Malaria, a life-threatening tropical disease kills a large number of people every year. Along with the ongoing pandemic, the disease can get more serious when it occurs with COVID. In this next part of our series of COVID-19 co-infections, we present the diagnosis and treatment intervention of malaria along with COVID-19.

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Pathogenesis

Malaria is a potentially fatal parasite infection produced by four different forms of protozoa: Plasmodium vivax (P. vivax), Plasmodium falciparum (P. falciparum), Plasmodium malariae (P. malariae), and Plasmodium ovale (P. ovale). It is spread by the bite of an Anopheles female mosquito. After being bitten by an infective mosquito in 10 to 14 days, the person gets infected.

Plasmodium vivax (Pv) and Plasmodium falciparum (Pf) are the two forms of human malaria parasites that are often reported from India. The parasite undergoes a variety of alterations within the human host as part of its intricate life cycle. The parasite completes its life cycle in red blood cells and liver cells (pre-erythrocytic schizogony, erythrocytic schizogony). P. falciparum infection is the most lethal type of malaria.

Diagnosis

Malaria can be diagnosed with an RDT (bivalent) or a microscopic examination of a blood smear. Early identification and rapid beginning of treatment, as recommended by national recommendations, are critical in avoiding uncomplicated malaria from progressing to severe forms that can be lethal. In the current environment, all fever cases in endemic regions should be checked for malaria utilising rapid diagnostic test kits.

Clinical characteristics

Malaria is typically accompanied by a fever, headache, vomiting, and other flu-like symptoms. The parasite infects and kills red blood cells, causing anaemia, fits/convulsions, and loss of consciousness. Parasites are transported to the brain (cerebral malaria) and other important organs via the bloodstream. Malaria provides a significant risk to the mother, the foetus, and the newborn infant throughout pregnancy. Pregnant women have a decreased ability to cope with and eliminate malaria infections, which has a negative effect on the unborn foetus.

Considerations for certain treatment interventions

Prompt malaria case treatment is critical for reducing major malaria cases and mortality. Plasmodium vivax (Pv) patients should be treated for three days with chloroquine (25 mg/kg body weight divided into 10 mg on day 1, 10 mg on day 2, and 5 mg on day 3) and primaquine (0.25 mg/kg body weight daily for 14 days). Primaquine is used to prevent relapse but is not recommended for pregnant women, babies, or those with G6PD deficiency.

Plasmodium falciparum (Pf) infections should be treated with ACT (artesunate 4 mg/kg body weight daily for 3 days + sulfadoxine 25 mg/kg body weight + pyrimethamine 1.25 mg/kg body weight on day 1). This should be followed by a single dosage of primaquine (0.75 mg/kg body weight) on day 2, preferable. However, in light of concerns of companion drug SP resistance, The Technical Advisory Committee of the North-Eastern States has advised that the co-formulated tablet of artemether-lumefantrine (ACT-AL) be used in the North-Eastern States (not advised during the first trimester of pregnancy or in children weighing 5 kg).

This article is part of our new series on managing COVID-19 coinfections. Stay tuned for a new update every week. To read the previous parts, click COVID-19 & seasonal illness- Protocol for determining co-infection, Managing dengue with COVID-19: Clinical considerations & COVID-19 + Influenza/bacterial co-infection