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"Child`s Health" 7 (50) 2013

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Pediatric aspects of malaria in children

Authors: Kirilenko V.A., Kirilenko T.V. - Vinnitsa National Medical University. N.I. Pirogov

Categories: Pediatrics/Neonatology

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Malaria is a potentially fatal blood disease caused by a parasite that is transmitted to human and animal hosts by the Anopheles mosquito. The human parasite, Plasmodium falciparum, is dangerous not only because it digests the red blood cells hemoglobin, but also because it changes the adhesive properties of the cell it inhabits.

Epidemiological malaria foci persist in more than 100 countries of tropical and Sub-tropical regions in a broad band around the equator, including much of Sub-Saharan Africa, Asia and the Americas. According to the World Malaria Report-2011 there were 216 million cases of malaria and 65,000 deaths mainly among children in 2010. Malaria is now returning to areas where it was once controlled, and it is entering new territories. Because of plasmodial and mosquito resistance to drugs and insecticides, the danger of malaria has worsened, and the disease is now a major global problem.

The main principles of global strategy in resistance to epidemics were considered at the Big Eight Summit of the most developed countries in 2006. The top three most topical infections included tuberculosis, HIV/AIDS and malaria.

Imported cases of malaria are recorded in Ukraine now. It could cause in perspective a threat of the local incidence restoration and children involvement in the epidemiological process.

The main spreading factors of malaria:

1. Uncontrolled migration of refugees from the endemic regions, infection of peacekeepers, different missions, pilgrims and tourists.

2. Environmental defects that accumulate plenty mosquitoes in a variety of artificial ponds, bogs, water in different containers in landfills, various developments, in recreational areas.

3. The increasing resistance of malaria parasites to antimalarial medication. Starting with 70-80 years the resistance to Chloroquine was registered in 44 countries in Africa, 25 - in Asia and Oceania, 10 - in Central and South America.

In malaria distinguish intrauterine infection, congenital infection during passing through the birth canal due to contact with the mother's blood and malaria from mosquito bites during the child subsequent development. Transplacental Congenital malaria affects the child's development as prematurity, malnutrition. The temperature is normal or subfebrile; there are anxiety periods, clonic tonic seizures and cyanosis. Malaria infants infected during passing through the birth canal develops after an incubation period due to the pathogen. Attacks of typical fever in infants are rare, cyanosis appears instead of shivering. Also hiccups begin at a certain time instead of fever. The general condition of patients is characterized by anxiety, the chest rejection, repeated vomiting, diarrhea and exsicosis. Up to 3 years of age malaria is especially hard with multi-organ lesions and the appearance of heart, kidney, adrenal, nervous, pancreatic and other forms, as well as prognostically unfavorable complications: cerebral malaria (coma), hemoglobinuric fever, malarial algid. In particular this applies to falciparum malaria with acyclic transient current.

Diagnosis. The direct evidence is the detection of malaria parasites in red blood cells. Blood sample should be taken regardless of the attack - quickly at any time. A thick blood drop and smear are examined to look for parasites. Plasmodium is detected in the thick blood drop. The smear allows species identification because each of the four major parasite species has distinguishing characteristics. The negative results need to be tested again in the dynamics. Among the modern tests Enzyme Immunoassay can detect antibodies within a few days after the malaria onset.

A single dose of Fansidar is prescribed for the treatment of all malaria types except falciparum malaria. A three-day cycle with a 14-day course of preventive treatment only under P.vivax and P.ovale is held by alternative Chloroquine.

Treatment of falciparum malaria is treated separately because of chemical resistance and high pathogenicity of P. falciparum. The current drugs of choice are Artemether and Lumefantrine. Artemether is derivative of Artemisinin, isolated from a special type of wormwood. It has been used in China to treat fever for a long time. Lumefantrine is a chemotherapy drug similar in action to quinine. The compulsory factor is to combine these two components in the tablets form. According to the WHO recommendations the combination therapy is the only effective treatment for uncomplicated falciparum malaria, especially in children.

Malaria prevention needs improvement. Individual prevention of antimalarial drugs should be given before leaving, during staying and after returning from the endemic regions. It is advisable to visit a pediatrician or an infectious disease doctor before leaving and returning. Protection against mosquito is provided by repellents, space grids, especially in the twilight.

The test vaccine program against falciparum malaria is carried out in seven African countries. Completion of the program will be planned in 2014.

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