Malaria

　　Malaria parasites are the causative agents of malaria, a class of unicellular eukaryotic organisms that belong to intracellular parasites. They use Anopheles mosquitoes (one of the genera of mosquitoes, part of the Anopheles genus) as vectors, spreading the pathogen through the female mosquito's biting and blood-sucking. Most vertebrates can serve as the primary hosts of malaria parasites, such as rodents, bats, lizards, birds, and so on.
　　Only four types of Plasmodium can infect humans, including Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale, and Plasmodium vivax. Among them, Plasmodium falciparum is the main pathogen of epidemic malaria in Africa and also the Plasmodium that causes the highest mortality rate in patients.
　　In China, the most common types of malaria are tertian malaria and malignant malaria, with rare cases of quartan malaria and very rare cases of ovale malaria. Malignant malaria mainly occurs in southwest China and Hainan. Tertian malaria occurs in the northeast, north, and northwest.

　　1. The initial symptoms of malaria are similar to those of a cold, with intermittent fever and chills, and headaches, which can lead to complications such as pulmonary edema, liver and kidney failure, anemia, and even coma.
　　2. If not treated in the later stage, serious complications such as cerebral malaria, blackwater fever, and even death may occur.
　　Cerebral malaria can be divided into adult cerebral malaria and pediatric cerebral malaria.
　　Blackwater fever is one of the serious complications of malignant malaria, and it is rare in malaria and tertian malaria, caused by acute hemolysis. The main manifestations are sudden chills, high fever, back pain, progressive anemia, and jaundice, with a sudden decrease in urine volume to soy sauce color. The urine contains a large amount of hemoglobin, casts, and epithelial cells. Severe cases can lead to acute renal insufficiency.
　　3. Malaria nephropathy is mainly manifested as hypertension, proteinuria, hematuria, and edema, and it can occur in all four types of malaria, but it is more common in malaria. Enlarged spleen, liver, blood cell changes, and pseudo-peritonitis are also common complications.

　　Clinically, the symptoms of malaria are divided into four stages, namely the prodromal period, the chill period, the fever period, and the sweating period.
　　Prodromal period
　　As for fatigue, drowsiness, and yawning; headache, muscle aches in the limbs; loss of appetite, abdominal discomfort, or diarrhea; irregular low fever. Generally lasts for 2-3 days, with some lasting a week. Then it turns into a typical attack. It is divided into three stages.
　　Chill period
　　Suddenly feeling cold, first the extremities feel cold, then quickly the back and whole body feel cold. The skin develops goosebumps, the lips and nails turn cyanotic, the face is pale, and the whole body's muscles and joints ache. Then the whole body shakes, the teeth chatter, and some cannot be stopped even with several blankets, lasting about 10 minutes to an hour, until the shivering stops naturally, and body temperature rises. During this period, patients often have a sense of serious illness.
　　Febrile period
　　After the cold sensation disappears, the face turns red, cyanosis fades, body temperature rises rapidly, usually the more severe the chills, the higher the body temperature, which can reach above 40℃. Patients with high fever suffer greatly. Some are restless and moan ceaselessly; some are delirious, clutching at thin air, or even have convulsions or lose consciousness; some have severe headaches. They have persistent vomiting and a flushed face. They breathe rapidly; conjunctivitis; the skin feels hot and dry; the pulse is strong and rapid; urine is short and dark. They often complain of palpitations, thirst, and a desire for cold drinks. It lasts for 2-6 hours, with some lasting over 10 hours. After several attacks, herpes on the lips and nose are common.
　　The sweating phase
　　In the late stage of high fever, there is slight sweating on the face and palms, which then spreads throughout the body, with profuse sweating, wet clothes, and a decrease in body temperature for about 2-3 hours, often dropping to 35.5℃. Patients feel comfortable but are very tired and often fall asleep peacefully. After waking up, they feel refreshed, their appetite returns, and they can work normally again. This is the intermission period.
　　The entire attack process lasts about 6-12 hours, with typical attacks repeating every 48 hours. Generally, there are 5-10 attacks, which naturally terminate due to the development of immunity in the body.

　　The main method of preventing malaria is to avoid being bitten by mosquitoes.
　　1. Avoid staying in primary forests and ravines.
　　2. Use insecticides such as DDT, but be careful of ecological damage and the development of mosquito resistance.
　　3. Before going to an area where malaria is prevalent, it is necessary to take preventive measures, such as consulting a doctor to prescribe Quinine for prevention.
　　4. If you need to go to the countryside or forest, try to avoid the peak activity periods of Anopheles in the morning or evening.
　　5. Wear light-colored long-sleeved shirts, long pants, and hats to minimize skin exposure.
　　6. Use mosquito nets, mosquito incense, and other mosquito control measures; mosquito nets soaked in insecticides are more effective.
　　7. Use mosquito repellent containing DEET and apply it to exposed skin. Reapply after sweating.
　　8. In terms of eradicating the larvae of Anopheles, the weeds in river channels can be cleared, and some obstacles in part of the river channels, such as stones, can be removed to accelerate the flow of the river.
　　9. In the room, insecticides can be sprayed on the walls. Because mosquitoes have the habit of resting and digesting after biting human blood and sticking to the wall, the insecticides left on the walls can kill mosquitoes.
　　10. If traveling to a place, be sure to keep a detailed record of the places visited to provide reliable information to medical staff when you suspect you may have been infected.

　　Laboratory tests for malaria include routine blood tests, blood smear tests, abdominal ultrasound, and more.
　　One, blood count: White blood cells are normal or reduced, and there may be a reduction in red blood cells, hemoglobin, and platelets.
　　Two, malaria parasite examination: Blood smear staining to detect malaria parasites is the most reliable method for diagnosis. In addition, bone marrow puncture smear staining can also be performed to detect malaria parasites.
　　Three, rapid detection of malaria parasites: Clinical application in recent years has confirmed that this method is simple, quick, convenient, and accurate.
　　Four, abdominal ultrasound examination shows that the liver and spleen are slightly to moderately enlarged.

　　Malaria patients should pay attention to fluid intake. For those with poor appetite, a liquid or semi-liquid diet should be provided until recovery, followed by a high-protein diet; for those unable to eat due to vomiting and diarrhea, appropriate fluid replacement is necessary; iron supplements can be given to those with anemia.
　　Food suitable for consumption
　　Food should be light, refreshing, and easy to digest, with high protein content, rich in various nutrients, and sufficient water. Milk, liver soup, egg soup, fruit juice, and vegetables are some examples of such foods.
　　During the high fever period, eat light, plain semi-liquid foods, such as rice porridge, noodles, vegetable soup, fruit juice, milk, egg soup, etc.
　　For those with a strong fever and dry mouth and tongue, eat fresh fruits and vegetables, such as watermelons, pears, water chestnuts, sugarcane.
　　Food to avoid
　　1. For those with warm malaria, high fever, thirst, red urine, constipation, avoid spicy, warm, and irritating foods, such as cigarettes, alcohol, garlic, chili, pepper, chives.
　　2. For those with cold malaria, chest tightness, indigestion, nausea, and thick, greasy fur, avoid fatty, sweet foods, such as fried foods, fatty meat, sweet potatoes, molasses, glutinous rice sweets.
　　3. For those with recurrent malaria, avoid seafood and vinegar, pickled food, such as rubber fish, yellow croaker, mackerel, shrimp, pickled fish, sour and spicy vegetables, pumpkin.

　　Malaria requires symptomatic treatment and treatment with antimalarial drugs.
　　1. Treatment of intermittent fever, three-day fever, and ovale fever: 1.5g of chloroquine taken in three doses over three days (0.6g on the first day, 0.45g on the second and third days), plus 90-180mg of primaquine taken in four to eight doses over four to eight days (22.5mg per day), all of which are adult doses, with children's doses reduced accordingly.
　　2. Treatment of malignant malaria: 1.5g of chloroquine taken in three doses over three days (0.6g on the first day, 0.45g on the second and third days), plus 45mg of primaquine taken in two doses over two days (22.5mg per day).
　　3. Treatment of chloroquine-resistant malignant malaria: 1.2g of artemether, 1.0g of sulfadoxine, and 45mg of primaquine, taken in two doses over two days; or 600mg of artesunate taken in five doses over five days (200mg on the first day, taken twice; 100mg per day from the second to fifth day, taken twice), plus 45mg of primaquine taken in two doses over two days.
　　4. Treatment of severe malaria: Sodium artesunate or artemether or quinine dihydrochloride injection for antimalarial treatment, as well as intravenous fluid therapy, vitamin supplementation, and auxiliary and symptomatic treatment.
　　5. Symptomatic treatment: (1) Physical降温 for those with high body temperature. (2) Ensure adequate fluid intake. (3) Apply low molecular dextran to prevent red blood cell aggregation in the blood vessels, which is beneficial for the treatment and prevention of DIC. (4) When brain edema occurs, use 250ml of 20% mannitol for rapid intravenous infusion, twice or thrice a day. (5) For severe patients, appropriate doses of adrenal cortical hormones can be used.