Diagnostics and treatment of various kinds and forms of malaria.
The basic method of diagnostics is research of Romanovsky–Gimza stained smears and thick drops of the blood. It is easier to find parasites in a thick drop and to determine a kind of a parasite in a smear.
Features of tropical malaria are: in smears and thick drops only rings and semilunar gamonts are found out, invased erythrocytes have larger diameter, frequently of irregular form, there are some rings (1/5-1/6 of a diameter of erythrocyte) in erythrocyte.
In quartan malaria damaged erythrocytes have smaller diameter, the granulation is absent, trophozoits are compact, nuclei are little, teniform schizont is typical, morula looks like the rosula.
In vivax-malaria the erythrocytes are enlarged with small abundant granulation, trophozoits are fragmented, nuclei are little, there can be 2-3 rings (1/3 of the diameter of erythrocyte).
In ovale-malaria granulation is large and infrequent in an erythrocyte, trophozoits are compact, nuclei are large.
The kind of a parasite and number of parasites in 1 мkl of the blood (more than 100000 in tropical malaria is a bad prognostic sign) are determined during investigation.
Serological tests (Indirect Hemagglutination Test, Reaction of ImmunoFluorescence, ELISA) have secondary importance.
There is an express method (immunochromatography) of diagnostics of tropical malaria (change of the color of the blood during putting it on a plate with antibodies) in the endemic foci.
Treatment has three problems of an etiotropic therapy:
1. To stop an attack (to interrupt erythrocytic schizogony) hematoschizotropic drugs are used:
- Chloroquinum 1st day 1g (0,6g base), in 8 hours - 0,5g (0,3g base) 2nd-3d days 0,5g (0,3g base), a maximum in 5 days;
- at resistance to Chloroquinum: Qininum 15-20 мg/кg/day (no more than 2g/day) 7-10 days p.o.; Fansidar (sulfadoxin+pirimethamin) 3 tab. once; Meflochin (lariam) 1,5g once; Fansimef (Meflochin+Fansidar) 3 tab. once; Metakelfin 2 tab. once; Artemisinin; Galofantrin.
The combination of hematoschizotropic preparations with Tetracyclines or Sulfanilamide is possible.
2. To prevent late relapses (to interrupt tissue schizogony) histoschizotropic preparations are used:
- Primaquine 5 mg base. tid 14 days
3. To interrupt an epidemiological chain (to destroy gamonts) gametocide preparations are used:
- Primaquine 5 mg base. tid 3 days.
Treatment of tertian and ovale malaria outside of endemic foci (radical therapy) includes hematoschizotropic drug (it is more chloroqine mostly), then histoschizotropic preparation (it is destruction of gamonts simultaneously).
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For the treatment of qartan malaria hematoschizotropic drugs are used .
Treatment of tropical malaria includes hematoschizotropic drug then primaqinum for destruction of gamonts for 3 days . The injection of medicines is used i.v. and i.m. in severe course of the disease.
In the endemic focus an controlling therapy of malaria is carried out by hematoschizotropic drug only due to a constant reinfection.
Authors: ass.-prof. Los-Yatsenko N.G.
ass.-prof. Arshinov P.S.
Head English Teacher Litvinova V.A.
ass. Kozlovsky O.A.
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