Gone are the days when malaria could be cured by a visit to the doctor and by taking chloroquine. The malarial parasite, particularly the meeker vivax malaria, has undergone transformation and has become far more deadly.
While complications due to malaria are increasing, people are also developing resistance to anti-malarial drugs. The problem is compounded by the casual dispensing of chloroquine and other anti-malarial drug, leading to drug resistance.
“There are people who show malarial drug resistance though they have never received anti-malarial treatment in the past. This subset that responds poorly to treatment needs a multiple-drug regimen and a far more aggressive approach,” said Dr Om Shrivastav, infectious diseases specialist.
Dr Khusrav Bhajan, a critical care intensivist with PD Hinduja hospital, said: “We do see first-time malaria victims developing resistance. I suppose the plasmodium has mutated. We do not resort to monotherapy anymore. As per World Health Organisation (WHO) guidelines, doctors are putting malaria patients on a two-drug therapy.”
Over the past 5-7 years, the way malaria affects a patient has changed. Doctors say that patients tend to fall sick much faster than before, with different complications like leg pains, chest pains, etc.
“There is a need to understand the parasite’s molecular changes that have caused a diminished immunological response to it. Also, people react differently to the illness in some parts of the country. There is a need to study the malarial resistance in the community,” said Dr Shrivastav.
Apart from resistance, ‘improper treatment’ leads to recurrent malaria in people. “Intermittent, inadequate and wrong treatment is causing resistance. In cases of vivax, doctors have to give acute phase treatment and eradication phase treatment for another 15 days, after which they should put patients on prophylaxis to prevent any recurrent malaria,” said Dr Hemant Thakker, consulting physician at Jaslok hospital.
Dr Shrivastav said: “Absence of symptoms does not indicate absence of the disease. There is often a relapse in case of partially treated malaria. Patients should not stop treatment in five days after the fever subsides.”
Explaining this, Dr Thakker said, “The lifecycle of vivax plasmodium is different from that of the malaria of falciparum. Falciparum can be contained within five days of treatment.”
Comments
