Monday, August 22, 2011

MALARIA – Or is it something else?

35 year old IS works somewhere in the Jharkhand-Uttar Pradesh border as a daily wage labourer. 4 days back, he had high grade fever with chills and rigor. He was treated for malaria by the local quack. As the fever was persisting, he thought of going back home along with one of his fellow villagers who worked along with him.

IS was brought in an almost unconscious state to our casualty sometime today afternoon. The look on his face was enough to tell us that he was gravely ill. The whole of his face was flushed, the sclera of his eyes very chrome yellow and the conjunctiva was all congested. The breathing was labored and chest examination revealed that there was quite a lot of fluid in the lungs. His liver was tender. It looked more like Weils’ disease than malaria to me.

The investigations were terrifying – the serum bilirubin came an astounding 51 mg%, the total count was in the range of 50,000, the platelets 15,000 and a serum creatinine of 4 mg%. Medically speaking, he cannot survive with the sort of facilities we have. The saving grace was that his hemoglobin is 8.9 gm%. And of course, his blood cells was teeming with falciparum malaria.

After reaching his village in Leslieganj yesterday, IS continued to have fever and he became unconscious sometime around midnight. IS’s family is very poor. The reason for IS working so far away from home was to earn a living for his family - 3 little children and a young wife. IS was brought to NJH by fellow villagers and his elder brother.

The elder brother and his villagers were aghast after we pronounced our prognosis and gave them an option of taking the patient elsewhere. As I write this, IS has pulled through so far. I’ve asked the people who brought him to arrange for blood.

In addition, I’ve started him on anti-malarials and treatment for leptospirosis. Many a time, we’ve seen that presence of malarial parasite in the blood tends to be a red herring.

After the persistant rains over the last 2 weeks, it has now become very humid – quite a good environment for the mosquitoes to breed.

We are having quite a lot of malaria than last year. After the last year, when we had lesser cases – most probably due to the drought, I have a feeling that people had started to take possibility of contracting malaria quite lightly. To compound this problem is the practice of single dose treatment by many quacks – it is not uncommon to see people who come with persistent fever after having taken a single injection of artesunate or quinine.

From my experience of 2003-04, one more condition which becomes quite common during high incidence of malaria is the occurrence of injection abscesses. Giving quinine as deep intramuscular injections is something practiced by quacks and many of them ultimately end up as big abscesses. This year, I’ve seen one where the abscess had already organized, solidified and probably fibrosed– sparing the poor sufferer of an incision and drainage surgery.

Today evening, I’ve seen one more patient, a pregnant lady who has come in with fever. Blood examination shows falciparum.

Deaths which could be directly attributed to malaria are quite less nowadays. This is mainly because many of the fever cases come after some form of partial malaria treatment. As far as I remember, almost all the patients who tested positive by smear for malaria have recovered completely.

There has been one death over the last 2 weeks – a 16 year old girl with fever. She had been treated as malaria elsewhere. She had hemoglobin of 3 gm% and was unconscious since the day she came in. She never tested positive for malaria. Most of my colleagues strongly felt thatit was malaria.

Now, this is where we need to do some sort of research on. Are we only dealing with malaria alone or are there other infectious diseases which are very similar to malaria – dengue, leptospirosis, rickettsia etc. I wish we could have help whereby we could explore more on this . . .

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