MALARIA IN KIDS-
MALARIA IN KIDS fever (cold stage, hot stage and sweating stage) is not commonly seen, the incidence of malaria is quite high in children. Every time it may not be possible to prove the diagnosis clinically or by laboratory investigation. Response to antimalarial treatment dramatic in some of the cases of fever not responding to antibacterial therapy.
Causative Agents of MALARIA IN KIDS
1. Plasmodium vivax
2. Plasmodium falciparum
3. Plasmodium malariae
4. Plasmodium ovale
It requires 2 hosts to complete the cycle-
1. Human being acts as intermediate host: Because in human being par- asites are reproduced by asexual method (Schizogony)
2. Female Anopheline Mosquito: It acts as definitive host because in the mosquito parasites are repro- duced by sexual method.
For a General Practitioner it may be a bit difficult to remember the life cycle in detail because many terms are intermixing and confusing.
From the clinical angle following things of the life cycle are worth remembering.
1. Entry of the infection: The female Anopheline Mosquito pierces proboscis into the skin of the affected person and the salivary secretion containing sporozoites is injected into the punctured wound.
2 Affected organs of the infected fi) In chronic cases spleen; (iii) In severe cases (due to P falciparum) brain and entire peripheral vascular system is involved.
3. Clinical presentation varies with the species of the infective agent.
(a) P. vivax: Benign tertian fever- fever after 48 hrs
(b). P. falciparum: Malignant tertian fever.
(c) P. malariae: Quartan fever- fever after 72 hrs.
(d). P. ovale: Ovale tertian fever.
It occurs due to two different sets of RBCS rupturing at different time and releasing the parasite in the blood stream. This may give rise to continuous fever or fever occurring after 24 hours (Quotidian fever).
SYMPTOMS OF MALARIA IN KIDS-
Febrile paroxysm is the typical pre- sentation of malaria. It consists of 3 stages-
1. Cold Stage
Patient gets severe shivering which may last for 20 minutes to 1 hour. in children this may be confused with attack of convulsions. The cold stage of typical malarial fever will not be associated with (i) Change of sensorium or rolling up of eye balls; (ii) Shivering is not associated with tonic movements of the limbs; (iii) Frothing at the mouth is absent;(iv) The cold stage is followed by hot stage in which fever may rise up to 103° F to 104° F but it is not associated with temporary paralysis of limbs (Todd’s Palsy).
2. Hot Stage
Sudden increase in body tempera- ture which may go up to 103° F. This stage lasts for 1 to 4 hours, after that temperature comes down to normal.
3. Sweating Stage
The hot stage is followed by profuse sweating which may last for 2 to 3 hours.
If not treated with antimalarial drugs the febrile paroxysm repeats periodically. In case of P. Vivax, P. Falciparum and P Ovale it repeats every 48 hours or 3rd day- tertian fever. In case of P Malariae the febrile paroxysm is repeated every 72 hours 4th day (Quartan fever).
Atypical Presentation of malaria in kids
As discussed earlier it may present with continuous fever or fever paroxysm repeated at the lesser interval than mentioned above. In children atypical presentation is more common. In severe cases like pernicious malaria there might be other associated symp- toms like vomiting, loose motions with blood and mucus, altered sensorium, cough and breathlessness.
SIGNS OF MALARIA IN KIDS
During first attack of febrile paroxysm there may not be any signs. In chronic cases getting repeated attacks follow- ing signs may be present (i) Pallor; (ii) Splenomegaly; (iii) Hepatomegaly observed in some of the cases.