Malaria is a major public health problem in India. India contributes to 3% of the global burden of Malaria. It is a potentially life-threatening vector-borne disease, caused by plasmodium species, namely Plasmodium vivax (P. vivax), Plasmodium falciparum (P. falciparum), Plasmodium malariae (P. malariae) and Plasmodium ovale (P. ovale). The disease gets transmitted by the infective bite of the female Anopheles mosquito.
Clinical presentation of Malaria Infection
The symptoms usually start appearing within 10-14 days of getting bitten by an infected mosquito. They include fever, chills, and headache. In severe cases, a person infected will experience fatigue, seizures, confusion, and difficulty breathing. The symptoms may be mild for some people, especially those who have suffered from malaria earlier.
In some people, malaria disease can cause severe illness and death. Those at risk generally include infants, children under 5 years, pregnant women, travelers, people with HIV or AIDS, etc.
Most people develop symptoms of falciparum malaria within 1 month of exposure; however, as per reports, the symptoms may present even up to 4 years later. For non-falciparum malaria, the incubation period is usually longer; and P.vivax may even relapse, months or years after exposure.
Early malaria diagnosis is critical because some symptoms may not be specific and may be difficult to diagnose.
Complications of Malaria
Almost all severe forms and deaths from malaria are caused by P.falciparum. P.vivax rarely causes serious complications or death. The symptoms may progress to severe malaria usually 3-7 days after fever onset. The major complications of severe malaria include the following:
Cerebral Malaria – Clotting of the infected erythrocytes in the blood vessels in the brain; the most common clinical presentation and cause of death in adults, with severe malaria
Pulmonary Edema – Buildup of fluid in lungs that may develop rapidly, even after initial response to anti-malarial treatment and clearance of parasitemia
Renal failure – Acute renal failure in severe malaria may require temporary dialysis. Another renal complication – ‘Blackwater fever’ causes the passage of dark, red, brown, or black urine due to massive intravascular hemolysis and resulting hemoglobinuria
Diagnosis of Malaria
Microscopy – Light microscopy of thick and thin stained blood smears, remains the gold standard technique for diagnosing malaria. The diagnostic accuracy of microscopy is determined by the quality of the blood smear and the expertise of laboratory personnel.
Rapid Diagnostic Tests (RDTs) – Antigen-detecting malaria rapids is considered to be an essential tool in malaria diagnosis, management, and routine malaria surveillance. These rapid tests can detect and differentiate species-specific circulating malaria parasite antigens, targeting either Histidine-rich protein-2 (HRP-2) of P.falciparum, Pan-species Lactate dehydrogenase (Pan pLDH); or parasite-specific Lactate dehydrogenase (eg. Pv-specific pLDH). The rapid tests provide quicker results, ensure excellent sensitivity & specificity, and are suitable for limited resource setups.
Malaria Antigen ELISA – For blood donor settings in endemic areas, ELISA for the detection of Pan pLDH is ideal for screening multiple blood samples in a smaller time interval.
Transasia Bio-Medicals Ltd. provides both, ELISA and Rapid kits, for Malaria detection. ErbaQik RDTs (Rapid Diagnostic Tests), utilize Black Gold Particle in the conjugate to create distinctly coloured bands, giving it a unique dual colour advantage. ErbaQik rapids are the only bi-colour detection rapid test in India, with enhanced sensitivity and specificity and, have been approved by reputed NABL laboratories. ErbaLisa PAN (LDH) Malaria ELISA is another innovative tool for screening Malaria in blood banks.
References:
- van Eijk, A.M., Mannan, A.S., Sullivan, S.A. et al. Defining symptoms of malaria in India in an era of asymptomatic infections. Malar J 19, 237 (2020). https://doi.org/10.1186/s12936-020-03310-9
- Moody A. (2002). Rapid diagnostic tests for malaria parasites. Clinical microbiology reviews, 15(1), 66–78. https://doi.org/10.1128/CMR.15.1.66-78.2002
- https://www.who.int/news-room/fact-sheets/detail/malaria
- https://www.who.int/india/health-topics/malaria
- https://www.cdc.gov/malaria/diagnosis_treatment/index.htm
- https://www.cdc.gov/malaria/diagnosis_treatment/diagnostic_tools.html
