DIAGNOSING MALARIA

UNCOMPLICATED MALARIA 

Children and adults infected with malaria commonly suffer from high fever and severe aches but symptoms may also include cough and diarrhoea. Any child who presents with fever in a malaria endemic region or who recently visited such a region, must be assumed to have malaria until proven otherwise, and requires urgent treatment. The most important feature of malaria is fever. Early diagnosis and treatment will save lives and prevent the development of complications. All parents and caregivers should be made aware of malaria symptoms and urged to seek prompt treatment.


SEVERE OR COMPLICATED MALARIA 

Untreated malaria in a young child or in a non-immune individual may become complicated: the patient presents with very high body temperature, drowsiness, convulsions and coma indicating heavy parasitaemia and cerebral malaria. Other complications may include bleeding, jaundice, diminished urine output, all signifying liver and/or kidney failure.

HOW TO RECOGNIZE MALARIA

It is difficult to tell whether a sickness is caused by malaria or some other disease, because the features may be similar. Ask the patient, or the adult accompanying a young patient, whether there has been any fever at any time during the past 2-3 days. The patient has a fever when the forehead feels hot, or more precisely when his or her temperature is more than 37.5 degrees centigrade on a thermometer. Very young children with malaria may present with low body temperatures or hypothermia. Patients who have had fever during the last 2-3 days may have malaria. In this case, ask and then look for danger signs.

Diagnosing Malaria


DANGER SIGNS OF SEVERE MALARIA

Look for the following signs of malaria, and ask the following questions to each patient, or parent or care-giver accompanying a child:
  • if he/she is able to drink
  • if he/she has had fever at home 
  • if he/she has had convulsions (fits) 
  • does he/she vomit repeatedly or have diarrhoea or a cough 
  • how much urine he/she has passed – very little, none at all? Is it dark or blood coloured? 
LOOK FOR:
  • changes in behaviour (convulsions (fits); unconsciousness; sleepiness; confusion; inability to walk, sit, speak or recognize relatives) 
  • repeated vomiting; inability to retain oral medication; inability to eat or to drink 
  • passage of small quantities of urine or no urine, or passage of dark urine 
  • severe diarrhoea 
  • unexplained heavy bleeding from nose, gums, or other sites 
  • high fever (above 39 degrees centigrade) 
  • severe dehydration (loose skin and sunken eyes)
  • anaemia (look at the patient’s facial colour and hands – the palms of a patient with anaemia do not have the redness of a healthy person’s palms)
  • yellowness of the eyes. 
If you identify any of the danger signs, urgent treatment is needed at a clinic or hospital to save the patient’s life.

Each attack may last several hours and often begins with shivering (body shaking). Next, there is a period of fever, and finally there is profuse sweating. During an attack, the patient often complains of headache and pain in the back, joints and all over the body. There may also be loss of appetite, vomiting and diarrhoea. Alternatively, the child may present with symptoms of severe malaria such as loss of consciousness, drowsiness and/or convulsions, diarrhoea, dark urine and reduced urine output (anuria).

If untreated (or inadequately treated), malaria may cause several weeks or months of poor health because of repeated attacks of fever, anaemia and general weakness. Malaria symptoms can mimic many illnesses and can affect most organs in the body.

It is particularly important to make an early diagnosis of malaria in young children and in pregnant women. These two groups may rapidly become very ill and may die within a few days. Pregnancy reduces the immune status of individuals and hence makes them more susceptible to malaria infection. Malaria during pregnancy is more difficult to treat, because the parasites tend to hide in the placenta, making diagnosis and treatment difficult.

BLOOD TESTS 

Examining a stained blood film under a microscope will show whether a patient has malaria parasites in the blood (parasitaemia). This does not prove the parasites are causing the illness. However, the more dense the parasitaemia, the more likely it is to be the cause of the disease. For example, a patient with more than 10% of red cells containing parasites, in an endemic area (or more than 4% in a nonendemic area) is at increased risk of developing severe malaria. Repeat testing will show whether or not the percentage of parasites in the red cells is increasing. 

DISTINGUISHING MALARIA FROM OTHER SERIOUS CONDITIONS 

Complications of severe malaria may be similar to those caused by other diseases. For each complication, examine the patient carefully and think of other possible causes. For example, a lumbar puncture may distinguish malarial coma from meningitis; careful examination of the chest may distinguish malarial breathing from pneumonia. Other conditions which may present with similar symptoms to malaria include: hepatitis – causing jaundice; acute renal (kidney) failure – causing diminished urine output; diabetes – causing deep acidotic breathing. Complications due to malaria may mimic many diseases, so a good history and physical examination are critical, followed by blood examination to confirm the diagnosis.

(Meyda Azzahra)