Are you going for proper test to diagnose Malaria?

Are you going for proper test to diagnose Malaria?

n A completely
cured patient of Maralia may also carry the parasite. Hence, blood smear test is extremely important, feels
Dr L G Ramavat and Dr Sudha Ramavat, retired professors from AIIMS,
New Delhi

By Vikas Vaidya

It is high time now that it needs to be seen scrupulously while conducting tests to diagnose Malaria. The reason is when a person gets cured of Malaria, the antigen test shows a negative result. But if the same person goes for microscopic or blood film test then he may test positive for Malaria. The reason behind this is antigen test gives the result for Falciparam malaria which is very common. The microscopic test can detect Malarie parasite in the body, diagnosing the person positive for Malaria. The person who gets cured may feel healthy but mosquitoes in the atmosphere bite him. This bite may allow the entry of Malarie parasite, because of that he may fall ill frequently, erroneously assuming this condition as viral fever. But it can be Malaria. Hence it becomes necessary to undergo the microscpoic test to make sure that there is no residual effect of the earlier malarial attack. This particular aspect was identified by Dr L G Ramavat and his wife Dr Sudha Ramavat. Dr L G Ramavat had been to many countries to render his services. He along with his wife were at the All India Institute of Medical Sciences (AIIMS) and have done extensive work in this field. Both of them have, on a cautious note, have warned that if the above mentioned aspect of Malaria is not taken seriously then in next 10 years, India’s 50 per cent population may die of Malaria.
Dr L G Ramavat and his wife Dr Sudha Ramavat have been working on this particular aspect of Malaria since long. They practice in the periphery of Nagpur. Most of the patients coming to their clinic are from Bhilgaon, Masala, Khasala, Khairi, Kamptee etc. Out of 772 patients Dr Ramavat has checked, 364 patients have tested positive for malarial parasites, in which peripheral smear of blood was done. Out of these, 170 were female and 190 were males.
Dr Ramavat said, “The data includes almost equal number of males and females. Meaning thereby mosquito female Anopheles is the culprit for biting humans and injecting malarial parasites in their blood.
Dr Ramavat pointed, “This mosquito specie, Anopheles usually grow in unhygienic surroundings where there is stagnation of water. The area where I practice, it is in the periphery of Nagpur and is a living breading ground.”
Malarial parasites recognized in human beings are of four types: Plasmodium Falciparum, Plasmodium Vivax, Plasmodium Malarie and Plasmodium Ovale. Falciparam and Vivex are common and can be identified through Malaria Antigen Detection Test. But the Ovale and Malarie are rare.
Dr Sudha Ramavat said, “In Falciparum, patients have a very high fever that can reach the brain resulting in death of the patient. It is curable if one reaches the doctor in time. Normally Chlroquin is given initially but patients should not consume the drugs on their own as there are stipulated doses as per the body condition of a person.”
Out of these different species of malarial parasites, plasmodium falciparum is notorious for its complications. Fortunately, in our area, we had most cases of plasmodium malarie, two with plasmodium vivax and none with plasmodium falciparum, added Dr Ramavat.
Dr Ramavat said, “When we treated these patients, they got cured, started doing their work routinely but their tests showed positive results. In such cases we found the parasite malarie. To treat malarie, the patients are given primaquin along with chloroquin. But the patient who consumes primaquin must have Glucose-6-phosphate dehydrogenase (G6PD) (a type of protein, called an enzyme, that helps red blood cells work properly). So we conduct G6PD test. Through this test we can know the presence of this enzyme in the body.”
The microscopic or blood film test is more effective because many times when a patient consumes medicine, the parasite may try to protect itself, may hide in spleen etc. This can be idenfied through blood film test.                                                                                                                                                                                                                  
The patient comes with intermittent fever with chills and rigors, severe headache, body ache and dry cough. When initially treated with chloroquine, the patients respond very well but they do not come back after three days of treatment as required and requested. The fever returns and being private practitioners, we do not know whether they go elsewhere or remain untreated, said Dr Sudha Ramavat. Dr Sudha has developed a small laboratory in their clinic to conduct tests.
The patient comes, suffering from anemia, body ache, feeling of malaise and malnourishment. They may or may not complain of fever. Such people prove positive for malarial parasites again and we prefer to label it as chronic stage of malaria. It can be treated but it requires lot of perseverance and patience on both the clinician and the patient’s front, said Dr L G Ramavat.
Almost half of the world has malaria in rampant condition, including the Asian sub-continent, Africa and India as well, being an endemic for the same. If untreated or self-medicated or wrongly treated, it can lead to many severe complications and even death, warned Dr Ramavat.

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Symptoms of some of the diseases

The easiest way to diagnose malaria clinically would be to be aware of the following symptoms:
·    Malaria – Intermittent fever with chills and rigors initially.
·    Typhoid – Continuous fever.
·    Viral – Remittent fever.
·    Tuberculosis – rise in temperature in the evening.
It has been noticed widely that antigen test for malaria is negative for plasmodium malarie and ovale, even when the blood film is positive for parasites. My feeling is that antigen test might be good in case of plasmodium falciparum and vivax and not for plasmodium malarie.
The fact is that if we want to get rid of this disease, we have to work on war footing and improve living standards and hygiene consciousness, educating the general masses about treating the problem when patient comes with intermittent fever with chills, rigors, severe headache, body ache, and dry cough who need utmost care. Self medication and wrong medication can prove dangerous, said Dr L G Ramavat.


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Mosquito should not bite you

When asked how one should protect oneself from getting affected by Malaria, Dr Ramavat said that one should take care that mosquito should not bite oneself. When the patient gets full treatment for Malaria, even after that in the outside world mosquitoes bite him. So one can not say that his Malaria had got cured completely. The premises should be clean. The doors, windows should be netted properly, use Camphor everywhere in the house. This can keep mosquitoes away from you. Put naphthalin balls in the cooler. They last for one year. They kill the larva. It can be put in the area where water is stagnated. Children and adults should be fully clothed and should apply repellant. The mosquito net can be used on beds.