Malaria. Learn again. Notes from the Russian doctor in Africa

There were registered the small numbers of cases of imported malaria in the Russian Federation last decades. This leads to the lost of skills to recognize this disease by the general practitioners and they make many mistakes in the cases of the contact with malaria patients. In African countries, by contrast, the widespread prevalence of malaria tends to evaluate any symptom in individuals who get a positive malaria test as symptoms of malaria without a differential diagnosis from other diseases. The clinical manifestations of malaria are nonspecific, different systems are involved in the process, in addition, different types of malaria plasmodia cause different changes. The most studied in malaria are hematological disorders, pathology of the kidneys, the central nervous system, and respiratory complications. All of them can occur both in uncomplicated and in severe malaria, in different periods of the diseases. The clinical manifestations of malaria are differ between immune and non-immune individuals. In the latter case, symptoms may appear with a lower level of parasitemia, severe malaria is more often recorded, and mortality is higher. The diagnosis of malaria must necessarily be confirmed by the detection of parasitemia. In Russia, microscopic examination of a blood is used for this, abroad immunological (express tests) and molecular biological methods may be used. However, laboratory testing does not reveal the stage of parasite developing in the liver and may give negative or questionable results in the cases with a low level of parasitemia, therefore, if there is clinical suspicion, it must be repeated. Improving the diagnosis of malaria requires constant vigilance and careful collection of the patient's epidemiological history. In endemic regions with high rates of asymptomatic parasitemia, newly emerging symptoms should be classified as malaria after differentiation with the other causes. In non-endemic, for example, the Russian Federation, regions the cases of the patients with an appropriate history (even in people who visited areas of possible infection several years ago) must be rule out as malaria first of all. 

1. 25 aprelya – Vsemirnyy den' bor'by s malyariyey 25.04.2020 [elektronnyy resurs] / Federal'naya sluzhba po nadzoru v sfere zashchity prav potrebiteley i blagopoluchiya cheloveka [April 25 – World Malaria Day 25.04.2020 [electronic resource] / Federal Service for Surveillance on Consumer Rights Protection and Human Welfare] [sayt]: URL: https://www.rospotrebnadzor.ru/about/info/predpr/news_predpr.php?ELEMENT_ID=14311&sphrase_id=2731300 (data obrashcheniya: 01.08.2020).

2. Baranova A. M., Sergiyev V. P., Guzeyeva T. M., Tokmalayev A. K. Klinicheskaya nastorozhennost' k zavoznoy malyarii: privivnyye sluchai i smertel'nyye iskhody v Rossii [Clinical alertness to imported malaria: vaccinations and deaths in Russia] Infektsionnyye bolezni: novosti, mneniya, obucheniye. 2018. T. 7, № 4. Pp. 97-101.

3. Novak K. Ye., Esaulenko Ye. V., D'yachkov A. G. Epidemiologicheskiye i klinikolaboratornyye osobennosti techeniya zavoznykh sluchayev malyarii na territorii Severo-Zapadnogo federal'nogo okruga [Epidemiological and clinical laboratory features of the course of imported cases of malaria in the North-West Federal District] Zhurnal infektologii. 2017. T. 79, № 1. Pp. 91-99.

4. Baranova A. M., Guzeyeva T. M., Ivanova T. N., Morozova L. F. Cmertel'nyye iskhody ot tropicheskoy malyarii v Rossii (2013-2017 gg.) [Deaths from tropical malaria in Russia (2013-2017)] Meditsinskaya parazitologiya i parazitarnyye bolezni. 2017. № 3. Pp. 36-40.

5. Goldman-Yassen A. E., Mony V. K., Arguin P. M., Daily J. P. Higher rates of misdiagnosis in pediatric patients versus adults hospitalized with imported malaria // Pediatr. Emerg. Care. 2016; 32 (4): 227-231.

6. Mace K. E., Arguin P. M., Lucchi N. W. et al. Malaria Surveillance – United States, 2016 // MMWR Surveill Summ. 2019; 68 (5): 1-35.

7. Cowman A. F., Healer J., Marapana D., Marsh K. Malaria: Biology and Disease // Cell. 2016; 167 (3): 610-624.

8. Klinicheskiye rekomendatsii. Malyariya u vzroslykh [Clinical guidelines. Malaria in adults] Natsional'noye obshchestvo infektsionistov. 2014. p. 54

9. Milner D. A. Jr. Malaria Pathogenesis [электронный ресурс] // Cold Spring Harb Perspect Med. 2018; 8 (1): 1-11: URL: http://perspectivesinmedicine.cshlp.org/content/8/1/a025569.full.pdf+html (дата обращения: 01.08.2020).

10. Metodicheskiye rekomendatsii po profilaktike, diagnostike i lecheniyu malyarii v Vooruzhennykh Silakh Rossiyskoy Federatsii [Guidelines for the prevention, diagnosis and treatment of malaria in the Armed Forces of the Russian Federation] Ministerstvo oborony Rossiyskoy Federatsi i Glavnoye voyenno-meditsinskoye upravleniye MO RF. 2019. 92.

11. World malaria report 2015 [электронный ресурс] / World Health Organization. [сайт]:URL: https://www.who.int/malaria/publications/worldmalaria-report-2015/report/en/ (дата обращения: 01.08.2020)

12. Kimenyi K. M., Wamae K., Ochola-Oyier L. I. Understanding P. falciparum Asymptomatic Infections: A Proposition for a Transcriptomic Approach [электронный ресурс] // Front Immunol. 2019; 10: 2398. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803459/ (дата обращения: 01.08.2020).