Malaria in children. Signs of malaria in older children. The duration of the attack depends on the form of malaria

Many people probably know that such a small nasty insect as a mosquito can be a source of human infection with many serious infectious diseases. After a small bite under the skin, an infected mosquito introduces harmful bacilli, and this is enough for the first symptoms of malaria or another disease to appear soon. In this article we will take a closer look at the main symptoms of malaria disease.

How to understand that a child is infected with such a mosquito or managed to become infected from a sick person. With the observation of what primary symptoms should we start sounding the alarm? What will manifest itself and how the disease can affect the health of children:

With primary symptoms, the child may experience a slight increase in readings on the thermometer, general malaise, and often a headache;
The onset of the disease is acute. The child will shiver very much, then after a couple of hours the temperature may rise to 40-41 C. The skin becomes reddish and coldish, especially the limbs, and the skin feels rough to the touch;
Slight cyanosis occurs on the fingers and the tip of the nose, shortness of breath appears, the muscle surface is painful;
Gag reflex, nausea, delirium and convulsions;
The child is very excited, does not find a place for himself, and constantly rushes about. The pulse quickens and is faintly audible due to sharp decline blood pressure;
Pain in the right hypochondrium and in the area of the spleen.

Usually the attacks are spasmodic, lasting from one hour to 12 hours. After the attack ends, the child’s body becomes covered with profuse sweat, while the body temperature drops, and the child becomes very lethargic due to weakness.

The spasmodic nature of attacks depends on the type of malaria, the age of the children, and the duration of the disease. How older in age child, they are cyclical. The incubation period varies. It all depends on the state of the immune system, what type of pathogen it belongs to:

With three-day malaria, the incubation period can last up to 7-21 days;
If malaria is 4 days old, then this period can be 14-35 days;
In the tropical form of the disease - less than 14 days.

The duration of incubation may also depend on the climacteric conditions where the child is located, on the use of chemotherapy drugs in treatment, etc. It can end faster in a climate where the weather is warmer.

If treatment is delayed for a long period, then the development of hemolytic anemia may be observed, too high magnification liver and spleen. The lips and wings of the nose become covered with hyperemic rashes.

Treating symptoms of malaria in adults

This disease must be treated strictly in a medical facility. Drug therapy can be combined with chemotherapy. They are given plenty of fluids to prevent dehydration, provide bed rest, and are monitored by medical personnel.

For the treatment of malaria in children younger age hemodialysis, therapy with infusion drugs, hemosorption are used. The complex of all therapies leads to good results and complete recovery.

Vaccination and preventive measures

For children, it is customary to carry out preventive measures against malaria in several areas. All of them are necessary to thoroughly strengthen the child’s immune system from the very first day of life. This includes:

Carrying out health procedures;
Purpose vitamin complexes, according to the child’s age;
Adjust the baby food diet in a timely manner;
It is necessary to harden children;
In the form of games, children should receive sufficient physical exercise for normal development.

Preventive measures are carried out in those regions where there is a potential risk of developing malaria of any type.

If a child is traveling with his parents, then he must take with him protective equipment against mosquitoes;
If there is a risk of contracting malaria, it is recommended that children be given, for example, Delagil or Chloridine. The treatment course is 5-7 days;
It is necessary to be vaccinated against malaria. Its effect can be significantly reduced by other vaccinations against infectious diseases, for example, against typhoid fever, jaundice or yellow fever.

Anti-malarial vaccination is not a mandatory procedure, but if it is done when traveling to an exotic country where there is a risk of disease, then the vaccination will save the child’s life in the future.

The most typical and most likely sign that a person has become infected with malaria is severe chills and fever that recur cyclically. At this moment, a critical point occurs due to the fact that the pathogen reaches its goal - it penetrates the blood red blood cells and destroys them.

Treatment of malaria in adults

If a person was diagnosed in a timely manner and a regimen was selected therapeutic therapy, recovery usually occurs quickly. A sick person is hospitalized in infectious diseases department, where the main treatment is carried out.

To eliminate the causes of the disease, the following actions are taken:

For tropical malaria, treatment is aimed at destroying gametocytes;
With the help of therapeutic therapy for three-day malaria and oval-form, tissue schizonts are neutralized;
The main effort is aimed at reducing attacks.

To quickly stop acute febrile manifestations in a patient with malaria, drugs are used in medicine fast acting- hematoschizotropic. The most common medication for the treatment of this disease is Khingamin or Rezokhin. If observed malignant form malaria, it is recommended to administer medicine Chingamine intravenously three times a day, 20 mg/kg.

To reduce intoxication of the body, an infectious disease doctor prescribes colloidal and crystalline liquid solutions to the patient intravenously. To reduce the temperature, an antipyretic agent will not be superfluous.

Development of malaria

Let's take a closer look at the main primary symptoms of malaria:

Acute initial stage with an initial febrile state that lasts for 5-7 days;
Most often, body chills are minor, headache;
Alternating attacks, repeating every other day or two. In the first half of the day there can usually be intense body heat, reaching high marks, increased hyperhidrosis, chills;
After several such attacks, the liver significantly enlarges under the right hypochondrium, and the spleen on the left.

Malaria of this type can be observed in humans for 2-3 years;

This stage of the disease is somewhat similar to the previous type, but passes much easier. The development of pathogenic bacteria in the body takes 10-11 days, and most often it can last 6-18 months.

The chronic stage of malaria lasts for many years, from 5 to 50 years. The disease is characterized by relapses;

The incubation period of the disease with this form is usually a week, but it can be longer, somewhere up to 16 days. The initial state is uncharacteristic of the disease, since chills are practically not manifested and there are no typical primary symptoms.

The febrile state can last up to two days;
Body temperature decreases without signs of sweating;
Convulsive syndrome, headache;
There is pain in the muscle surface and joints;
Respiratory manifestations progressing to bronchitis or pneumonia;
Moderate renal failure.

In the tropical form of the disease, doctors often put misdiagnosis, since the manifestations of malaria itself are not very typical for it.

How is malaria transmitted?

More than 100-200 years ago, it was common in medical circles that malaria was transmitted only by airborne droplets. But this is not an entirely accurate hypothesis. Now scientists have already proven that the pathogen can enter the body in other ways.

Let's look at them briefly:

The main route of infection with malaria was, and still is, a mosquito bite;
People can also infect each other, for example, a woman is in interesting position expecting the birth of a child, but during this period she suffered from malaria. Happens here intrauterine infection from the mother if the placental layer has been damaged. In other cases, it is almost impossible for people to infect each other;
The disease can be caught in a medical facility if the treatment was carried out with poorly processed instruments, for example, the injections were given with an unsterile needle;
At a blood transfusion station, contaminated blood fluid may be taken from a patient, which will then be injected into another person. This method of transmission concerns only carriers of the virus;
Donor organ transplantation.

Can people get infected from each other?

As described above, infection can only occur in the case of intrauterine transmission from a mother to her unborn child. A pregnant woman constantly undergoes hormonal, immunological and other changes in her body throughout the nine months.

There is a medical theory that expectant mothers become too weak during pregnancy. the immune system, the body is not protected as necessary, which allows harmful microorganisms to penetrate it.

If a pregnant woman or a woman who has just given birth becomes infected with malaria, it is likely that the disease will be very severe with subsequent complications. side effects. For example:

This may be fetal loss;
The risk of developing intrauterine pathologies in a child;
The baby may be born underweight.

If a woman expecting the birth of a child has primary symptoms, she must be immediately hospitalized in a medical facility for the necessary medical therapy. The disease can develop rapidly; treatment should not be delayed.

The causative agent of malaria

The source of the disease is several varieties of harmful microorganisms belonging to the class of protozoa - these are plasmodia. Depending on which of them enters the body with mosquito bite, the development of malaria in one form or another begins. Most often, epidemic outbreaks can be observed:

Among children, since they are most susceptible to infection;
For tourists visiting exotic countries with hot and humid climates.

Sporozoites in the human body look for a fertile place for reproduction. To do this, they travel a long way and most often settle in the liver. Hepatocyte microorganisms invade the liver cell structure, where their transformation actually occurs. Here they are transformed by multicellular division into schizonts - large spherical cells.

In tropical malaria, such harmful cellular structures multiply in occupied liver hepatocytes. Each cycle of their reproduction can occur within 7-10 days. At the same time, they multiply beautifully, killing the hepatocyte cells themselves. This process occurs at lightning speed, which causes a febrile malarial state in humans.

During malarial attacks, during moments of severe chills, extensive narrowing of the periphery of nerve endings is observed. During sharp increase temperature, a strong expansion of the capillaries occurs, from which the person becomes red and sweats profusely.

Such spasmodic conditions can increase the secretion of substances that are responsible for increasing the permeability of capillary walls. Due to the entry of plasma and protein into the space outside the vessels, the blood becomes thicker, as a result of which the movement of blood in the system slows down and blood clotting increases. Also, due to the death of red blood cells, anemia may develop.

Conclusion

Before visiting any exotic islands or countries, tourists should visit an infectious disease doctor for consultation. He will advise which vaccine to take, talk about possible ways infections, what to watch out for, techniques preventive measures. Don't think that malaria is simple illness. Behind this simplicity there are many people who have passed away.

The causative agent of malaria, also known as malarial plasmodium, is merciless towards all its potential hosts, regardless of their age. Malaria in infants is extremely rare. But for children older risk being bitten by a malarial mosquito and infected with single-celled protozoa is quite high.

Characteristics of the pathogen

There are several types of plasmodia that can harm humans:

P. vivax causes tertian malaria;
P. falciparum is its tropical variety.

The development of malarial plasmodium occurs with a change of hosts. He has two of them: a human and a mosquito from the genus Anopheles. Life cycle The protozoa consists of asexual and sexual generations. Asexual schizonts develop in human red blood cells. They fill the entire space of the erythrocyte, mature in it, break up into asexual micromerozoites, which penetrate into new healthy shaped elements blood and the cycle repeats. The erythrocyte cycle lasts for a day in the three-day-old form and two days in the tropical form.

The disease is most often found in areas where there are many bodies of water - places suitable for the development of mosquito larvae. Malaria is characterized by seasonality. It also depends on the duration of incubation and the developmental characteristics of the vector. The sexual generation of protozoa develops in the tissues of the mosquito. As a result, sporoumbrellas are formed, ready for infection.

Pathogenesis of the disease

Symptoms of malaria in adults and older children are almost the same. In the youngest patients, the disease occurs with a number of features.

In the southern regions, incubation of the pathogen lasts from 10 to 20 days. The main symptom is attacks of fever that occur every 2 days in the three-day form and every 4 days in the four-day form. The tropical form is characterized by an abnormally remitting attack.

Malaria in a child begins with shaking chills with a temperature of up to 41°C. The patient suffers from pain in the legs and lower back, from overexcitement, headaches, delirium, clouded consciousness. Chills give way to thirst and fever. Heavy sweat ends the attack. After a certain time, the temperature returns to normal, the patient feels better, but remains drowsy and weak.

The duration of the attack depends on the form of malaria:

up to 8 hours with three days;
up to 36 hours with four-day and tropical conditions.

In addition, anemia develops, caused by massive damage to red blood cells. The duration of three-day malaria without treatment is 1.5-2 years, four-day malaria is many years.

Deterioration of the condition is accompanied by cirrhosis of the liver, mental disorders, swelling of brain tissue, malarial coma, acute renal failure. An attack of tropical fever can be fatal.

The cause of death of the patient is blockage of the capillary network of the brain by the simplest and consequences in the form of:

circulatory brain disorders;
spontaneous urination and bowel movements;
respiratory and urinary disorders;
seizures;
stunned;
disappearance of some reflexes (tendon, skin, etc.).

Symptoms of malaria in infants

Malaria in infants is characterized by less severe chills and the absence of profuse sweating at the end of the attack. Heat the body does not jump, but remains constant. Developing symptoms resemble meningoencephalitis with seizures, intestinal dysfunction, severe toxicosis and cardiovascular failure.

When making a diagnosis, the staging characteristic of attacks and the temperature curve are taken into account. Additional diagnostics is carried out in order to distinguish malaria from leishmaniasis, which is common in the southern regions, as well as from sepsis. For laboratory examination Blood is taken 2 times: during an attack and after it. If protozoa are present, the diagnosis is confirmed. Their absence does not exclude malaria.

Treatment of malaria in children

Therapy is based on antimalarial drugs, which should preferably be used as early as possible. Treatment is carried out until the protozoa are completely destroyed in the patient’s body and the source of plasmodium is eliminated.

Antimalarial compounds act on the pathogen at different stages of its development.

There are 3 groups of medicines:

Those that act on the asexual generation. Represented by Quinine, Bigumal, Akrikhin, Chloroquine, etc.
Active against gametes or germ cells (Primaquine, Plasmocide).
Destructive forms located outside of red blood cells.

Influencing protozoa on different stages development, it is possible to achieve positive dynamics in the treatment of malaria.

Start with Chloroquine, taken for 3 days. Akrikhin therapy is continued for the next 4-5 days. For the tropical form, Bigumal is used additionally for 5 days. At the end of the cycle, take Quinocid. The treatment course lasts 2-3 weeks.

Malaria was once treated with anti-relapse methods. Today, with the advent of Khinocid, this technique is used in the treatment of tropical malaria, which appeared at the end of last year or at the beginning of this year.

Patients with malignant and comatose forms require immediate treatment. The patient receives intravenous (0.1 g) and intramuscular injections Arinina (0.2 g). After 6 hours, another 0.3 g is administered.

Effective treatment with Chloroquine with the introduction of 10 ml of solution with a mass fraction active substance 0.05 and repeat after 6 hours. The dosage presented is for adults. Children's doses are determined by the attending physician and depend on the age of the child. In a coma state, the treatment tactics adopted for the corresponding conditions are carried out.

With timely treatment, the disease ends after the first attack. Patients who have recovered from malaria are monitored at the dispensary for about 2.5 years, and throughout this period they donate blood for testing.

Prevention

The solution to the problem of eliminating the source of infection is carried out by early diagnosis and treatment of gamete carriers and patients with malaria. To prevent infection in areas where the malarial mosquito is widespread, mechanical methods of control are used in the form of netting windows, installing curtains over sleeping places, as well as prevention with special ointments, creams, chloroquine (1 daily dose in Week).

Persons traveling to countries where malaria is a problem are given chemoprophylaxis. Active vaccination is also possible.

To combat vectors of malarial plasmodium:

Gambusia fish, which feed on mosquito larvae, are bred in reservoirs;
carry out reclamation of wet areas;
Mosquito habitats are filled with oil;
pollinated with the preparation “Paris greens”;
insecticides are used.

Malaria- an infectious disease that lasts a long time, manifests itself in periodic attacks of fever, provokes an enlargement of the liver, spleen and progressive anemia.

Malaria caused Plasmodium falciparum, may occur with cerebral complications or without them. Salaria caused by Plasmodium vivax, can lead to splenic rupture or other complications, and can also occur without complications. Malaria caused Plasmodium malariae, may occur with nephropathy, with or without other complications. The disease can also be caused Plasmodium ovale.

The duration of passive immunity received by a baby in the womb lasts from 5 to 8 months. Children with a genetically determined deficiency of certain erythrocyte enzymes and indigenous residents of natural foci of malaria are relatively resistant to the disease.

Malaria is most common in the summer and fall, as this is when mosquitoes are active. In winter, the pathogen lives in the human body. In countries with a tropical climate, malaria is one of the most common infectious diseases. In our country, malaria practically does not occur; almost all cases are a disease of children who came from countries with a tropical climate.

What provokes / Causes of Malaria in children:

The causative agent - malarial plasmodium - belongs to the type of protozoa, the genus Plasmodium. There are 4 types of malaria pathogens in children: P. malariae, P. vivax, P. falciparum, P. ovale.

Pathogenesis (what happens?) during Malaria in children:

Attacks of the disease are caused by the erythrocyte phase of development of malarial plasmodia. An attack begins when infected erythrocytes disintegrate and merozoites, free hemoglobin, metabolic products of the pathogen, fragments of erythrocytes with pyrogenic substances, etc. are released into the blood. They affect the thermoregulatory center, which causes a pyrogenic reaction. They also have a general toxic effect.

The response to the process described above is hyperplasia of the reticuloendothelial and lymphoid elements of the liver and spleen and the phenomenon of sensitization with possible reactions hyperergic type.

Pathomorphology. When you have malaria, brown pigment is deposited in many organs. Its greatest amount is in the liver, bone marrow and spleen. This leads to the fact that the internal organs are painted in the corresponding shade. A sharp enlargement of the liver and spleen is recorded. With a long course of malaria in parenchymal organs Areas of sclerosis are formed, interspersed with foci of anemic infarctions. Congestion of the internal organs of a child with malaria is observed.

Symptoms of Malaria in children:

The duration of incubation depends on the immunoreactivity of the child and the type of pathogen that has entered the body. The incubation period for 3-day malaria is from 1 to 3 weeks, for 4-day malaria - from 2 to 5 weeks, for tropical - less than 2 weeks. Also, its duration depends on the climate in which the child lives, the use of chemotherapy for preventive purposes, etc. The warmer the climate, the shorter the incubation period.

The symptoms observed during the illness largely depend on the age of the patient. If the child is over 3 years old, then he exhibits the same clinical picture as in adults with malaria. Before the first symptoms, sometimes headaches, malaise occur, and body temperature rises slightly.

The onset of the disease is acute, severe chills, body temperature may be slightly elevated. The skin becomes cool and rough. The extremities become especially cold, slight cyanosis of the tip of the nose and fingers, severe headache, and shortness of breath appear. There is a possibility muscle pain and vomiting.

Chills after 1-2 hours are replaced by a feeling of heat, at the same time the temperature rises to a level of 40-41 ˚С. The face turns red, the patient becomes thirsty, hiccups and vomiting appear. The child is excited, tossing about, loss of consciousness, delirium, and convulsions are possible. The pulse weakens, becomes frequent, and blood pressure decreases. There is enlargement and tenderness of the liver and spleen.

The attack lasts 1-15 hours and ends in heavy sweat. The temperature drops significantly, the child feels severe weakness, which quickly passes and the condition becomes satisfactory. The frequency and sequence of attacks depend on the type of malaria, the age of the child and the duration of the disease. The attacks are more cyclical than older child.

With a long course of the disease, anemia of the hemolytic type develops; the liver and spleen can be very enlarged. Also, in frequent cases, herpetic-type rashes are recorded on the lips and wings of the nose, subicteric skin and sclera with unchanged color of urine and feces.

A blood test at the onset of the disease shows leukocytosis and neutrophilia. At the peak of the attack, the number of leukocytes in the blood decreases; during the period of apyrexia, leukopenia with neutropenia and relative lymphocytosis is detected with great consistency. In almost all cases, the ESR is higher than normal. In severe forms of malaria in children, the number of red blood cells and hemoglobin is greatly reduced.

Late relapses occur after 5-9 months or more from the onset of the disease. The attacks are milder than at the beginning of malaria or during early relapses. The occurrence of late relapses is presumably associated with the release of tissue forms of malarial plasmodia into the blood from the liver.

If treatment is not carried out, the disease can last about 2 years with 3-day malaria, about 1 year with tropical malaria, and with 4-day malaria - many years.

Complications. The most difficult complications of malaria in children are:

malarial coma,
cerebral edema,
malarial algid,
acute renal failure,
mental disorders.

Malarial coma, as a rule, occurs in children from 5 to 12 years of age with tropical malaria. The reason is severe violations cerebral hemodynamics after filling almost the entire capillary network with erythrocytes infected with schizonts.

In patients in such cases, the following symptoms dominate:

disorder of consciousness,
stupefaction,
meningeal symptoms,
cramps,
disappearance of skin and then tendon reflexes,
clonus stop,
disorders of the kidneys, lungs, etc.,
build-up cardiovascular disorders,
spontaneous passage of stool and urine.

If the necessary treatment is not carried out in time, the disease can result in death.

Malarial algid- This rare complication tropical malaria. A collaptoid state appears. The patient is indifferent, but consciousness is preserved, the skin is pale and cyanotic, facial features are sharpened, the skin is covered with cold sweat, blood pressure and body temperature are low, the pulse is thready, not caused tendon reflexes, diarrhea occurs, dehydration is possible.

Acute renal failure in malaria in children appears due to intense hemolysis of red blood cells, severe hemoglobinuria, and impaired renal microcirculation.

Mental disorders in malaria they are manifested by motor agitation, hallucinations, clouding of consciousness, etc. This complication almost always appears with tropical malaria (much more often than with other types of disease).

Brain swelling signifies malignant lightning-fast form diseases. At the height of one of the attacks, symptoms such as convulsions, severe headache, foam at the mouth, and loss of consciousness suddenly appear. Soon, edema and swelling of the brain develop acutely, leading to death.

Malaria in children under 12 months. Typical attacks of malaria in infants under 1 year of age are rare. No chills. There is no typical frequency of attacks. Coldness of the extremities, attacks of cyanosis appear, there is a possibility of repeated vomiting, convulsions, and meningeal symptoms. Symptoms such as sleep disturbance, breast refusal, and anxiety are common. Also, often from the first days of the disease the body temperature becomes very high, then the temperature curve becomes irregular shape, often low-grade fever.

Infants under 1 year of age with malaria almost never sweat, but the scalp and torso may be moist. Appetite is greatly reduced, there may be anorexia, regurgitation, and sometimes vomiting, especially after eating. Symptoms such as loose stool and abdominal pain. Persistent dyspeptic disorders can lead to dehydration. Anemia develops rapidly, the liver and spleen are enlarged.

Malaria in children under 1 year of age is often severe, toxicosis is pronounced, damage to the central nervous system is noted, hepatolienal syndrome, severe anemia and dystrophy are pronounced. In a child under 12 months of age, malaria may occur without attacks, but at certain times hiccups appear. There is no increase in temperature, sweats or chills. But in such cases, the liver and spleen are always enlarged, and progressive anemia is recorded.

Congenital malaria in children. A baby can become infected while in the womb if the placenta is damaged. If the fetus is infected in the first half of pregnancy, miscarriage may occur. If the fetus becomes infected with malaria in the second half of pregnancy, children are born in most cases weak, premature, with manifestations of intrauterine malnutrition and anemia.

Congenital malaria is characterized by cyanosis, restlessness, toxic-clonic seizures, regurgitation and stomach upset. Fever is often absent, and the temperature reaction is of the wrong type. Characteristic phenomena are hypochromic anemia, hepatolienal syndrome, and dystrophy. If the baby becomes infected during birth, the body weight after birth is normal and symptoms of malaria do not appear. The incubation period passes, the disease begins and manifests itself with the same clinical symptoms as in children under 12 months.

Diagnosis of Malaria in children:

The simplest diagnostic option is when a child has periodic repeated attacks (with chills, sweats and fever), attacks of hypochromic anemia, an enlarged liver and spleen, and subicteric skin and sclera appear.

Diagnosing malaria in infants is difficult. It is important for the doctor to know about the presence of a sick baby in an endemic focus of malaria. For a final diagnosis, laboratory tests are necessary - in peripheral blood detect the causative agent of malaria. It is better to take blood for research during an attack, but it is also possible in a non-attack period.

For serological diagnosis, RIF (most often), RNGA and enzyme-labeled antibody reaction (ERA) are used. Blood preparations containing many schizonts are taken as antigens in RIF. RIF becomes positive at 2 weeks of erythrocyte schizogony.

Malaria during diagnosis is differentiated from relapsing fever, brucellosis, hemolytic jaundice, visceral leishmaniasis, sepsis, leukemia, liver cirrhosis, tuberculosis, etc. Malarial coma is differentiated from comatose states arising from typhoid fever, viral hepatitis B, meningoencephalitis, less often with purulent meningitis.

Treatment of Malaria in children:

For treatment, drugs are used that affect the asexual erythrocyte forms of plasmodium, the sexual forms found in the blood, and tissue forms found in hepatocytes. Chingamine (resoquine, delagil, chloroquine) is often used.

Other treatment regimens for malaria in children are also used. If plasmodia are resistant to quinine, quinine sulfate is prescribed in a dose appropriate to the age, the course is 2 weeks. In some cases, quinine is combined with sulfonamide drugs.

Malaria is an infectious disease transmitted to humans by infected female mosquitoes through their bites. Another source of the disease can be transfusion of contaminated blood, although transmission of the disease in this way is unlikely.

The disease is characterized by attacks of fever. Translated from Italian, malaria, from mala aria - bad air. Used to be the reason The occurrence of the disease was considered to be bad air - hence the name.

The mechanism of infection is as follows: after a female mosquito bites a person infected with malaria, his blood penetrates the salivary glands of the insect and becomes a source of infection for the next person bitten.

Causes

The main cause of malaria in children is bites from infected female mosquitoes. In addition to cases where the disease is caused by a mosquito bite, cases of infection of children in the womb of an infected mother have been observed. The peak incidence occurs in summer and autumn - a period of particular activity of mosquitoes. Malaria is common in countries with a pronounced tropical climate. In our country, the disease was observed in children who came from these countries.

The causative agent of malaria in children is Plasmodium falciparum. The causative agent belongs to the phylum of protozoa, the class of Sporozoans, the order of Bloodspores, and the family of Plasmodium. To date, the following types of malaria pathogens have been identified:

P. malariae - plasmodium - the causative agent of the so-called four-day malaria;
P. vivax is the causative agent of tertian malaria;
P. falciparum is the causative agent of tropical malaria;
P. ovale is the causative agent of tertian malaria.

Symptoms

Malaria in children occurs over a long period of time and is characterized by atypical attacks. The main symptoms of the disease include:

paleness of the skin and cyanosis;
coldness of the extremities - the child’s arms and legs become numb;
temperature increase;
frequent seizures;
vomit;
gastrointestinal upset and diarrhea;
development of anemia;
enlarged liver and spleen.

As mentioned above, children are characterized by atypical attacks of fever. Therefore, a blood test is especially important and must be taken before antimalarial treatment is prescribed.

If your child shows symptoms of malaria, including up to a year after you return from travel, you should seek immediate medical attention. This infectious disease has a very long incubation period and can occur many months after infection.

Diagnosis of malaria in a child

Early diagnosis of the disease in a child will reduce the severity of malaria, and most importantly, prevent death. In addition, diagnosing malaria prevents it further distribution, as the level of its transmission decreases.

microscopy;
or a diagnostic rapid test.

Complications

If a disease is detected in a child, everything should be done immediately necessary measures aimed at combating the disease. If malaria in a child is not diagnosed and treated in time, the consequences of the disease can be very severe, including death. Main possible complications malaria in children are:

anemia;
cerebral malaria;
difficulty breathing as fluid accumulates in the lungs;
renal failure and jaundice;
shock from a sharp drop in blood pressure;
bleeding;
Very low performance blood sugar;
swelling and rupture of the spleen;
dehydration is a lack of water in the body.

It is worth especially noting the fact that complications of malaria can occur within just a few hours after the first symptoms of the disease. The disease develops very rapidly. It is important to provide urgent, timely medical care, and to do it as soon as possible.

If the disease appears in a child after you return from a trip, you must call a doctor at home. This should be done even if anti-malarial tablets have been taken. The doctor should receive full information about which countries you have visited in the last 12 months, including any stopovers.

As mentioned above, malaria is characterized by rapid development. In this regard, timely and accurate diagnosis, as well as correct treatment illness in a child. Remember that you are putting your child at great risk of contracting malaria if you travel with him to an affected area. of this disease area. It is necessary to take increased precautions in order to reduce the risk of developing a dangerous disease.

Treatment

Treatment of malaria is reduced to eliminating all symptoms and is aimed at eliminating them as quickly as possible.

What can you do

The first thing you need to do is urgently answer the following questions:

whether the child has partial immunity to malaria;
whether the disease is caused by Plasmodium falciparum;
what strains of malarial plasmodia are common in the area of infection;
Is there a history and physical or laboratory research any signs of complications of malaria.

What does a doctor do

Based on the answers to the above questions, the doctor will prescribe the child antimalarial treatment with appropriate drugs in the required doses. All prescriptions must be strictly followed in order to avoid complications and severe progression of the disease. The prognosis for malaria in children is favorable if all conditions of the prescribed treatment are met. Otherwise, there may be a risk of death. If you are offered hospitalization, you do not need to refuse it.

Prevention

To prevent malaria in children, it is recommended to avoid traveling with children to endemic areas whenever possible. If you are in an area with a high incidence of malaria, do not allow children to be in areas where there are large concentrations of insects. Active phase mosquitoes from sunset to sunrise. At this time, it is better for children not to be outside.

It is also advisable that children cover all areas of their body with clothing. Dress them in long sleeved shirts and long pants. You need to get a mosquito net and cover it with it sleeping area child.

Malaria is an acute infectious disease caused by malarial plasmodia, characterized by certain patterns: a cyclic course with alternating periods of acute febrile attacks and interictal conditions, splenomegaly, anemia.

From this article you will learn the main causes and symptoms of malaria in children, how malaria in children is treated and what preventive measures you can take to protect your child from this disease.

Treatment of malaria in children

How to cure malaria?

Treatment of children with malaria is carried out in a hospital. Patients with severe, complicated forms of tropical malaria are treated in the intensive care unit. Bed rest for the period of febrile attacks. Diet according to age.

Etiotropic therapy. Antimalarial drugs for treatment are divided into two groups: schizotropic, acting on asexual forms, and gametotropic, acting on sexual forms of plasmodium.

Treatments for malaria in children

Among the schizotropic drugs for the treatment of malaria in children are:

Gametotropic drugs for the treatment of malaria cause the death of gametocytes (primaquine, quinocide); prevent the formation of sporozoites (bigumal, chloridine).

Specific treatment for malaria should be started immediately after diagnosis based on epidemiological history and clinical picture. After taking blood (a “thick” drop and smear), the patient is prescribed a hemato-schizotropic drug (Delagil), without waiting for the results of a blood test.

To cure uncomplicated malaria, relief therapy with dela-gil (chloridine) is carried out. Subsequent administration of primaquine depends on the type of malaria:

for tropical malaria it is used for treatment as a gametocidal agent during the transmission season - for 3 days;
for three-day and oval malaria - as a histoschizotropic drug to prevent late relapses - for 10-14 days;
for four days - not shown.

Fansidar (metakel-fin) is used to treat malaria caused by chloroquine-resistant strains of P. falciparum.

In the treatment of delagil-resistant, as well as severe forms of malaria in children, quinine is used as an etiotropic agent at the rate of 10 mg/kg twice a day after 8-12 hours intravenously drip very slowly (over 2-4 hours) in 100-200 ml of physiological solution. For malarial coma, quinine is administered intravenously in a slow stream (over 20-30 minutes) in 20 ml of glucose. Quinine is prescribed for up to 10 days (more often - 4 - 5 days), then treatment of malaria with Fansidar is continued (up to 10 days).

Infusion therapy for the purpose of detoxification and dehydration, corticosteroids (5-10 mg/kg body weight for prednisolone), diuretics, iron supplements, and drugs for the treatment of disseminated intravascular coagulation are used as pathogenetic agents.

Prevention. Measures to prevent malaria are carried out in the following areas: neutralization of the source of infection, destruction of vectors, protecting people from mosquito attacks, rational use of chemoprophylaxis. Before entering endemic areas, children and adults are given chemoprophylaxis with chloridine (Delagil) for 7 days; upon departure, an antimalarial drug is prescribed for another 4-6 weeks.

In malarial areas, chloroquine, amodiaquine, bigumal, chloridine are taken daily in a dose equal to 1/3 - lU of the therapeutic dose. Important have the fight against mosquitoes of the genus Anopheles, carrying out measures aimed at draining the area and thereby eliminating mosquito habitats.

Treatment prognosis. For malaria, the prognosis is unfavorable, but with timely initiation and proper treatment, complete recovery occurs. Mortality is 0.2 - 0.3% and is observed in cases of complicated or malignant disease (in children with fulminant, comatose or algid forms of malaria).

Symptoms of malaria in children

Typical forms of malaria are characterized by a cyclic course with alternating next periods: incubation, prodromal, primary attack, relapse (early and late).

Incubation period - from the moment of infection until the appearance of the first clinical symptoms malaria. The duration of the incubation period depends on the type of plasmodium (for vivax malaria - from 10 - 20 days to 8-10 months, for ovale malaria - 11 - 16 days, falciparum - 8 - 16 days, four-day - 21 - 42 days), and also the dose of the pathogen and the state of immunity.

The prodromal period lasts from several hours to 1 week and is characterized by malaise, headache, arthralgia, myalgia, loss of appetite, sometimes nausea, vomiting, and diarrhea. There may be slight chilling, an increase in body temperature to subfebrile levels and higher (initial fever). The prodromal period is especially characteristic of vivax and ovale malaria, but is not observed in four-day malaria.

Course of the disease before treatment of malaria in children

Primary attack (primary malaria). After the prodromal period or from the first days of illness (with four-day malaria), symptoms of malaria develop, such as typical malarial paroxysms, occurring with a change in phases: chills, heat, sweat.

Chills are manifested by a trembling symptom. The patient's skin is pale, cold, cyanotic, rough (" goose pimples"). Chills last from 10-15 minutes to 2-3 hours, the longest and most pronounced - with tropical malaria.

Fever - the second phase of paroxysm - is manifested by the following symptoms: a rapid rise in body temperature, cessation of chills, and the appearance of a feeling of warmth. Body temperature rises to 39-40° C, intoxication, tachycardia, and shortness of breath increase. Blood pressure decreases. Delirium and impaired consciousness are possible. The heat phase is especially long in tropical malaria: it can reach 12-24 hours and even 36 hours.

Sweat is the third phase, characterized by the following symptoms: a critical decrease in body temperature to subnormal numbers, profuse sweating, improvement in well-being against the background severe weakness.

Malarial paroxysm lasts 6-12 hours, and with tropical malaria - up to a day or more. The peculiarity of malarial fever is the onset of paroxysm at certain time intervals, at the same time of day (with vivax and quartan malaria - in the morning and afternoon hours, with ovale malaria - in the evening, with tropical malaria - at any time of the day). Fever usually has an irregular intermittent nature with the onset of paroxysms after 48 hours in vivax and ovale malaria and after 72 hours in quartan malaria. Fever in tropical malaria may be of the wrong type. At the beginning of the disease, attacks are not always strictly periodic.

Hepatolienal syndrome is characteristic of all types of malaria (the degree of enlargement of the spleen is greater than that of the liver). By palpation, an enlarged spleen is detected by the end of the 1st - beginning of the 2nd week. diseases with vivax- and falciparum-malaria and at a later date with ovale- and four-day malaria. The liver also increases significantly in size by the end of the 1st week. diseases. Liver functions are moderately impaired only in tropical malaria: the levels of direct and indirect bilirubin in the blood serum and the level of transferases increase, the concentration decreases total protein(due to albumin), later hypergammaglobulinemia appears, and jaundice is possible. As the disease progresses, the liver and spleen continue to increase in size and become dense.

Hemolytic anemia develops due to the destruction of red blood cells at the end of the cycle of erythrocyte schizogony, hypersplenism, and autoimmune mechanisms hemolysis. There is a pale icteric discoloration of the skin and visible mucous membranes with unchanged color of urine and feces.

Duration of malaria:

tropical malaria - from 6 months. up to 20 months (usually 1 year);
three-day malaria - 1.5-3.0 years;
oval malaria - 2-4 years;
four-day malaria - 4-5 years.

Malaria in young children

Characterized by a number of features:

typical attacks may be absent (body temperature first rises to febrile levels, then subfebrile, instead of chills there are attacks of cyanosis and coldness of the extremities, the equivalent of sweat is moistening of the scalp and torso);
the frequency of attacks is not typical;
anxiety, sleep disturbance, breast refusal, even anorexia are often noted;
vomiting, convulsions, meningeal symptoms are possible;
frequent regurgitation, abdominal pain, loose stools;
dehydration may develop;
anemia increases rapidly;
hepatolienal syndrome is expressed;
often found severe forms diseases;
Possible death.

In some cases, an attack-free course of malaria is observed: the child develops hiccups at certain hours without an increase in body temperature, chills and sweat. In this case, hepatolienal syndrome and progressive anemia are always pronounced.

Complications of malaria in children

Specific complications: cerebral malaria, mental disorders, acute hemolysis and hemoglobinuric fever, acute renal failure, cerebral edema, splenic rupture, secondary hypochromic anemia, nephrotic syndrome. Specific complications often cause deaths, mainly in tropical malaria.

Cerebral malaria is a complication of malaria

Occurs due to severe disturbances of cerebral hemodynamics after filling the capillary network with red blood cells infected with schizonts, lasts from 1-2 to 4-5 days. During cerebral malaria, three stages are distinguished: somnolent (precoma), stupor, deep coma. In the precoma stage, lethargy and darkening of consciousness are noted, but there are phenomena of mental and motor excitation, convulsions, hyperkinesis, and stiff neck. The temperature curve in somnolence is of an intermittent nature, in cases of stupor and coma it is constant or of an irregular type. Cerebrospinal fluid pressure is normal, sometimes slightly elevated. The cerebrospinal fluid is transparent, contains 0.15-0.2% protein, and single leukocytes. Blood pressure decreases, toxic breathing appears. Swallowing disorders and gastroenteritis are observed. The liver and spleen are enlarged. Changes in the blood, as in severe malaria.

Mental disorders - complications of malaria

Mental disorders also occur more often with tropical malaria and are characterized by motor agitation, confusion, and the appearance of hallucinations.

Acute hemolysis and hemoglobinuric fever - complications of malaria

The main symptom of hemoglobinuria is the appearance of black or red urine as a result of the predominance of methemoglobin or oxyhemoglobin in it, respectively. After sedimentation of urine, two layers are observed: the upper one is transparent red and the lower one is dark brown, consisting of blood detritus, granular and hyaline cylinders. Contains in urine high concentration protein and bile pigments. With developing renal failure, oliguria is observed (excretion small quantity thick dark tarry urine), then anuria. Uremia develops, coma and after 3-4 days the patient dies. Mortality reaches 50%. If the course is favorable, the attack ends after 3-5 days. The urine becomes lighter and the body temperature decreases, blood repair begins.

Acute renal failure - a complication of malaria

Acute renal failure (ARF) can develop as an independent complication of tropical malaria or accompany cerebral malaria or hemoglobinuric fever. Low urine density, decreased urea concentration, severe proteinuria and cylindruria are determined, and oligo- or anuria develops. The level of urea and creatinine in the blood serum increases. Later changes electrolyte balance.

Cerebral edema is a complication of malaria

Cerebral edema has been observed in past years with primary or recurrent tertian malaria in middle lane Russia. The complication occurred mainly in children preschool age and teenagers. At the height of one of the attacks, a severe headache, convulsions, loss of consciousness, and foam at the mouth suddenly appeared. Death occurred quickly due to the phenomena of respiratory arrest and cardiac activity.

Splenic rupture is a complication of malaria

Rupture of the spleen is more often observed in patients with primary cases of three-day malaria. Immediate reasons rupture of a sharply enlarged spleen may even result in a minor abdominal injury, vomiting, or vigorous palpation during examination. Signs of a splenic rupture are acute and severe pain with symptoms of peritoneal irritation and internal bleeding, decreased heart rate and blood pressure, state of shock.

Secondary hypochromic anemia - a complication of malaria

Nephrotic syndrome - a complication of malaria

Nephrotic syndrome develops with quartan malaria. Pathogenetically caused by the deposition of immunoglobulin complexes IgG and IgM with a specific antigen and complement on the basement membrane renal glomeruli. It is characterized by a slow, steadily progressive course and increase in proteinuria, hypoproteinemia, widespread edema, hypertension and renal failure.

Also complications of malaria are nephrosis, which is relieved under the influence of specific therapy, cirrhosis of the liver, life-threatening damage to the central nervous system with the development of psychosis, focal symptoms (aphasia, mono- and hemiplegia, etc.), coma, occurring gradually or lightning fast, due to circulatory disorders, hemoglobinuric fever (vomiting, colicky abdominal pain, hemoglobinuria , anuria is possible).

Causes of malaria in children

Malaria has been known since ancient times. The disease mainly affects the population of countries with tropical climates, but is also observed in temperate latitudes. In Europe, over much of the continent, the disease was widespread until the 19th century.

The causative agent of malaria

The causative agent of malaria was isolated by the French scientist Laveran in 1880. A few years later, the role of mosquitoes of the genus Anopheles as a carrier of the causative agent of malaria to humans was established. Russian scientists V. A. Afanasyev, V. A. Danilevsky, N. A. Sakharov, E. A. Pavlovsky, S. P. Botkin, N. F. Filatov, E. I. Martsinovsky made a great contribution to the study of malaria.

At the beginning of the 20th century, the incidence of malaria fell sharply, but during the First and Second World Wars it increased again. The malaria eradication efforts carried out by WHO in 1955-1969, although they helped reduce the incidence in many countries around the world, did not bring significant results, especially in Africa.

Etiology. The causative agent - malarial plasmodium - belongs to the half-kingdom Protozoa, phylum Apicomplexa, family Plasmodiidae, genus Plasmodium.

More than 100 species of malaria pathogens are known in monkeys, rodents, and lizards.

P. vivax, which causes tertian malaria,
P. falciparum - tropical malaria,
P. malariae - four-day malaria,
P. ovale - three-day malaria in tropical Africa.

Types of pathogens differ in sensitivity to chemotherapy drugs, morphological characteristics and symptoms, and the diseases caused by them - by the duration of the incubation period, immunological and epidemiological characteristics, and outcomes.

Epidemiology. Malaria is a typical anthroponosis with natural focality.

Transmission mechanism: hemocontact.

Transmission routes:

vector-borne (carriers are female mosquitoes of the genus Anopheles);
blood transfusion (during the transfusion of infected blood and its preparations);
transplacental - from mother to fetus.

Morbidity. Currently, the disease is widespread in Africa, the Near and Middle East, South-East Asia, Latin America. Of the 180 countries, 90 are endemic for malaria. The total number of infected people in the world is 300-400 million people. Every year, 120 million people fall ill with malaria, of which 1-2 million die, 80% of which are children.

Seasonality. In countries with temperate climates, the incidence of malaria is characterized by pronounced seasonality with an increase in the summer-autumn months. In countries with tropical climates, malaria infection occurs all year round. Depending on natural, climatic and social conditions, malaria foci are formed with a certain level of transmission intensity, which remains unchanged for decades (endemic foci).

Mortality. Most types of malaria are benign, but tropical malaria is fatal in 0.5-7% of cases.

Tropical malaria

Tropical malaria often occurs with severe, life-threatening symptoms. This is malignant (pernicious) malaria, ending in death. The pathogenetic features of infection caused by P. falciparum are:

Outcome of infection and nature clinical course infections are determined by the characteristics of the child’s immunological status, in particular the activity of factors of nonspecific congenital resistance, the intensity of post-infectious immunity and the level of specific antibodies received from the mother (in newborns).

The beginning of the immune response is the phagocytosis of malarial plasmodia by macrophages of the liver, spleen, bone marrow. The formation of IgM class antibodies begins from the first days of infection, IgG are produced later. There are antisporozontic, antimerozoite, antischizont, antitoxic and antigametocyte antibodies.

Types of malaria in children

Classification of malaria:

By type of pathogen:

three-day malaria;
ovalemalaria;
tropical malaria;
quartan.

Type:

Typical.

Atypical:

By severity:

Light form.

Moderate form.

Severe form.

By flow (by character):

Unsmooth:

with complications;
with a layer of secondary infection;
with exacerbation chronic diseases;
with relapses (early and late).

Diagnosis of malaria in children

Musculoskeletal diagnostic signs and symptoms of malaria:

stay in an endemic area;
intermittent nature of the temperature curve with peaks after 48 or 72 hours;
the presence of malarial paroxysm (chills, fever, sweat);
progressive enlargement of the spleen;
progressive enlargement of the liver;
anemia.

Laboratory diagnosis of malaria

The diagnosis of malaria can be made clinically, but must be confirmed by laboratory testing before registration.

Indications for blood tests malarial plasmodia are:

increased body temperature and malaise in those arriving from areas where malaria is endemic;
fever for more than 5 days, and in the epidemic season for more than 2 days;
treatment-resistant fever;
increase in body temperature after 2 months. after a blood transfusion;
any increase in body temperature in patients with a history of malaria;
the presence of hepatolienal syndrome in the patient against the background of increased body temperature, anemia, and jaundice of the sclera.

The serological method for diagnosing malaria is mainly used when examining donors. Immunofluorescence reaction is used and linked immunosorbent assay.

In the blood test, at the beginning of the disease, leukocytosis with neutrophilia is noted, then leukopenia with neutropenia and relative lymphocytosis develops; ESR increases significantly from the 2nd week of the disease; the number of reticulocytes increases.

Differential diagnosis carried out with brucellosis, typhoparatyphoid diseases, influenza, visceral leishmaniasis, leptospirosis, tick-borne spirochetosis, sepsis, dengue and pappataci fevers, hemolytic disease and anemia. Malarial coma is differentiated from hepatic, diabetic, uremic, and cerebral coma.

Congenital malaria

It is rare, more often in hypo- and meso-endemic areas where pregnant women with malaria are not treated.

Infection is possible in utero through a damaged placenta (more often with tropical malaria). If the fetus becomes infected in the first half of pregnancy, spontaneous miscarriage may occur. When infected in the second half of pregnancy, children are often born premature, with manifestations of intrauterine malnutrition and anemia. The disease is manifested by attacks of anxiety, cyanosis, convulsions, dyspeptic disorders, regurgitation; Hepatolienal syndrome, hypochromic anemia, and dystrophy are constantly observed.