Hidoc Bulletin

Malaria is mostly observed in tropical countries and it mostly spikes during the monsoon season. According to the 2020 report of WHO, about 241 million cases of malaria are observed worldwide and near about 627 000 malaria deaths. In order to control the incidence of malaria and also to prevent the deaths it is important to take preventive measures against the mosquitoes and get diagnosed and initiate treatment on time. Diagnosing the patients includes identifying the history of the patients by asking them their travel history to any endemic area, their immune status, age, and pregnancy status. If they have any allergies or other medical conditions and their ongoing medications. These will help in understanding whether the person has the chances of getting infected or not. Further, performing the blood tests which include blood culture, hemoglobin concentration, platelet count, liver functioning tests, renal functioning tests, electrolyte concentrations (especially sodium) and other parameters of haemolysis (haptoglobin, lactic dehydrogenase, reticulocyte count) can be done to confirm the diagnosis of malaria. It is also important to monitor white blood cell count as the malaria patients may develop the condition of leukocytosis. In cases the patients are treated with primaquine, glucose-6-phosphate dehydrogenase (G6PD) levels need to be checked as G6PD deficiency provides great protection from malaria, especially for falciparum infections. Other than this, antimalarial drugs can also severely affect by causing hemolytic anemia in patients with G6PD deficiency. Moreover, imaging studies like chest radiography, computed tomography of the head can also be applied in special cases. Apart from these, specific tests are also there which include microhematocrit centrifugation, fluorescent dyes/ultraviolet indicator tests, thin or thick blood smears examined over a 36-hour period, rapid diagnostic tests such as polymerase chain reaction assay, nucleic acid sequence-based amplification and others. The treatment approaches of malaria depend on the severity of the disease, the causative species of malaria parasite (Plasmodium falciparum, P vivax, P ovale, P malariae, P knowlesi) and the part of the world in which the infection is acquired. The latter 2 characteristics are considered, because it helps in determining the probability of being resistant to certain antimalarial drugs. Additional factors such as age, weight, and pregnancy status are also considered as they serve as limiting factors for malaria treatment. It is really important to diagnose and treat malaria at an early basis in order to save the life of the individuals. In case there is a delay in laboratory diagnosis, physicians are required to begin the treatment based on the clinical indicators and travel history. While treating malaria patients, care should be taken that the same medicine should not be administered in case the patient has already gone through malaria chemoprophylaxis. Further, the physicians should also take care of mixed P. falciparum–P. vivax infections which requires combination therapies like artemether–lumefantrine, atovaquone–proguanil, dihydroartemisinin–piperaquine, quinine plus doxycycline or clindamycin.