Initially malaria was considered a disease which cannot be cured but presently due to so much advancement in medication there is hardly any risk of complications. Plus with growing awareness, vaccines are even in trial for malaria.
Malaria can be deadly indeed. In cases of plasmodium falciparum infection, adhesiveness increases due to increment in membrane adhesive protein on the surface of erythrocytes. This causes adhesion of erythrocytes to the capillary endothelium. This process is known as cytoadherance. This causes capillary occlusion and if this occlusion occurs in cerebral areas, it can cause ischemic necrosis which may further lead to death.
This cytoadherance is due to change in membrane of RBC. There is change in shape of RBC associated with antigen changes on its surface. These changes are brought by parasite present inside it.
Thus, all the infected RBC block the capillaries and eventually they even infect other uninfected RBCs. This process of cytoadherance and agglutination is the main pathogenesis of falciparum malaria. When such clots are formed inside vital organs like brain and lungs, microcirculation is disturbed and metabolism is hampered.
How Malaria Can Kill You?
The death usually occurs if following complications occurs with the onset of malaria-
Cerebral Malaria- When a person presents with abnormal behavior and delirium, it should be taken care of. This is the initial stage of development of cerebral malaria. There is diffuse symmetric encephalopathy. If fundoscopy is performed at least 15%, the patient will be diagnosed to have retinal hemorrhages and pupillary dilatation. Chances of epilepsy is increased in such patients. Seizures are more common in young children as compared to adults. Few with cerebral malaria may suffer from language problems.
Hypoglycemia- Failure of liver to perform gluconeogenesis is the main cause of hypoglycemia. Along with decreased production there is increased consumption of glucose by host and parasite as well. And if quinine is given then the hypoglycemia is further exaggerated as quinine is stimulant of pancreatic insulin. When disease is progressed to severe condition hypoglycemia is difficult to diagnose as signs of hypoglycemia, which includes tremors, sweating, tachycardia all are absent in severe disease condition.
Renal Impairment- This occurs due to erythrocytes sequestrations and agglutination in renal vessels, which interferes with renal circulation and metabolism. This causes necrosis of renal tubules. The one who survives resumes its normal state within 4 days. The choice of treatment is dialysis and hemofiltration.
Acidosis- It is an important cause of death, which is commonly encountered in one suffering from severe malaria. Here plasma concentration of lactate or bicarbonate gives the better idea about the real condition. Lactic acidosis occurs as blood flow is hindered to a particular tissue and due to lack of blood supply anaerobic glycolysis begins in that particular tissue associated with hypovolemia and failure of liver.
Noncardiogenic Pulmonary Edema- The cause of this condition is not specified yet. The infusion of fluids aggravates the situation.
Hematological Abnormalities- As RBC becomes infected splenic clearance is enhanced. This causes severe anemia. Plus anemia is caused by antimalarial drugs. Severe bleeding and at times disseminated intravascular coagulation may occur in severe cases.
Liver Dysfunction- Hemolytic jaundice is commonly associated with malaria. When there is hepatic dysfunction then again chances of hypoglycemia, lactic acidosis increases.
All these complications if not treated early can lead to death. Thus, management of all the above mentioned condition is important.
So malaria, which was initially a condition to worry about, is no more a matter of worry due to present day medications. Vaccine which is in trial will further reduce the chance of disease. Thus, the malaria should be diagnosed as early as possible and relevant medication should be given so as to prevent complications which are deadly. So, in case one has high fever with chills and rigor, they should immediately consult a doctor and take proper medications. Because if it gets too late chances of complications increases. Malaria is no more a matter to worry. Proper diagnostic facilities and treatment has made everything easy.
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