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The Clinical Presentations Of Vivax And Falciparum Malaria

Updated on March 27, 2014

Prophylaxis Against Malaria In Epidemic Regions


Vivax Malaria

The incubation period in this infection ranges from 10 to 15 days which may be prolonged in subjects taking antimalarial prophylaxis irregularly. The disease manifests with fever, headache, vague discomfort, aches and pains, nausea and vomiting, all of which may resemble other febrile illnesses. The pattern of fever does not show periodicity in the early phase of the illness.

After a week or two of the primary attack, periodicity gets established. The paraoxysms occur in three stages- cold stage, hot stage and sweating stage. These stages are very characteristic of malaria. The cold stage starts with the feeling of chills and rigor. The temperature shoots up to 400C or more, and the pulse is rapid. The skin is pale and cold. The hot stage sets in 30 to 60 minutes later with flushing of the skin, bounding pulse, severe headache of the skin, bounding pulse, severe headache and restlessness. Hyperpyrexia may occur in non-immunes. Herpes labialis is common. Sweating starts after 2 to 6 hours and this becomes profuse. Temperature rapidly comes down to normal, the pulse becomes slow and the patient goes to sleep, fully exhausted and dehydrated, to wake up fresh. These paroxysms repeat at an interval of 48 hours. The temperature is normal and the patient feels well in between the attacks. These paroxysms recur for about three months after which they subside even without treatment. Late relapses may occur even 2 to 3 years after leaving the endemic areas. Liver and spleen become palpably enlarged after two weeks of illness. Vivax malaria is not usually fatal. The relapse may resemble the primary attack except for the fact that the typical periodicity is evident from the beginning.

Ovale tertian malaria is similar to vivax.

Falciparum Malaria Manifested In An Infant Child


Falciparum Malaria

The incubation period ranges between 10 to 14 days. Prodormal symptoms like body ache, headache and vomiting may be more severe than those of vivax malaria. The disease starts either acutely or insidiously in the classical form with the three stages, or atypically. Unlike as in vivax malaria, the patient may not feel well in between the febrile paroxysms. The periodicity may be either quotidian (daily) or subtertian (less than 48 hours). In some cases, the fever may be remittent or continuous when two groups of parasites develop simultaneously and sporulate on alternate days. The initial symptoms may be deceptively mild and fatal complications may set in unexpectedly at any time. When mixed infections with different specieis occur, symptoms due to P. falciparum predominate. Rapid hemolysis may give rise to normocytic anemia. In severe cases, hemoglobinuria may develop. In the majority of cases, only the ring form and gametocytes are present in peripheral blood. Leucopenia, especially neutropenia is common. Pregnancy may result in abortion or premature labour. Falciparum malaria is dreaded on account of the development of pernicious complications. These include cerebral malaria, malarial hyperpyrexia, gastrointestinal form, and algid malaria. Pernicious complications should be anticipated when more than 5% of erythrocytes are parasite and more than one parasite and the growing forms are seen in peripheral blood.

© 2014 Funom Theophilus Makama


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