This year is the tenth "National Malaria Day." This year's propaganda theme is "Promoting Malaria, Beware of Foreign Input." Malaria is a parasitic disease caused by human infection and is mainly transmitted by the bite of female Anopheles mosquitoes. Plasmodium first invades the development and reproduction of hepatocytes, and then invades red blood cells, resulting in a burst of red blood cells and the onset of disease.
The clinical manifestations of malaria
In the 1960s and 1970s, the disease appeared to have a large epidemic in the country, seriously endangering people's physical health and social productivity. After more than 20 years of vigorous prevention and control, local infected cases of malaria were basically eliminated in the late 1980s. There are four types of malaria: Plasmodium vivax, Plasmodium falciparum, Malaria ovale and Plasmodium vivax.
Malaria is characterized by recurrent intermittent chills and fever, followed by remission after sweating. Malaria and oval malaria can recur. Malignant malaria fever irregular, serious condition, can cause brain malaria and other attacks. The source of infection is malaria patients and those with malaria parasites, a small number of imported blood with Plasmodium, mother-to-child transmission (congenital malaria) or malaria transmitted through the placenta. The most prevalent area is Plasmodium vivax, and Plasmodium falciparum is prevalent in the tropics. In addition to the mixed epidemic of vivax malaria and falciparum malaria in Yunnan and Hainan provinces, the majority of other countries are predominantly vivax malaria. After opening to the outside world, there are also many imported cases.
The disease ranks first among the world’s deadliest parasites. Currently, there are about 2 billion people living in malaria-endemic areas in the world. There are about 300 million to 500 million new cases of malaria each year, and about 3 million cases of illness and death. About 1 million of them are children, mostly under 5 years of age. The severity of the patient's clinical presentation is related to the type of malaria infection. Plasmodium falciparum can invade red blood cells of any age and can cause infection of more than 20% of peripheral blood red blood cells. The density of malaria parasites in the blood is high. The number of red blood cells infected with 10 cells of 6 cubic millimeters per cubic millimeter is very short. The reproductive cycle in red blood cells is very short. Only 36 to 48 hours, so the anemia and clinical symptoms are very heavy. Plasmodium vivax and Plasmodium ovale often invade younger red blood cells. The infection rate of red blood cells is low, and less than 25,000 red blood cells per cubic millimeter are infected. Plasmodium malaria only infects older red blood cells and is often less than 10,000 per cubic millimeter. Red blood cells, so anemia and other clinical manifestations are lighter.
The clinical manifestations are sudden chills, high fever, and excessive sweating. The chills last for 20 to 60 minutes with high fever, up to 40 degrees Celsius, and 2 to 4 hours. The body temperature slowly drops after sweating, and then the symptoms ease. The clinical should be differentiated from sepsis, typhoid fever, leptospirosis, hemorrhagic fever with renal syndrome, tsutsugamushi disease, biliary tract infection, and urinary tract infection. Cerebral malaria should be differentiated from encephalitis B, poisoned sputum, and viral encephalitis. Mortality rate: Due to different species of insects, the death rate of Plasmodium vivax, Plasmodium vivax malaria and malaria is low, the mortality rate of Plasmodium falciparum is high, infants and young children are delayed in diagnosis and treatment, and many malaria-resistant strains are dead. With a high rate, the death rate of cerebral malaria reaches 9% to 31%.
The malaria hazards and prevention measures
When Plasmodium falciparum reproduces in erythrocytes, it causes narrowing or blockage of the local lumen of micro-vessels, which results in ischemic hypoxia causing pathological changes of degeneration and necrosis. If such pathological changes occur in brain and lung, Important organs such as the kidney can cause serious clinical manifestations such as cerebral malaria.
A large number of erythrocytes parasitized by Plasmodium are lysed in blood vessels, which can cause high hemoglobinemia, low back pain and soy sauce-like urine. In severe cases, there may be moderate to moderate anemia, jaundice, and even acute renal failure, known as hemolytic uremic syndrome. Also known as black urine fever, this condition is easily induced by antimalarials, such as primaquine. Intermittent fever: 48 hours between Plasmodium vivax and oocyte malaria, 72 hours on the third day of malaria, and 36 to 48 hours of falciparum malaria. Cerebral malaria is a severe clinical type of falciparum malaria and is also found in P. vivax. Confusion, confusion, convulsions, and coma occur in addition to the blockage of micro-vessels by infected red blood cells, and also associated with hypoglycemia and elevated cytokines such as tumor necrosis factor. Cerebral malaria has a high mortality rate.
After the blood transfusion, the latent period of malaria is 7 to 10 days. Most of them are P. vivax in China. However, because there is no intrahepatic intracellular propagation stage and lack of delayed sporozoites, it will not recur. Mother-to-child transmission of malaria usually occurs about one week after birth and does not recur. Reburning: It is caused by the remaining Plasmodium in the blood. Therefore, there may be reburning of all four types of malaria. It usually occurs one to four weeks after recovery, and can occur repeatedly. It must continue to take antimalarial medication. Recurrence: Caused by sporadic sporozoites parasitizing in hepatocytes. The disease develops after 3 to 6 months of illness. It is found only in P. vivax and oocyte malaria. The incubation period is 13 to 15 days for P. vivax, 24 to 30 days for malaria on the 3rd, and 7 to 12 days for falciparum malaria.
In treatment, antimalarial treatment is mainly used to kill erythrocytic chloroquine, artemisinin and derivatives, piperaquine, quinine, etc., and to kill erythrocyte plasmodia gametophytes and late-onset sporozoites. Ammonia and so on. There are artesunate, chloroquine, quinine, and pyronaridine phosphate in the treatment of cerebral malaria, and chloroquine is used for prevention in pregnant women and children.
Dr. Zhu Xiannu, chief physician of the second district of the Second People’s Hospital of Yuebei Second People’s Hospital (Source: Source: Shaoguan Daily)
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