The diagnosis of malaria relies mainly on clinical assessment and laboratory investigations. The clinical assessment has two main elements i.e. history and physical examination. The laboratory investigation comprises mainly of tests for malaria parasites (i.e. microscopy or rapid diagnosis tests) and other supplementary tests / procedures.
The diagnosis (and subsequent management) of malaria has two important dimensions i.e. separating malaria from other febrile illness and deciding the severity of malaria illness. The golden thumb rule of detailed history and thorough physical examination is must for both these decisions.
Early symptoms of malaria are non-specific and usually resemble that of influenza and consist of the following: an intermittent fever, headache, muscle aches, chills and malaise (a general feeling of illness).Few days later the typical paroxysms of malaria start characterized by chills, followed by fever (up to 104 degree Fahrenheit) followed by sweating. The paroxysms usually last about 8 to 10 hours. In between the paroxysms patients often feel remarkably well. The paroxysms recur every 48 hours. The paroxysms occur at about same time that the red blood cells burst and release more parasites (i.e. merozoites) thus explaining the 48 and 72 hours cycle.
Malaria should be suspected in a person who has fever and chills (periodic) with no other apparent cause (such as respiratory, urinary, ENT infections). It should also be suspected in persons presenting with large tender spleen or jaundice or anemia without an obvious cause. Prompt diagnosis and early treatment are important.
Patients do not always give a clear history. It may require careful questioning to find out how long a symptom(s) has been present. The following point’s needs to be considered while taking the history of malaria suspect.
The diagnosis (and subsequent management) of malaria has two important dimensions i.e. separating malaria from other febrile illness and deciding the severity of malaria illness. The golden thumb rule of detailed history and thorough physical examination is must for both these decisions.
Early symptoms of malaria are non-specific and usually resemble that of influenza and consist of the following: an intermittent fever, headache, muscle aches, chills and malaise (a general feeling of illness).Few days later the typical paroxysms of malaria start characterized by chills, followed by fever (up to 104 degree Fahrenheit) followed by sweating. The paroxysms usually last about 8 to 10 hours. In between the paroxysms patients often feel remarkably well. The paroxysms recur every 48 hours. The paroxysms occur at about same time that the red blood cells burst and release more parasites (i.e. merozoites) thus explaining the 48 and 72 hours cycle.
Malaria should be suspected in a person who has fever and chills (periodic) with no other apparent cause (such as respiratory, urinary, ENT infections). It should also be suspected in persons presenting with large tender spleen or jaundice or anemia without an obvious cause. Prompt diagnosis and early treatment are important.
Patients do not always give a clear history. It may require careful questioning to find out how long a symptom(s) has been present. The following point’s needs to be considered while taking the history of malaria suspect.
Ø Fever (>101 F) during the last three days, with one or more of the following:
ü Chills (shivering)
ü Headache
ü Generalized body aches and pains
ü Profuse sweating
ü Vomiting or diarrhea
ü Poor or loss of appetite
ü Body weakness and dizziness
Ø Based on the history, the suspect needs to be looked for:
ü Anemia
ü Enlarged and tender spleen
ü Signs of other obvious diseases e.g. infections of urinary tract, chest, intestine, ENT.
Ø Always remember that:
ü Young children may present with high fever associated with vomiting and seizures. However, in some cases children may present with cough and/ or diarrhea.
ü In P. vivax infection fever usually becomes cyclic after a few days, with no fever between attacks.
ü In P. falciparum infection the fever may be continuous with bouts of higher peaks.
Other causes of febrile illness including infections of urinary tract, chest, intestine, ENT must be excluded before making the diagnosis of uncomplicated malaria. This assessment process may include detailed clinical examination with few additional laboratory investigations.
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