A Simple Guide to Malaria

A Simple Guide to Malaria
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What is Malaria?
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Malaria is a parasitic disease transmitted to humans through the bite of infected Anopheles mosquitoes characterised by high fever at certain times of the day, chills and rigors.

What is the cause of Malaria?
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The cause of Malaria is a parasite called Plasmodium of which there are 4 species:
P.vivax,
P.falciparium,
P.malariae and
P.ovale.
When the parasites (Plasmodium) enter the blood in the human body through the mosquito bite, they travel to the liver.
In the liver after 6 -14 days depending on the species, they mature and then re-enter the bloodstream and infect the red blood cells.
There they multiply inside them.
Within 48 hours of becoming infected in the case of P.vivax, falciparium,and ovale, the red blood cells rupture, releasing more parasites (merozoites) which in turn infect more red blood cells.
In the case of P.malariae, the cycle is 72 hours.
Malaria causes anaemia by the rupturing of the red blood cells.
The large amounts of free haemoglobin released into the circulation after red blood cells rupture accumulate in the liver and spleen causing enlargement.
The symptoms of Malaria occur in cycles of 48 to 72 hours, due to the massive release of merozoites into the bloodstream.

What are the Symptoms of Malaria?
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1.Fever, chills and sweating -
fever is high coinciding with the release of merozoites in the blood stream.
It drops to a lower fever, then goes up again when the parasites are released into the blood stream again.

2.muscle pain & rigors -
due to the high fever and sweating

3.headache, nausea and vomiting -
due to high fever and liver infection

4.jaundice with enlarged and tender liver
due to infection of the liver

5.anaemia and bloody stools
due to the rupture of the red blood cells

6.convulsion and coma
if the brain is affected.

What are the investigations done in Malaria?
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Blood smear tests for the malaria parasite-
a thick blood smear done at the height of the fever is able to show up the parasite more accurately than a thin blood film done randomly.

Blood tests for anemia, liver and kidney functions.

What is the Treatment of Malaria?
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Malaria is treatable and curable.

Antimalarial drugs are readily available.
Drugs used include chloroquine, quinine and primaquine.
The drug used for treatment depends on factors such as
1. age,
2. where the malaria was acquired (as the malarial parasite from certain areas may be resistant to common ant-malarial drugs),
3.drug allergies and
4.G6PD deficiency patients who can have severe reactions to quinine based drugs.

For patients who have G6PD deficiency or are allergic to quinine drugs, the use of Lariam(mefloquine), Malarone(Atovaquone) and Doxycycline have been used effectively against the Malaria parasite.

In severe cases, the person suffering from malaria may require treatment in the intensive care unit of a hospital, especially if there are complications involving the brain or kidneys.

What is the Prognosis of Malaria?
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The outcome is expected to be good in most cases of malaria with treatment,
but poor in Falciparum infections with complications.

What are the Complications of Malaria?
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Complications are liver, kidney, spleen or brain damage usually as a result of bleeding and ruptured red blood cells.
1.liver failure and kidney failure
2.destruction of blood cells (haemolytic anaemia)
3.meningitis
4.rupture of the spleen and subsequent massive haemorrhage

What is the Prevention measures against Malaria?
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There is no effective vaccine against malaria.
Antimalarial drugs may be given prophylactically to persons travelling to areas where the disease is widespread, or to pregnant women in areas in which the disease is endemic.

Antimalarial drugs should be prescribed for visitors to areas where malaria is prevalent at least one week before entering the area, and continue for 2 weeks after leaving the area.
The types of antimalarial medicine prescribed will depend on the drug-resistance patterns in the areas to be visited. It is very important to know the countries and areas you will be visiting to obtain appropriate preventive support for malaria.

What is the prognosis of Malaria?
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Most cases of Malaria are completely cured.
In rare cases, reinfection may occur if the patient remains in the endemic area without proper prophylaxis.

How do you prevent Malaria?
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Preventive measures are concentrated on getting rid of the anopheles mosquito by removing all possible breeding grounds such as places containing stagnant water.

Use of insecticides and natural biologic predators of mosquitoes will help to reduce the population of the anopheles mosquito.

A Simple Guide to Tonsillitis

A Simple Guide to Tonsillitis
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What is Tonsillitis?
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Tonsillitis is inflammation (swelling) of the tonsils.
The tonsils are lymph nodes in the back of the mouth and top of the throat.
They normally help to filter out bacteria and other germs to prevent infection in the body.
They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing tonsillitis.
The infection may also be present in the throat and surrounding areas, causing pharyngitis. The inflammation may involve other areas of the back of the throat including the adenoids and the lingual tonsils (areas of tonsil tissue at the back of the tongue).

What causes Tonsillitis?
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Viral or bacterial infections and low immunity lead to tonsillitis and its complications.
Viral:
The herpes simplex virus, Epstein-Barr virus (EBV), cytomegalovirus, adenovirus, and the measles virus cause most cases of acute pharyngitis and acute tonsillitis.
Bacteria:
Bacteria cause 15-30 percent of pharyngotonsillitis cases.
Streptococcus pyogenes is the most common bacteria causing acute Tonsillitis

Who gets tonsillitis?
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Tonsillitis most often occurs in children but rarely in children younger than 2 years.
Tonsillitis caused by Streptococcus species typically occurs in children aged 5-15 years.
Viral tonsillitis is more common in younger children.
A peritonsillar abscess is usually found in young adults but occur occasionally in children.

What are types of Tonsillitis?
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There are several variations of tonsillitis:
1.acute
2.recurrent
3.chronic tonsillitis and
4.peritonsillar abscess.

What are the symptoms of tonsillitis?
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The type of tonsillitis determines what symptoms will occur.

Acute tonsillitis:
Patients have a
Ear pain
Fever, chills
Headache
Sore throat - severe, lasts longer than 48 hours
Tenderness of the jaw and throat
Voice changes, loss of voice
Foul breath
dysphagia (difficulty swallowing)
Odynophagia (painful swallowing) and
tender cervical lymph nodes.

Airway obstruction due to swollen tonsils may cause mouth breathing, snoring, nocturnal breathing pauses, or sleep apnea.
Lethargy and malaise are common.

These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.

Recurrent tonsillitis:
This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.

Chronic tonsillitis:
Individuals often have
Chronic sore throat,
Foul breath,
Enlarged tonsils, and
Persistently tender cervical nodes.

Peritonsillar abscess:
Individuals often have
Severe throat pain,
fever, Drooling,
Foul breath,
Trismus (difficulty opening the mouth), and
Muffled voice quality (as if talking with a hot potato in his or her mouth).

What are the signs of Tonsillitis?
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The health care provider will look in the mouth and throat for signs of:

1.enlarged, visible tonsils that are usually reddened with white spots (pus) on them.

2.enlarged and tender lymph nodes of the jaw and neck.

3.Fever and chills.

4.Open-mouth breathing and muffled voice resulting from obstructive enlarged tonsils.

5.neck and jaw stiffness (often found in acute tonsillitis).

6.Signs of dehydration (found by examination of skin and mucosa).

7.Palatal petechiae (pinpoint bleeding spots on the soft palate).

8.Unilateral bulging above and to the side of one of the tonsils in peritonsillar abscess .

A culture of the tonsils may show bacterial infection.
A culture for the streptococcus bacteria (strep) may be taken using a throat swab because it is the most common and most dangerous form of tonsillitis.

What is the treatment of Tonsillitis?
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1.If the cause of the tonsillitis is bacteria such as strep, antibiotics are given to cure the infection.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.Some health care providers will treat all tonsillitis with antibiotics to prevent the chance of strep-related complications.

2.Rest to allow the body to heal.

3. Fluids especially warm (not hot), bland fluids or very cold fluids may soothe the throat. Gargle with warm salt water or suck on lozenges (containing benzocaine or similar ingredients) to reduce pain.Fluid replacement and pain control are important.

4.Hospitalization may be required in severe cases and when there is airway obstruction.

5. When the condition is chronic or recurrent, a surgical procedure to remove the tonsils (tonsillectomy) is often recommended.

What is the Prognosis of Tonsillitis?
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Tonsillitis symptoms usually lessen in 2 or 3 days after treatment starts.
The infection usually is cured by then, but may require more than one course of antibiotics.
A tonsillectomy may be recommended if tonsillitis is severe, recurrent, or does not respond to antibiotics.

What are the Complications of Tonsillitis?
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1.Complications of untreated strep tonsillitis may be severe:
Rheumatic fever and subsequent cardiovascular disorders
Post-streptococcal glomerulonephritis followed by kidney failure

2.Dehydration from difficulty swallowing fluids

3.Blocked airway from enlarged tonsils

4.Peritonsillar abscess or abscess in other parts of the throat