Malaria is a type of fever which is a major cause of morbidity in the developing countries. Despite world-wide attempts to eradicate this disease it continues to be a big problem.
Caused by bite by female Anopheles mosquito which trasmits four types of parasites of genus Plasmodium – vivax, ovale, falciparum, malariae.
Plasmodium vivax is the most common and the Plasmodium falciparum is the most deadly.
Malaria is charactirised by relapsing fever with shaking chills, prostration, anaemia, and enlarged spleen.
Fever paroxysms are characterised by three phases:
Cold phase – lasting for 1-2 hours, during which sudden feeling of cold is followed by shivering, then intense rigors.
Hot phase – lasting for 3-4 hours, when there are hot flushes with headache and exhaustion as temperature reaches its peak.
Wet phase – lasting for 2-4 hours, when profuse sweating occurs as temperature returns to normal.
Fever paroxysms occur
every 48 hours in case of P.vivax, P.ovale,
every 72 hours in case of P. malariae.
In case of P.falciparum periodic fever paroxysms are not seen rather irregular intermittent fever or daily paroxysms may be seen.

Other symptoms – nausea, vomiting, cough, joint pains, abdominal and joint pain. Pallor and jaundice.

Death due to vivax malaria is very rare. Most malaria related fatalities occur due to P. falciparum malaria that can kill a non immune person within a week or two of infection.

Red Blood Cells which are invaded by the P.falciparum become very sticky and attach themselves to the walls of the capillaries. This blocks the microcirculation and thus causes cellular hypoxia, hypoglycemia, lacticacidosis and increased cellular permeability. These changes result in cerebral, pulmonary and renal manifestations.

Complications of Falciparum Malaria.
1. Cerebral Malaria – should be suspected in cases with history of short fever followed by deep unconsciousness in endemic areas. This accounts for 80% of deaths from acute malaria.
2. Algid Malaria – characterised by vomiting, nausea, diarrhoea, dehydration, low blood pressure, rapid respiration and low urine output.
3. Blackwater Fever – is caused by sudden extensive destruction of RBCs in the blood. Haemoglobin is found in the urine and this condition may precipitate renal failure. At times this condition is precipitated by the administration of Quinine to the patient.
4. Pernicious Anaemia – when blood contains a very high number of malaria parasite leading to rapid destruction of the RBCs.
5. Pulmonary Oedema and Adult Respiratory distress syndrome.
6. Vascular Collapse and Shock with Hypothermia and Adrenal Insufficiency.
7. Febrile Convulsions.
8. Hyperpyrexia
9. Metabolic Acidosis

In the management of Malaria the important and critical aspect is the diagnosis and treatment of falciparum malaria as soon as possible as deterioration of the patient’s condition can be rapid and sudden.
Besides drug treatment management of serious sign and symptoms are also very important.

Drug treatment of Malaria
Chloroquine: 600 mg immediately, 300 mg after 6 hrs., 300 mg on day 2, 300 mg on day 3 — for all four types of malaria.

Artemether: For Chloroquine resistant falciparum malaria.
day 1 – 80 mg IM twice.
Next 4 days 80 mg Once daily.

Quinine: For Chloroquine resistant falciparum malaria.
Slow infusion over 4 hrs. Initial loading dose 20 mg /kg followed every 8 hrs. with 10mg / kg. for 10 days.

Mefloquine: For Chloroquine resistant falciparum malaria.
750 mg immediately. 500 mg 8 hrs. later.

Primaquine: given after a course of chloroquine for the elimination of P. vivax and P. ovale from the body.

Other drugs: Pyrimethamine/sulfadoxine combination. Doxycycline.

Caution :
Quinine or Chloroquine not to be given as IV bolus.
Dexamethasone IV , Manitol, Heparine to be avoided in Cerebral Malaria

Prophylactic medication for Malaria.

In endemic areas regular intake of chloroquine 2 tabs. for adults or Pyrimethamine/sulfadoxine 1 tab. for adults weekly may be use to prevent malaria.

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About Manbir & Gurpreet

Gurpreet Kaur’s journey in this world .... Gurpreet Kaur was a Musician. She was a singer and a composer of music. Her interest was composing and singing Gurbani Shabads in Indian Classical style. She sang Shabads in All the Raags mentioned in Sri Guru Granth Sahib Ji. She also taught Gurmat Sangeet at Gurmat Gian Missionary College, Jawadi, Ludhiana. Elder child to Pushpinder Kaur and Dr. Brig. Harminder Singh, was born in Amritsar on 13th Jan 1962. She attended various convent schools as a child because her father would get frequent Army postings as a dental surgeon. She graduated with Music Honors from Govt. College for Women, Chandigarh. Music was her hobby and she composed and sang Raag based Gurbani Shabads. Doing Kirtan was part of growing up nurtured by her parents. She learned music from her father Dr. Brigadier Harminder Singh who was a dental surgeon in Indian Army and a very good singer himself. Gurpreet’s Bhua (father’s sister), Ajit Kaur retied as a Head of Department of Music from Govt. College for Women Ludhiana, and was a renounced Punjabi singer of her time. Gurpreet Kaur also learned nuances of Indian Classical Music from Pandita Sharma. She was a mother of three children, and a grandmother. Her daughter Keerat Kaur is a Computer Engineer. Her two sons Gurkeerat Singh and Jaskeerat Singh are doctors in USA. Her daughter Keerat Kaur too was part of her group ~ Gurmat Gian Group. Gurpreet Kaur left this world at the age of 54yrs on 12th Sept 2016 in Baltimore USA. She had recorded around 25 cds of Gurbani Keertan. 'Raag Ratan' Album (6 CDs) is a Compilation of Shabads in All the 31 Sudh Raags of Sri Guru Granth Sahib Ji. 'Gauri Sagar' Album (3 CDs) is a Compilation of All forms of Raag Gauri in Sri Guru Granth Sahib Ji. 'Nanak Ki Malhaar' ~ ((3 CDs) is an album of Raag Malhar Shabads in various forms of Malhar. 'Gur Parsaad Basant Bana' ~ (3 CDs) is an album of Shabads in Raag Basant sung in various forms of Raag Basant. Har Ki Vadeyai Sarni Aayea Sewa Priya Kee Preet Piyaree Mohan Ghar Aavho Karo Jodariya Mo Kao Taar Le Raama Taar Le Tere Kavan Kavan Gun Keh Keh Gawan Mera Baid Guru Govinda Saajanrraa Mera Saajanrraa

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