About two decades ago it was thought that malaria had been eradicated from India. However, recently, there has been a resurgence of this disease.
Malaria spreads through a mosquito bite (female anopheles) and the common causative organisms in India is plasmodium vivax and p falciparum (malaria parasite). Malaria caused by this parasite does not cause any permanent damage. It is characterized by fever every third day, followed by rigonr or shivering and accompanied by headache and muscle pain. In some cases, there may be enlargement of the liver and spleen. The final diagnosis can be made by examining the blood for the presence of the parasite. Lately a resistant strain of plasmodium vivax and p, falciparum has erupted in some areas of India. This has made the treatment more difficult since it is resistant to usual anti-malarial drugs. How Does the Disease Progress? The malarial parasite gets injected into the bloodstream by the bite of the female anopheles mosquito and reaches the liver where it multiplies. The baby parasites are released from the liver into the bloodstream, where they enter the red blood cells (RBCs) or return to the liver. Those which enter the RBCs, grow and further multiply. This leads to distension and bursting of RBCs and releasing the toxic metabolites of these multiplied parasites, resulting in rigour and fever. The released parasite may re-enter into other RBCs to repeat the cycle of growth and multliplication, causing another attack of rigonr and fever. This new cycle in RBCs takes about 48 hours and account for the occurrence of fever and rigour every third day. Those who enter the liver may be responsible for continuance of the disease; it takes about two weeks' time to complete the multiplication cycle. The parasites can be attacked in the RBCs or in the liver. Drugs ChloroquineThis is the drug of choice for benign tertian malaria which is usually caused by plasmodium vivax. The oral dose is 600 mg twice of chloroquine (base), followed after 6 hours by 300 mg, then 150mg twise daily, for the next two days. The other drug of this group is amodiaquine. However, some stains of P. falciparum are resistant to chloroquine. In such a situation, quinine is given intravenously. Chloroquine may cause nausea, vomiting and stomach pain. It can be given during pregnancy.MefloquineIt is used for treating an acute attack and curing malaria due to resistant strains of parasites. It should be kept reserved for only these patients of malaria, since its misuse may result in the development of mefloquine-resistant strains of the parasites. It is taken in a single dose of 1.5g. Adverse Effects: Adverse effects of mefloquine are seen in about 1 % patients. These includes irritation in the stomach, fatigue, neurological symptoms in the form of headache, dizziness, visual disturbances, vertigo, tinnitus, insomnia, restlessness, anxiety psychosis, or seizures. It can produce heart-rate irregularities when given along with digoxin, anti-depressants and propranolol.
