THE Department of Health has declared the third week of April is End-Malaria Awareness Week, and this column would like to do its share in bringing a closer look and focus on one of the most problematic illnesses of the world which the WHO is still grappling with a definite solution, which include Aids and resurgence of tuberculosis resistant to conventional medicines. The urgency of the DOH in promoting this awareness is due to the fact that most of the attention of the Philippines, at the moment is on dengue especially its newly-approved vaccine Gengvaxia. Obviously, malaria deserves as much information dissemination.
Malaria is a disease caused by a single-celled organism which belongs to the Plasmodium family. Malaria is coined from the Spanish word "mal- bad, aria - air” which is transmitted by the female Anopheles flavitrostric mosquito. Unlike dengue which is a viral disease, malaria is a protozoal illness. Dengue is transmitted by Aedes aegypti and the Aedes albopictus mosquito which like to bite on early morning hours or late afternoon, the Anopheline female bites at night. The dengue virus likes to thrive in stagnant and collected waters while the plasmodium loves to multiply in slow flowing waters, usually in brooks and streams at the foothills of mountains.
There are four species of Plasmodium; vivax, ovale, malariae and falciparum. When the Anopheline mosquito bites and infected person, the plasmodium is stored in its salivary gland. Thus, on the next occasion, the mosquito does something really nasty- bites, sucks blood of the victim and then spit into the bloodstream what it had stored in its salivary gland. The parasite goes to the liver where they undergo maturation and later on exit the liver and invade the red blood cells.
Their development and maturation in the liver would later change the structure of the red blood cell converting its normal biconcave- dumbbell shape- into a large round ball-like structure whose walls easily rupture and break, thus releasing many parasites into the blood stream. This is particularly true with vivax and ovale species- which stay in the liver for a while_ and this episode of red blood cell rupture coincides with the chills the patient suffers from followed by profuse sweating and a fever that comes close to 103 degrees Fahrenheit, leaving the patient emaciated and very weak. The periodic rupture of red blood cells with its attendant chills and fever is called tertian if the episode occurs every 48 hours. The plasmodium malariae species has a quartan pattern of chills and fever or every 72 hours. The falciparum, admittedly cause of the most serious and even fatal malaria has a quotidian pattern of chills and fever which could vary from 35 to 72 hours. Aside from the chills, diaphoresis-excessive sweating - and fever, the patients complain of severe headache. Physical exam may reveal jaundice, especially for those patients with chronic recurrent malaria of Plasmodium malariae because it stays long in the bloodstream for years. The liver and the spleen may get enlarged.
The falciparum species is the most problematic. For one, it is known to be resistant to the most commonly used anti-malarial drug, Chlroquine or Aralen. It also causes cerebral malaria in which the enlarged bulging red blood cells would cause congestion and sludging thus simulating or mimicking a cerebral thrombosis or a blockade or obstruction to blood flow in the brain, thus causing neurologic signs and symptoms like paralysis, confusion, seizures and even coma. Blackwater fever is also attributed to falciparum in which the massive destruction of red blood cells leads to clogging of the renal tubules with the debris as well as the pigment hemoglobin which gives the urine of the patient the so-called “coca cola colored urine."
Like dengue, a concerted community effort is needed thru cleaning the yard, environmental sanitation, installing screens on doors and windows, wearing long sleeved clothes especially when outdoors near the habitat of the Anopheline, spraying nooks and corners where they hide and of course, sleeping inside and under good old reliable mosquito net.
Let us not allow these pesky mosquitoes spoil our restful sleep. Dream on!