Treatment of acute manifestations of Vivax-, ovale- and 4-day malaria is usually carried out with delagil, since most pathogens have retained sensitivity to this drug. Delagil tablets should be taken after meals with plenty of water.
Doses of delagil for adults on day 1: 1.5 g in two doses (1 g and another 0.5 g after 6-8 hours); Days 2 and 3 - 0.5 g in one dose.
Age-specific doses of delagil (daily dose in g)
Up to 1 g: 1st day - 0.05; 2nd day - 0.025; 3rd day - 0.025.
1-3 g: 1st day - 0.125; 2nd day - 0.05; 3rd day - 0.05.
6-10 years: 1st day - 0.25; 2nd day - 0.125; 3rd day - 0.125.
10-15 years: 1st day - 0.5; 2nd day - 0.25; 3rd day - 0.25.
Treatment of children over 15 years of age is carried out according to the scheme for adults.
Delagil at orally at usual antimalarial doses it is usually well tolerated. In some cases there may be headache, itching of the skin, diarrhea, when taken on an empty stomach - nausea and vomiting.
For 4-day malaria, radical treatment is achieved by administering a blood merozoiticide. For Vivax and oval malaria, after stopping erythrocyte schizogony, a tissue schizonticide is prescribed - primaquine. The course of treatment with primaquine is 14 days. The daily dose for adults is 0.027 g of the drug. The daily dose can be divided into 3 doses.
Age-specific doses of primaquine (daily dose in g).
Up to 1 year: in g - 0.00225; in tab - 1/4;
1-2 years: in g - 0.0045; in tab - 1/2;
2-4 years: in g - 0.00675; in tab - 3/4;
4-7 years: in g - 0.009; in tab - 1;
7-12 years: in g - 0.0135; in the tab - 1.5.
Treatment of tropical malaria is carried out according to one of the following schemes.
Quinine + tetracycline. Quinine 10 mg/kg 3 times a day every 8 hours for 7-10 days, in some cases - 14 days.
The daily dose is up to 2 g. At the same time, tetracycline is prescribed up to 5 mg/kg 4 times a day every 6 hours for 7-10 days. Instead of tetracycline, docycycline can be prescribed at a dose of up to 2 mg/kg 2 times a day.
Mefloquine - dose 15 mg/kg in one dose. Maximum dose- 1,000 mg (250 mg tablets).
Halofantrine - course dose of 15 mg/kg in two doses over one day. The maximum dose is 1,000 mg.
Treatment of a patient with severe tropical malaria is carried out in an intensive care unit. Treatment begins with intravenous administration of quinine hydrochloride at a dose of 10 mg/kg per saline solution or 5% glucose solution at the rate of 10 ml/kg body weight. The solution should be heated to 35 °C and should be administered slowly over 4 hours; after 4 hours, the administration of quinine in the same dosage is repeated again, and this is continued until the patient’s condition improves, until he can take it orally. At successful treatment improvement may be observed after 24-48 hours.
In some cases, resistance to chloroquine, quinine, and mefloquine may be observed.
It is recommended to use artelisanin 10 mg/kg once a day for 5 days or artesunate 2 mg/kg once a day for 5 days.
Along with the prescription of chemotherapy drugs to patients with malignant and severe forms of malaria, intensive pathogenetic therapy is carried out, including detoxification agents (hemodez, neocompensan), drugs that improve microcirculation (reopoliglyukin, polyglyukin, etc.), vitamins, cocarboxylase, hemostatic agents. To prevent intravascular coagulation in early dates heparin is used. According to indications, cardiovascular drugs, antihistamines and anticonvulsants. In some cases, a spinal puncture has a positive effect.
Treatment of malaria complicated by hemoglobinuria includes a complex of antishock drugs (norepinephrine, mesaton, calcium gluconate, cardiac glycosides, glucocorticosteroids, diuretics, blood transfusions and detoxification solutions). Chemotherapy is continued because relapse of malaria can lead to relapse of hemoglobinuria.
Treatment of malaria is carried out only in a hospital setting as prescribed by a doctor. The patient should consult a doctor as soon as possible to undergo a course of treatment. Self-medication is unacceptable. ethnoscience has long treated all forms of malaria with quinine. Below are several ways to treat with this remedy:
Give the patient the first time 0.5 g of powder 4 hours before the onset of the attack, and the second time at sunrise. Give this until the attack stops, and then for another week, 1 powder per day;
Cut 1 lemon into small pieces, put it in a saucepan and pour 1 glass of water. Boil until half has boiled away, strain, add 1 tbsp. l. vodka and boil again on fire; As soon as it boils, add 50 mg of quinine, remove from heat, and cool. Take the entire portion at once on an empty stomach for 3-4 days in a row;
The Egyptian way: take 10 g of quinine, put it in a small bag, lie down on the bed and put the bag of quinine on your chest. Lie for 3-4 hours until there is no quinine left in the bag (it will be absorbed by the skin).
Forecast. Modern methods Treatment of malaria leads to recovery. Deaths occur mainly in malignant forms of tropical malaria (see above).
Specific treatment should be started immediately after the diagnosis of malaria is made.
Treatment regimens . The course of treatment with 4-aminoquinoline derivatives - chloroquine, etc. - takes three days. On the first day, drugs are prescribed at the rate of 0.6 g of base (chloroquine 0.5 g 2 times) in two doses every 5-6 hours. In cases of severe malaria daily dose adjust to 0.9 g base. The drugs are administered parenterally (mainly intramuscularly). On the second and third days, patients receive 0.3 g of base. For fastest impact for gamonts of P. falciparum, following the treatment course, quinocide is prescribed in a daily dose of 0.02 g or primaquine in a dose of 0.015 g for 3-5 days.
Akrikhin is prescribed 0.3 g per day for 5 days; on the first day of treatment the daily dose can be doubled. To influence the sexual forms of plasmodia in the absence of quinocide, give plasmocide 0.02 g 2-3 times or in the form of combined tablets of quinocide with plasmocide. Bigumal is prescribed at a dose of 0.3 g per day for 5-7 days, also together with plasmacid.
For a radical cure of three-day and four-day malaria, immediately after finishing taking schizontocidal drugs, patients are prescribed quinocide 0.03 g per day for 10 days or 0.02 g for 15 days, a total of 0.3 g per course, or primaquine 0.015 g for 10-14 days, only 0.15-0.2 g per course.
For malignant malaria, treatment begins with parenteral, usually intramuscular, administration of the first one or two doses of schizontocidal drugs. In urgent cases (threat of coma, malarial algid), drugs are administered intravenously. Most effective intramuscular injection 10 ml of 5% chloroquine diphosphate solution (0.3 g base). If the condition improves, a second dose can be given orally. In especially severe cases, the first dose of chloroquine is administered into a vein by drip. isotonic solution glucose or table salt. Very effective too intravenous administration 2.5 ml of 4% solution of quinacrine in 40% glucose solution. If necessary, infusions can be repeated. You can administer intravenously 10-15 ml of a 1% solution of bigumal hydrochloride or 5-7.5 ml of a 2% solution of bigumal acetate. In this case, the daily dose of the drug is reduced to 0.45 g. Treatment with quinine begins with the injection of 5 ml of a 5% solution into a vein, then switches to injections of a 25-50% solution of quinine hydrochloride. (Inject deeply into the subcutaneous tissue to avoid necrosis! Do not inject in case of hemoglobinuric fever!)
When treating malignant forms of malaria, solutions of glucose and table salt, norepinephrine, sympathol, caffeine, cordiamine, camphor, calcium salts, etc. are also administered. To relieve agitation and seizures, chlorpromazine, andaxin, and drugs are used. At in a state of shock transfuse 150-250 ml of blood. Rest and care for the patient are extremely important.
Timely diagnosis and adequate treatment of malaria always lead to recovery of the patient, even in cases of drug resistance. Before starting treatment, based on clinical examination data, it is necessary to assess the severity of the disease and the possible risk of complications. Information about taking antimalarial drugs in the past will help you choose correct treatment and avoid the risk of developing drug resistance.
Patients with fresh cases of malaria, early and late relapses are hospitalized in order to relieve the first attacks of the disease in a hospital setting. During the interictal period, the patient can be treated on an outpatient basis. The rooms where patients are located must be protected from mosquitoes.
Patients should be discharged only after laboratory confirmation of the disappearance of malarial plasmodia in the blood.
During attacks, the patient must be given semi-liquid, easily digestible food with a sufficient amount of vitamins. If anemia develops, the patient is prescribed iron supplements and brewer's yeast. If necessary, blood transfusions are performed in small portions - 150.0 - 200.0 every 2 days.
All antimalarial drugs are used only after meals.
Rice. 1. The photo shows malaria mosquitoes.
Principles of malaria treatment
Treatment of malaria begins in 2 cases:
- upon confirmation of diagnosis laboratory methods research;
- if the disease is suspected due to the presence of epidemiological and clinical indications.
Principle of malaria treatment:
- Combating acute manifestations of the disease and ensuring clinical effect.
- Prescription of hemashizotropic drugs for tetrad and tropical malaria and histoschizotropic drugs for tetrad and oval malaria in order to prevent relapses of the disease.
- Prescription of drugs effective against gametocytes (primary germ cells) in order to ensure an epidemiological effect.
- The treatment regimen must include symptomatic and pathogenetic therapy. A mandatory component of complex treatment should be restorative therapy.
Radical treatment of malaria involves completely ridding the body of the causative agents of the disease.
Rice. 2. In 2014, 214 million cases of the disease were registered, 480 thousand of which ended fatal.
Antimalarial drugs
There are several groups of antimalarial drugs. Their gradation is based on the effect on one or another stage of development of malarial plasmodia in the patient’s body.
Histoschizotropic drugs
Rice. 3. Tissue schizont in the liver.
Hematoschizotropic drugs
Hematoschizotropic drugs destroy malarial plasmodia that go through their development cycle in erythrocytes and stop attacks of malaria.
- This group includes: Quinine, Mepacrine (Akrikhin), Pyrimethamine (Chloridine, Malocid, Tindurin, Daraprim), Chloroquine (Hingamin, Rezokhin, Nivakhin, etc.), Plazmokhin.
- In addition to the above drugs, antibiotics and sulfa drugs are used to treat malaria ( Trimethoprim, Pyrimethamine, Sulfamethoxazole, Sulfadoxine, Tetracycline, Clindamycin, Mefloquine and fluoroquinolones). The administration of sulfone and sulfonamide derivatives can significantly reduce the doses of the main antimalarial drugs.
- Of the combination drugs used Fansidar- combination Pyrimethamine And Sulfadoxine.
- The deep reserve drug is Halofantrine.
Rice. 4. Hematoschizotropic drugs destroy malarial plasmodia that go through their development cycle in erythrocytes and stop an attack of malaria.
Gamontotropic drugs
Malarial plasmodia in the body of an infected person are at different stages development, therefore, when treating the disease, combinations of drugs from different groups are used.
Rice. 5. Female gametocytes of P. falciparum under a microscope.
Rice. 6. Quinine - an alkaloid from the cinchona tree is the first antimalarial drug.
Akrikhin
Akrikhin is a synthetic substitute By efficiency Akrikhin inferior , but is better tolerated. When taking the drug, the skin and mucous membranes become yellow in color, which disappears after stopping use. of this medicine. In cases of overdose, “acrichine psychoses” develop. Akrikhin has a detrimental effect not only on malarial plasmodia, but also on Giardia and some types of worms.
Widely used in the treatment of malaria. Being a hematoschizotropic drug, destroys malarial plasmodia that go through their development cycle in erythrocytes, stopping an attack of malaria.
Coming soon to the pharmaceutical market new drug Pyronaridine, clinical trials of which are in their final stages. They are planning to replace used in the treatment of tropical malaria with an uncomplicated course and combination drug Chlorproguanil/Dapsone as an alternative to the drug Sulfadoxine/Pyrimethamine.
Rice. 7. Chloroquine is a hematoschizotropic drug. It destroys malarial plasmodia that go through a development cycle in erythrocytes and stops an attack of malaria.
Hingamin
Hingamin It is the most effective drug from the group of hematoschizotropic drugs. It is used for all forms of malaria and extraintestinal amebiasis. The drug has anti-inflammatory and immunosuppressive properties, which is why its use is indicated for collagenosis and rheumatism. Hingamin rarely causes side effects. Dermatitis, dyspepsia, hemolytic reaction, liver damage, visual impairment and hematopoietic system are the main ones.
Quinocid
Chloridine
Chloridine (Pyrimethamine) appears to have an anti-toxoplasmoid effect in addition to the antimalarial effect. Effective against malaria caused by Plasmodium falciparum, Plasmodium vivax and Plasmodium malariae. It has both hematoschizotropic and histoschizotropic effects and is devoid of gamontocidal activity.
The drug has a number of side effects: allergic dermatitis, nausea and abdominal pain, vomiting and diarrhea, insomnia, headache, depression, epileptic seizures, arrhythmia, hematuria, inhibition of bone marrow circulation, etc. With prolonged use and poisoning, more serious complications develop.
Bigumal
Bigumal used as a schizonto-gamontocidal agent for all forms of malaria. It is a low-toxic drug, but drug resistance to it quickly develops. Bigumal widely used in the treatment of tropical malaria. Relapses with its use are not common - in every tenth patient. The drug is well tolerated. Headache, nausea and the appearance of neutrophil myelocytes in the blood occur, but are rare. Bigumal used for both therapeutic and prophylactic purposes.
Plasmicide
Plasmicide belongs to the group of gasontotropic drugs, has a detrimental effect on gametocytes of all types of malarial plasmodia. Used in combination with , Akrikhin or Bigumalem. In case of overdose medicine headache and epigastric pain, paresthesia, polyneuritis, cerebellar ataxia, neuralgia occur trigeminal nerve and atrophy optic nerve. Diseases of the optic nerve and retina, encephalitis and meningoencephalitis, even those suffered in the past, are the main contraindications to the use of the drug.
Shows effectiveness against erythrocyte (except for plasmodia of 3- and 4-day malaria) and tissue schizonts, as well as against sexual forms of all types of malarial plasmodia. The drug is not used to relieve attacks of 3- and 4-day malaria. To prevent relapses of malaria caused by P. ovale or P. vivax, prescribed after completion of treatment . For the purpose of preventing relapses, personal and public chemoprophylaxis, the drug is used together with Hingamin. From side effects sometimes dyspepsia and abdominal pain are recorded, methemoglobinemia develops, and rarely - hemolysis and granulocytopenia.
Rice. 8. Primaquine is active against the sexual forms of all types of malarial plasmodia.
Plazmokhin
During treatment In the blood of patients, the erythrocyte forms of schizonts disappear, but the germ cells - gametes - are not destroyed, so they remain carriers of infection for mosquitoes. This is the reason for the impossibility of completely freeing ourselves from infection in a number of regions of the globe. That's why complex treatment And Plazmokhin can produce the desired effect.
Plazmokhin has a detrimental effect on schizonts (asexual forms) of Plasmodium vivax and gametocytes (sexual forms) of Plasmodium falciparum.
The drug has some side effects. Sometimes causes epigastric pain, disorders heart rate. In case of poisoning, patients develop cyanosis, jaundice, vomiting, body temperature rises, protein appears in the urine, and cases of loss of consciousness are described.
It is recommended to use in the treatment of malaria Plazmokhin together with (“Plasmochin compositum” and “Plasmochinum compositum”), while therapeutic doses two drugs can be reduced, which significantly reduces the incidence of side effects of both drugs.
During treatment Plazmokhin The patient’s blood becomes non-infectious for mosquitoes within 24 hours. The drug is used for acute and chronic cases of malaria, for prophylactic purposes in regions dangerous for malaria, for their “sanitation”.
Rice. 9. Enlarged liver and spleen in a child with malaria.
Combined (combined) treatment of malaria
Most effective scheme treatment for malaria is a combination Akrikhin, Plazmocide and Bigumal. When used, the full therapeutic effect is quickly achieved, gamete carriage is eliminated and the number of relapses is reduced to a minimum. Due to development side effect antimalarial drugs, patients must be treated in a hospital.
Treatment of P. vivax and P. oval malaria
- Radical treatment of three-day and oval malaria is carried out with 2 drugs: a hematoschizotropic drug Delagil for 3 days and a histoschizotropic drug within 14 days.
- With the development of resistance of malarial plasmodia to and its derivatives treatment is carried out Chloridine within 3 - 6 days and within 7 days. You can use a combination With Tetracycline or sulfa drugs. Deep reserve drugs are used Mefloquine or Halofantrine.
- At severe forms malaria derivatives Chloroquine diphosphate They are initially administered intravenously or intramuscularly, and subsequently switch to oral administration.
- In order to prevent the development of late relapses, the impact on dormant forms of P. vivax- and P. ovale is carried out by taking And Quinocida.
- In order to carry out public prevention in malaria-endemic regions, in the period before the onset of transmission of pathogens for 14 days, the use of a hamontotropic drug is indicated Primaquine diphosphate, which prevents the development of sporozoites in the mosquito's body.
Rice. 10. The photo shows red blood cells deformed under the influence of Plasmodium vivax and Plasmodium ovale.
Treatment of 4-day malaria
When treating 4-day malaria, only one hematoschizotropic drug is used. Drug of choice in in this case is diphosphate within 5 days. During the epidemic season used together with a gamontotropic drug O m within 3 days.
Treatment of tropical malaria
Widespread drug resistance in Plasmodium falciparum and the development dangerous complications in non-immune patients often leads to significant difficulties encountered in the treatment of tropical malaria.
Rice. 11. Signs of hepatitis in malaria - jaundice skin and sclera.
Radical treatment of tropical malaria
Provided sensitivity to hemoschizotropic drugs is maintained, radical treatment of tropical malaria is possible. Reception shown Delagila within 5 days, and at the onset of the epidemic season, a drug with a gamontotropic effect is prescribed - Chloridine or for 2 and 3 days respectively.
For tropical malaria moderate severity relieves symptoms of the disease Mefloquine, which is taken for 1 day. With resistance to Meflohin a combination drug is prescribed Fansidar. Drugs that are highly effective in the treatment of tropical malaria Malarone, Halofantrine, combination drug Coatrem and preparations from Chinese wormwood Artemisinin And Artesunate in combination with Mefloquine.
Rice. 12. In the treatment of tropical malaria, preparations from Chinese wormwood are used.
Treatment of severe tropical malaria
When treating malignant malaria, it is necessary to strictly monitor the amount of fluid infused, avoid excessive infusion, and monitor water-salt metabolism and monitor the state of the blood coagulation system, carry out anti-shock measures in a timely manner.
Rice. 13. Enlargement of the liver and spleen during malaria in a child and an adult.
Treatment of tropical malaria in regions of Southeast Asia
In the treatment of tropical malaria in the regions of Southeast Asia (Thailand, Cambodia and Vietnam) used in combination with Doxycycline, or Clindamycin, or Azithromycin.
Pathogenetic treatment of malignant tropical malaria
Patients undergo intensive detoxification and oxygen therapy. The volume of intravenous infusions is constantly measured.
For cerebral form of tropical malaria the osmodiuretic mannitol is administered, artificial ventilation of the lungs and head cooling (craniohypothermia), and hyperbaric oxygenation are performed.
Renal and renal-liver failure are indications for detoxification using plasmapheresis, hemodialysis, hemosorption, etc.
Transfusions of fresh frozen plasma, blood clotting components and platelet mass are used for hemorrhagic forms of the disease.
Proper care balanced diet and prevention of complications have a beneficial effect on the outcome of tropical malaria.
Rice. 14. Brain damage due to malaria.
Anti-relapse treatment
Anti-relapse treatment is carried out 1.5 - 2 months after completion of the main course of treatment. To carry it out, you can use the same antimalarial drugs that were used previously, but the dose is reduced by 1/3. Next, anti-relapse treatment is carried out every other year: in April for 3-day malaria, in August - September for tropical malaria.
Timely initiation of adequate chemotherapy always guarantees the success of antimalarial treatment.
Rice. 15. An attack of malaria in a woman (India).
The content of the article
Malaria(disease synonyms: fever, swamp fever) is an acute infectious protozoal disease, which is caused by several species of Plasmodium, transmitted by mosquitoes of the genus Anopheles and is characterized by primary damage to the system of mononuclear phagocytes and erythrocytes, manifested by attacks of fever, hepatolienal syndrome, hemolytic anemia, tendency to relapse.Historical data of malaria
As an independent disease, malaria was isolated from the mass of febrile diseases by Hippocrates in the 5th century. BC e., however, the systematic study of malaria began only in the 17th century. Thus, in 1640, the doctor Juan del Vego proposed an infusion of cinchona bark to treat malaria.First detailed description clinical picture malaria was made in 1696 by the Genevan physician Morton. The Italian researcher G. Lancisi in 1717 associated cases of malaria with negative impact fumes from swampy areas (translated from Italian: Mala aria - spoiled air).
The causative agent of malaria discovered and described in 1880 p. A. Laveran. The role of mosquitoes from the genus Anopheles as carriers of malaria was established in 1887 p. R. Ross. Discoveries in malariology that were made in the 20th century. (Synthesis of effective antimalarial drugs, insecticides, etc.), studies of the epidemiological features of the disease made it possible to develop a global program for the elimination of malaria, adopted at the VIII session of WHO in 1955. The work carried out made it possible to sharply reduce the incidence in the world, however, as a result of the emergence of resistance of certain strains of Plasmodium to specific treatment and vectors for insecticides, the activity of the main foci of invasion has remained, as evidenced by the increase in the incidence of malaria in last years, as well as an increase in the importation of malaria into non-endemic regions.
Etiology of malaria
The causative agents of malaria belong to the phylum Protozoa, class Sporosoa, family Plasmodiidae, genus Plasmodium. Known four species of Plasmodium falciparum that can cause malaria in humans:- P. vivax - three-day malaria,
- P. ovale - three-day ovalemalaria,
- P. malariae - four-day malaria,
- P. falciparum - tropical malaria.
Sporogony
Mosquitoes of the genus Anopheles become infected by sucking the blood of a patient with malaria or a carrier of Plasmodium. At the same time, male and female sexual forms of plasmodium (micro- and macrogametocytes) enter the mosquito’s stomach, which transform into mature micro- and macrogametes. After the fusion of mature gametes (fertilization), a zygote is formed, which later turns into an ookinete.The latter penetrates the outer lining of the mosquito's stomach and turns into oocysts. Subsequently, the oocyst grows, its content is divided many times, resulting in the formation a large number of invasive forms - sporozoites. Sporozoites are concentrated in salivary glands mosquito, where they can be stored for 2 months. The rate of sporogony depends on the type of plasmodium and temperature environment. Thus, in P. vivax at the optimal temperature (25 ° C), sporogony lasts 10 days. If the ambient temperature does not exceed 15 ° C, sporogony stops.
Schizogony
Schizogony occurs in the human body and has two phases: tissue (pre- or extra-erythrocyte) and erythrocyte.Tissue schizogony occurs in hepatocytes, where sporozoites successively form tissue trophozoites, schizonts and an abundance of tissue merozoites (in P. vivax - up to 10 thousand per sporozoite, in P. falciparum - up to 50 thousand). The shortest duration of tissue schizogony is 6 days in P. falciparum, 8 in P. vivax, 9 in P. ovale and 15 days in P. malariae.
It has been proven that in case of four-day and tropical malaria, after the end of tissue schizogony, merozoites completely exit the liver into the blood, and in case of three-day and oval malaria, due to the genetic heterogeneity of sporozoites, tissue schizogony can occur both immediately after inoculation (tachysporozoites) and after 1. 5-2 years after it (brady or hypnozoites), which is the cause of long incubation and distant (real) relapses of the disease.
Susceptibility to infection is high, especially in young children. Carriers of abnormal hemoglobin-S (HbS) are relatively resistant to malaria. Seasonality in regions of temperate and subtropical climates is summer-autumn; in countries with a tropical climate, cases of malaria are recorded throughout the year.
Today, malaria is rarely seen in temperate zones, but is widespread in African countries. South America, Southeast Asia, where persistent foci of the disease have formed. In endemic regions, about 1 million children die each year from malaria, which is the leading cause of death, especially in early age. The degree of spread of malaria in individual endemic regions is characterized by the splenic index (SI) - the ratio of the number of people with an enlarged spleen to total number surveyed (%)
Pathomorphologically they reveal significant dystrophic changes in internal organs. The liver and especially the spleen are significantly enlarged, slate-gray in color due to pigment deposition, and foci of necrosis are detected. Necrobiotic changes and hemorrhages are found in the kidneys, myocardium, adrenal glands and other organs.
After the first attacks, patients develop subicteric sclera and skin, the spleen and liver become enlarged (splenohepatomegaly), which acquire a dense consistency. Blood tests reveal a decrease in the number of red blood cells, hemoglobin, leukopenia with relative lymphocytosis, thrombocytopenia, and an increase in ESR.
In primary malaria, the number of paroxysms can reach 10-14. If the course is favorable, from the 6th-8th attack the body temperature during paroxysms gradually decreases, the liver and spleen contract, the blood picture normalizes and the patient gradually recovers.
Malarial coma develops in malignant forms of the disease, more often in primary tropical malaria. First in the background high temperature bodies appear unbearable headache, repeated vomiting.
A disturbance of consciousness develops rapidly and goes through three successive phases:
- somnolence - adynamia, drowsiness, sleep inversion, the patient is reluctant to make contact,
- stupor - consciousness is sharply inhibited, the patient reacts only to strong stimuli, reflexes are reduced, convulsions, meningeal symptoms are possible,
- coma - fainting, reflexes are sharply reduced or not evoked.
Mortality is high. The patient dies due to manifestations of azotemic coma. More often, hemoglobinuric fever develops in individuals with a genetically determined deficiency of glucose-6-phosphate dehydrogenase, which leads to a decrease in erythrocyte resistance.
Splenic rupture occurs suddenly and is characterized by dagger pain in the upper sections abdomen spreading into left shoulder and a spatula. There is severe pallor, cold sweat, tachycardia, thready pulse, arterial pressure decreases. IN abdominal cavity appears free liquid. If emergency surgery is not performed, patients die from acute blood loss against the background of hypovolemic shock.
To others possible complications include malarial algid, pulmonary edema, disseminated intravascular coagulation syndrome, hemorrhagic syndrome, spicy renal failure etc.
Microscopic examination of blood for malaria should be carried out not only in patients with suspected malaria, but also in all patients with fever of unknown origin.
If in case of tropical and four-day malaria with the help of hemoschizotropic drugs it is possible to completely free the body from schizonts, then for radical treatment three-day and ovalemalaria requires the simultaneous administration of drugs with a histoschizotropic effect (against extra-erythrocytic schizonts). Primaquine is used at 0.027 g per day (15 mg base) in 1 - C doses for 14 days or quinocide at 30 mg per day for 10 days. This treatment is effective in 97-99% of cases.
Chloridine and primaquine have a gamontotropic effect. For three-day, oval and four-day malaria, gamontotropic treatment is not carried out, since in these forms of malaria the gamonts quickly disappear from the blood after the cessation of erythrocyte schizogony.
Persons traveling to endemic areas are given individual chemoprophylaxis. For this purpose, hemoschizotropic drugs are used, most often khingamine 0.5 g once a week, and in hyperendemic areas - 2 times a week. The drug is prescribed 5 days before entering an endemic zone, during stay in the zone and for 8 weeks after departure. Among the population of endemic areas, chemoprophylaxis begins 1-2 weeks before the appearance of mosquitoes. Chemoprophylaxis of malaria can also be carried out with bigumal (0.1 g per day), amodiaquine (0.3 g once a week), chloridine (0.025-0.05 g once a week), etc. The effectiveness of chemoprophylaxis increases in case of alternating two or three drugs every one to two months. In endemic foci caused by hingamine-resistant strains of malarial plasmodia, for the purpose of individual prevention, fanzidar, metakelfin (chloridine-bsulfalene) are used. Persons arriving from three-day malaria cells are given seasonal relapse prevention with primaquine (0.027 g per day for 14 days) for two years. To protect against mosquito bites, repellents, curtains, etc. are used.
The proposed merozoite, schizont and sporozoite vaccines are at the testing stage.
