Malaria is a serious parasitic disease that severely harms human health and was classified as one of the five major parasitic diseases in the early stages of the nation's founding. There are four types of Plasmodium that infect humans: Plasmodium vivax (Grassi and Feletti, 1890 Labb'e, 1899), Plasmodium malariae (Laveran, 1881 Grassi and Fetti, 1890), Plasmodium falciparum (Welch, 1897 Schaudinn, 1902), and Plasmodium ovale (Graig, 1900 Stephens, 1922). In China, the primary species are Plasmodium vivax and Plasmodium falciparum, while the other two are rare, with only occasional imported cases reported in recent years.

bubble_chart Epidemiology

Malaria is widely distributed around the world and is one of the parasitic diseases that severely harm human health, posing a major public health issue in vast regions of Asia, Africa, and Latin America. According to statistics, there are still 120 million malaria cases globally, with nearly 300 million carriers. In Africa alone, millions of children die from malaria each year. Except for individuals with innate immunity to certain malaria parasites due to genetic factors or infants in high-malaria areas who acquire some resistance from their mothers, the general population is highly susceptible to malaria parasites. In endemic regions, adults often experience repeated infections and may become carriers, while children are the primary susceptible group. Pregnant women, with their unique physiological conditions and weakened immunity, are also highly vulnerable to malaria. Additionally, non-immune individuals from non-endemic areas entering malaria zones become susceptible and may trigger outbreaks.

During the erythrocytic stage, malaria parasite merozoites rupture red blood cells, releasing merozoites, parasite metabolic products, residual and denatured hemoglobin, and red blood cell fragments into the bloodstream. A significant portion of these can be engulfed by polymorphonuclear leukocytes and cells of the mononuclear phagocyte system, stimulating these cells to produce endogenous pyrogens. These pyrogens, along with malaria parasite metabolites, act on the hypothalamus' thermoregulatory center, causing fever.

bubble_chart Pathological Changes

Anemia: After several episodes of malaria, symptoms of anemia may appear. The more frequent the episodes and the longer the course of the disease, the more severe the anemia becomes. The direct destruction of red blood cells by malaria parasites during the erythrocytic stage is one of the causes of anemia in malaria patients. Splenomegaly: The main causes are splenic congestion and hyperplasia of mononuclear phagocytes. Due to the phagocytes containing large amounts of malarial pigment, the color of the spleen's cut surface darkens. The spleen may enlarge to below the umbilicus, with its weight increasing from the normal 150g to 500g or even over 1000g.

bubble_chart Clinical Manifestations

The typical malaria attack manifests as three consecutive stages: periodic chills, fever, and sweating to defervescence. Common complications include anemia, splenomegaly, severe malaria, and malarial nephropathy.

bubble_chart Auxiliary Examination

Blood is usually collected from the earlobe or fingertip of the subject to prepare thin and thick blood films. After staining with Giemsa or Wright’s stain, the films are examined under a microscope. Blood should be collected at the onset of symptoms (for Plasmodium falciparum) or within a few hours to 10 hours after the onset (for tertian or quartan malaria). In the early stage of falciparum malaria, only ring forms can be detected, while gametocytes appear in the peripheral blood approximately 10 days after the detection of ring forms. Except in severe cases, trophozoites and schizonts of P. falciparum are rarely found in peripheral blood. Thin blood films, after staining, preserve the complete and clear morphological structure of the parasites, allowing identification of the species and developmental stages, making them suitable for clinical diagnosis. However, the number of parasites may be low, making detection challenging. Thick blood films, on the other hand, cause parasites to shrink and deform during processing, and red blood cells are lysed, complicating identification. Nevertheless, parasites are more concentrated and easier to detect. Familiarity with their morphological characteristics can improve detection rates, making thick films commonly used in epidemiological surveys.

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Etiological examination: The detection of malaria parasites in the peripheral blood of patients is the basis for the definitive diagnosis of malaria. The use of indirect immunofluorescence to detect specific malaria parasite antibodies has been employed in epidemiological surveys. In recent years, new methods have been developed, such as using monoclonal antibodies to detect malaria parasite antigens in patients' blood, DNA probes to detect malaria parasite nucleic acids, or PCR to amplify small amounts of malaria parasite DNA to improve detection rates, all of which have achieved certain results.

bubble_chart Treatment Measures

The treatment of malaria not only alleviates the suffering of patients but also aims to control the source of pestilence and prevent its spread. Current cases must be promptly identified and thoroughly treated. Tertian malaria is treated with chloroquine and primaquine (chloroquine-primaquine combination). For falciparum malaria, chloroquine alone may be administered. For tertian malaria patients, anti-relapse therapy can involve primaquine. In regions where falciparum malaria has developed resistance to chloroquine (such as Hainan Province and Yunnan Province), a combination of antimalarial drugs is recommended, such as artemisinin, pyronaridine, sulfadoxine, and pyrimethamine.

There are many types of antimalarial drugs, classified based on their effects on different stages of the malaria parasite's life cycle, mainly including the following categories:

1) Drugs that kill exoerythrocytic schizonts and hypnozoites, such as primaquine, which have anti-relapse effects and are also known as radical cure drugs. Pyrimethamine has some effect on the exoerythrocytic stage of Plasmodium falciparum.

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3) Drugs that kill gametocytes, such as primaquine, used to block transmission.

4) Drugs that kill sporozoites, such as pyrimethamine, which can inhibit sporozoite development in mosquitoes.

bubble_chart Follow-up Consultation

After treatment, the patient must be observed for more than one year to confirm a cure, ensuring there is no recrudescence or relapse. Once cured, there is no immunity, and reinfection can occur.

bubble_chart Prevention

The prevention of malaria refers to the protection of susceptible populations, including individual prevention and group prevention. Individual prevention involves protective measures taken by residents of malaria-endemic areas or individuals temporarily entering such areas to avoid mosquito bites, prevent illness, or alleviate clinical symptoms. Group prevention targets populations in high-risk malaria areas, outbreak zones, or large groups residing in malaria-endemic areas for extended periods. In addition to the objectives of individual prevention, group prevention also aims to curb transmission. Based on the weak links in the transmission chain, cost-effective and easily accepted protective measures should be selected. Preventive measures include mosquito vector control, drug prophylaxis, or vaccine prevention.