October 11, 2006
You feel nauseous and have a headache. You vomit, but don’t feel any better.
A fever develops. Muscles feel achy. The fever intensifies. You sweat profusely. This subsides and you notice a chill. You grab a sweatshirt and a blanket, but you shiver anyway. And it gets worse, exhausting your muscles as though having run a race.
You finally fall into an exhausted sleep. When you wake up you suspect malaria and seek medical help. If you do not think of malaria, you may decide to ride it out — and you are a day from slipping into a coma and dying.
You have joined the 300 hundred million people who get malaria each year, and you are in danger of joining the one to two million who die. In Indonesia, 15 million infections occur each year, and 42,000 die.
Global malaria
The global malaria situation has deteriorated substantially since the 1950s and 1960s. Malaria control in those decades used DDT and relatively cheap, safe and an effective new drug called chloroquine. Armies of technicians were trained and mobilized.
In India alone, the number of deaths caused by malaria in 1947 was 800,000, and in 1965 not a single death caused by malaria was reported (today about 30,000 die each year). So confident of victory over malaria were the experts of that time, that one published a book titled, Man’s Mastery over Malaria“.
The workhorse drugs of therapy have become virtually useless due to resistance. DDT vanished and mosquito control programs in most of the developing world became nonexistent or derelict.
The brightest minds and richest resources focused on developing a vaccine that has yet to materialize — and the well of creative thought and energy for malaria control evaporated.
Decentralization of government services over the past two decades severely challenged what remained of national malaria control programs, which had been built upon a centralized and authoritarian framework.
Vector control programs equipped with improved insecticides and structured for decentralized services are needed to bring malaria to heel.
Malaria biology
Single-celled protozoa in the genus Plasmodium cause malaria. Four species routinely infect humans: Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale.
All of these occur in Indonesia. Only P. falciparum, or falciparum malaria, represents a significant threat to the life of the host and accounts for 40% of malaria in Indonesia.
Vivax malaria sometimes kills, and it is the most common cause of malaria. The other two species are uncommon, even rare, and do not threaten life.
Mosquitoes in the genus Anopheles transmit malaria. Humans represent a means of infecting mosquitoes (where the most essential segment of their life cycle occurs). That cycle is complex.
Mosquitoes become infected when they bite a person with malaria. The parasites mate in the gut of the mosquito, undergo transformations, and after two weeks, a form called a sporozoite rests by the thousands in the salivary glands of the mosquito.
When the mosquito takes a blood meal, the sporozoites rush in. Within minutes each one penetrates a liver cell. Each sporozoite subsequently creates tens of thousands of copies of a stage called a merozoite.
The liver cell bursts and the merozoites flood into the bloodstream, each one infecting a red blood cell. Within a day or two, each parasite makes a dozen or more copies of itself.
The infected cell bursts and new parasites infect new red blood cells. Some of these differentiate into sexual forms called gametocytes that infect mosquitoes.
Disease mechanics
People feel no symptoms until parasites burst infected red blood cells a week or two after the mosquito bite. The patient breaks into a spiking fever and profuse sweating.
In falciparum malaria the parasites do things that place the host’s life in peril. It infects red blood cells of any age.
This allows it to achieve very high levels of infection — up to 40 percent to 50 percent of red cells infected has been recorded, and levels of 1 percent to 2 percent are not unusual.
Discount Pharmacy - Buy Pharmacy at discount prices including free shipping.Discount Pharmacy provides confortable and easy way to order discount pharmacy online.
In contrast, the other species rarely reach levels much higher than 0.1%. High levels of parasites threaten the host. With a reproduction cycle of just 24 to 48 hours, the mistake of delay in seeking medical attention may be your last.
This parasite also has the nasty trick of sticking in deep capillaries (protecting itself from destruction in the spleen).
The mass of sticky parasites upset normal circulation in large areas of the brain and cause cerebral malaria. About 20 percent of cerebral malaria patients cannot be saved, even with the best possible critical care — and none survive without care.
Clinical management
Microscopic examination of blood films by a certified technician provides reliable diagnosis. Unfortunately, certification of this skill in Indonesia, as elsewhere, is rare and incompetent technicians miss the diagnosis.
Ask your care provider to produce evidence of the competence of its technicians — a missed diagnosis can kill within days, and assurance of competency is critically important.
The treatment of malaria requires a knowledgeable physician supported by a qualified laboratory team. Only improper or no treatment allows malaria to recurs again and again. The infection is curable with correct medication taken as directed.
Drugs for preventing malaria also requires a physician’s training — many drugs are available and each carries risks/benefits varying from person to person.
Take a friend’s drugs without medical advice at your own peril. Many drugs against malaria remain abundant in apotik, despite no longer working in Indonesia.
Pregnant women and small children should avoid travel to where risk of malaria is very high. Their options for preventing malaria are limited, and the consequences of infection tend to be dire.
Personal protection
People can minimize malaria risk without drugs. These measures of personal protection should be the sole line of defense where risk is high.
Personal protection involves minimizing mosquito bites. Anopheline mosquitoes feed exclusively between sunset and dawn.
Avoid the countryside at night. Choose accommodation in a city, or with air-conditioning. Spray your room with household insecticide an hour or so before bed.
If sleeping in a primitive setting, take a good insecticide-treated mosquito net and use it properly (tuck it firmly).
Wear clothing covering as much skin as possible, especially the feet and ankles. Apply a mosquito repellent on exposed skin.
People living with high-risk malaria face difficult choices. Continuously taking drugs can be expensive, unpleasant and unhealthy.
Most, instead, adopt personal protective measures as part of their daily routine, and carry supplies of curative drugs (under a physician’s advice).
This strategy works fine provided a clear understanding of malaria and a healthy respect for its consequences.
Posted by toshko under Skin Care News | Comments (0)
Loading ...
Loading ...