Malaria in children

Malaria in children is a long-lasting infectious disease with periodic attacks of fever, increased liver, spleen and progressive anemia.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Epidemiology

[11], [12], [13], [14], [15], [16], [17], [18]

Causes of the malaria in children

The causative agent of malaria - malarial plasmodium - refers to the type of protozoa, a class of sporoviks, a group of bloodsuckers, a family of plasmodia, a genus of plasmodia. There are four types of malaria pathogens:

• P. Malariae, which causes four-day malaria;
• P. Vivax, which causes a three-day malaria;
• P. Falciparum, the causative agent of tropical malaria;
• P. Ovale, which causes malaria in tropical Africa as a three-day type.

[19], [20], [21], [22], [23], [24], [25], [26], [27], [28]

Pathogenesis

Attacks of malaria are caused by the erythrocyte phase of the development of malarial plasmodia. The onset of an attack can be associated with the disintegration of infected red blood cells and the release of merozoites, free hemoglobin, parasite exchange products, erythrocyte fragments with pyrogenic substances into the bloodstream, and others. As foreign to the body, they act on the thermoregulatory center to produce a pyrogenic reaction, and also act in general. In response to circulation in the blood of pathogenic substances, hyperplasia of the reticulo-endothelial and lymphoid elements of the liver and spleen, as well as the phenomenon of sensitization with possible reactions of the hyperergic type, arise. Repeated attacks with the collapse of red blood cells eventually lead to anemia and thrombocytopenia, impaired capillary circulation and the development of intravascular coagulation.

[29], [30], [31], [32], [33], [34], [35], [36]

Symptoms of the malaria in children

The incubation period of malaria depends on the type of pathogen and the immunoreactivity of the child. With a three-day malaria the duration of the incubation period is 1-3 weeks, with a four-day period - 2-5 weeks, and with a tropical one - no more than 2 weeks. In children older than 3 years, the disease manifests itself with the same symptoms as in adults.

Prodromal phenomena are rarely noted (malaise, headache, subfebrile temperature, etc.). Usually the disease begins acutely with a tremendous chill, sometimes a slight increase in body temperature. The skin becomes cold, rough to the touch (goosebumps), especially the limbs become colder, light cyanosis of the fingers, the tip of the nose, shortness of breath, severe headache, sometimes there is vomiting, muscle pain. After a few minutes or 1-2 hours, chills change to a feeling of heat, which coincides with a rise in body temperature to high figures (40-41 ° C). The skin is dry, hot to the touch, the face turns red, thirst, hiccups, vomiting. The patient rushes, is excited, delusions are possible, loss of consciousness, convulsions. The pulse is frequent, weak, arterial pressure goes down. The liver and spleen are enlarged and painful. The attack lasts from 1 to 10-15 hours and ends with a torrential sweat. At the same time, the temperature of the body falls critically and there is a sharp weakness, which quickly passes, and the patient feels quite satisfactory. The frequency and sequence of seizures depend on the type of malaria, the timing of the disease and the age of the child.

In the blood at the beginning of the disease, leukocytosis, neutrophilia is noted. At the height of the attack, the content of leukocytes decreases, and in the period of apyrexia, leukopenia with neutropenia and relative lymphocytosis is found with great persistence. ESR is almost always increased. In severe cases, the number of erythrocytes and hemoglobin is significantly reduced.

With timely treatment, malaria breaks down after 1-2 seizures. Without treatment, seizures are usually repeated up to 10 times or more and can spontaneously terminate, but this does not stop the disease. The period of visible well-being (latent period) lasts from several weeks to a year or more (four days of malaria). Early relapses occur within the first 2-3 months of the latent period. Clinically, they are virtually indistinguishable from the acute manifestation of the disease. Their occurrence is explained by increased reproduction of erythrocyte forms of the parasite. However, so-called parasitic relapses are possible, during which parasites reappear in the blood, with the complete absence of clinical symptoms of the disease.

The period of late relapse begins 5-9 months or more after the onset of the disease. Attacks with late relapses are easier than with early relapses and the initial manifestation of the disease. The occurrence of late relapses is associated with the release of tissue forms of malarial plasmodium into the blood from the liver.

Without treatment, the total duration of malaria with a three-day malaria of about 2 years, with a tropical one about 1 year, with a four-day malaria, the causative agent in the patient's body may persist for many years.

Diagnostics of the malaria in children

For the diagnosis of malaria, the stay of the patient in the endemic malaria focus is of particular importance. The final diagnosis is established based on the results of laboratory studies - detection of parasites in peripheral blood. In practical work, a thick drop, colored according to Romanovsky-Giemsa, is usually examined. Smear of peripheral blood is used less often for these purposes. When microscopy of a smear in erythrocytes, plasmodia are found.

For serological diagnosis, use of RIF, RIGA and the reaction of enzyme-labeled antibodies are used. The most commonly used is the RIF. As antigens in the RIF, blood preparations containing many schizonts are taken. A positive reaction (in titre 1:16 and higher) indicates that the child has had or is currently ill with malaria in the past. The RIF becomes positive at the 2nd week of erythrocytic schizogony.

[37], [38], [39], [40], [41], [42], [43], [44]

Differential diagnosis

Malaria in the child is differentiated with brucellosis, recurrent typhus, visceral leishmaniasis, hemolytic jaundice, leukemia, sepsis, tuberculosis, liver cirrhosis, etc. Malarial coma differentiate with comatose conditions arising in viral hepatitis B, typhoid fever, meningoencephalitis, less with purulent meningitis.

Treatment of the malaria in children

Use drugs that act as the asexual erythrocytic forms of plasmodium (hingamin, acrichine, chloride, quinine, etc.), and on the sexual forms found in the blood, and tissue that are in hepatocytes (quinocide, primaquine, etc.).

In the treatment of malaria, chloroquine (hingamin, delagil, resohin) is widely used in children.

• With tropical malaria, the course of treatment with hingamine is prolonged to 5 days according to the indications. Simultaneously, during this period, a primaquine or quinocide is administered. This treatment scheme provides a radical cure for most patients with tropical malaria.
• With a three-day and four-day malaria after a 3-day course of treatment with chingamine, primaquine or quinocide is given within 10 days to suppress the tissue forms of parasites.
• There are other treatments for malaria. In particular, when plasmodia is resistant to hingamine, quinine sulfate is given in the age-related dose for 2 weeks. Sometimes quinine is combined with sulfanilamide preparations (sulfapiridazine, sulfazin, etc.).

Prevention

Measures to prevent malaria include: neutralizing the source of infection, vector destruction, protecting people from mosquito attacks, rational use of individual chemoprophylaxis according to strict indications.

After malaria and parasites, malaria is fixed for 2.5 years, for tropical malaria, up to 1.5 years. During this time, periodically examine the blood for malarial plasmodia.

In the malaria endemic areas, a wide range of measures are used to combat winged mosquitoes and their larvae. The importance is also the careful implementation of recommendations for protecting housing from mosquito flight and the use of personal protective equipment (ointments, creams, protective nets, etc.).

Persons traveling to countries endemic for malaria should receive individual chemoprophylaxis with chloroquine or a fan-sidar. Individual chemoprophylaxis begins 2-3 days before arrival in a malaria endemic area and continues during the entire stay. For active prophylaxis, a number of vaccines prepared on the basis of attenuated strains of erythrocyte plasmodium are proposed.

[45], [46], [47], [48], [49], [50], [51], [52]