in less serious cases.
If the required blood test is carried out carefully, malarial parasites are normally seen in the blood cells in a peripheral smear. In falciparum malaria, the proportion of malarial parasite being more they can be seen very easily in the blood test, but in vivax type of malaria the numbers being less, many times they cannot be seen. The test called Q.B.C gives more accurate results. It is better to collect the blood sample when the patient has fever, but this can also be done later. Many a times the blood tests are negative in a patient who has self medicated himself and has taken 2 to 4 tablets of chloroquin. The doctor has to treat the patient solely on the basis of the symptoms or repeat Q.B.C. 3times every 8 hourly.
If the symptoms point more towards malaria, the treatment should be completed. If the fever is not cured even then, further investigations should be done to find out the exact cause and treatment given accordingly.