P. falciparum - Free Courseware at UWC

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					   The humoral imbalance of malaria is Hot &
    Dry to Hot & Moist. The liver (Hot & Moist)
    and blood (Hot and Moist) are primarily
    involved. The spleen (Hot & Moist), in most
    cases become enlarged due to malaria
    infection and the kidneys (Hot & Moist) and
    brain (Hot & Moist) may be involved due to
    complications either of the infection itself or
    as a side-effect of anti-malarial drugs.
   From Stedman’s Medical Dictionary, 28th Edition
   “Malaria- A disease caused by the presence of the sporozoan
    Plasmodium in humans or other vertebrate erythrocytes,
    usually transmitted to humans by the bite of an infected
    female mosquito of the genus Anopheles that previously
    sucked from a person with malaria. Human infection begins
    with the erythrocytic cycle in the liver parenchyma cells,
    followed by a series of erythrocytic schizogenous cycles
    repeated at regular intervals; production of gametocytes in
    other erythrocytes provides future gametes for another
    mosquito infection; characterized by episodic severe chills and
    high fever, prostration, occasional fatal termination.
    Synonyms include Jungle Fever, Marsh Fever and Paludal
    Fever.” (Lukens, 2006: 1145)
   Although mosquito transmission is the most effective, malaria
    is also (rarely) transmitted by the usage of contaminated
    needles or blood transfusion. (Beers, 2003:1031)
   According to Tibb, malaria is a Hot & Dry to Hot & Moist condition due
    to the classical presentation of high fevers (Hot & Dry) and the cycle
    of malarial infection that begins with the bite of the mosquito from
    the genus Anopheles on a person who is already infected with
    malaria. The parasite multiplies and migrates to the salivary gland
    (hot & moist in humans) (Supplementary Notes, 2010: 31) of the
    Mosquito. Upon the bite of the second person, saliva (moist & hot)
    (adulthood notes, 2010: 31) is injected into the skin (hot & moist)
    and migrates to the liver (hot & moist) where it multiplies again.
    These newly formed parasites take approximately 1 to 3 weeks to
    mature, after which they migrate to the circulatory system blood (hot
    & moist) where they yet again multiply in red blood cells which
    eventually ruptures. Malaria is also most prevalent in tropical areas
    (Hot & Moist). Malaria is a chronic condition, which follows pathway 2
    and can be characterized by severe fever followed by sweaty chills,
    body aches and other flu-like symptoms, but can result
    (complications) in infection of the major organs such as the brain and
    even be fatal.
   The humoral imbalance will differ according to the type of malaria
    infection, based on the type of mosquito that spread it (Dr.Flangeni,
   Symptoms
   Symptoms begin when infected RBC’s rupture and release parasites.
    Shaking chills and fever start- heat overcoming moisture, creating
    an unpleasant environment- physis response.
   Fever
    ◦ Can exceed 40˚C/ 104 F
    ◦ Occurrence vary according to the type of infection:
       P. vivax and P. ovale infection fevers occur at 48 hr intervals
       P. malariae occur at 72 hr (3 days)
       P. falciparum- sometimes occurs at 48 hour intervals, but is often not
   Headaches
   Body ache
   Nausea
   Heavy sweating occurs after fever has dropped.
   Travelers: sx’s are usually only experienced a few months after their
    return, but may take a full year to develop.
   Blood glucose levels are decreased in those
    infected with P. falciparum. Levels severely
    decreased in those being treated with
   Enlarged spleen in all cases. To be found
    after infection has already progressed.
   Positive blood smear with whichever of the
    four infections.
   Pulse- signs of coldness & dryness (depending on
    time after infection)
   Tongue- yellow coating, dryness    (dependent on time
    after infection)
   Differential Diagnosis (WHO, 2000)
   Diseases that are also common in Malarious countries.
       all types of meningitis
       typhoid fever
       septicaemia.
    ◦   Other differential diagnoses include:
    ◦   influenza
    ◦   hepatitis
    ◦   haemorrhagic fevers
    ◦   all types of viral encephalitis (including rabies)
    ◦   gastroenteritis and,
    ◦   in Africa, trypanosomiasis.
   In pregnant women:
    ◦ Sepsis in the uterus, urinary tract or breast should be distinguished from malaria
   In children:
    ◦ Convulsions should be differentiated from febrile convulsions, in which a coma rarely
      lasts for longer than 30 minutes.
   A final diagnosis is made by the examination of both thick and thin films of
    peripheral blood to reveal malaria parasites (WHO, 2000) as well as identifying
    which parasite is responsible for infection.

   Thick films:
    ◦   Erythrocytes are lysed, releasing all stages of the parasite in the blood (as opposed to being
        in the liver).
    ◦   More blood is used in
    ◦   Thus, (lyses and more blood) facilitates the diagnosis of low-level parasitaemias

   Thin Films:
    ◦   Essential to confirm diagnosis and confirm the species of parasite.
    ◦   P. falciparum infections- needed to quantify the parasite load. Parasites may be very few.
        This is particularly prevalent in patients who have already been partially treated. (Boon,
        Colledge and Walker, 2006:345-346)

   Immunochromatographic “dipstick” tests for P.falciparum antigen- can be used
    instead of blood films, but are 100 times less sensitive than the usage of blood
    films. (Boon, Colledge and Walker, 2006:346) Immunochromatographic “dipstick”
    tests for P.falciparum antigen- can be used instead of blood films, but are 100
    times less sensitive than the usage of blood films. (Boon, Colledge and Walker,
   Severe anaemia
   Hypoglycaemia
   Comas
   Acute renal failure
   Spontaneous bleeding
   Allopathic Approach:
   Drug Resistance- varies in different parts of the world
    (Beers, 2003:1023) - climate- favorable vs. unfavorable
    conditions of mosquito as well as temperament of
    susceptible people???
   Chloroquine: preferred drug for prevention of Malaria
    infection with P. falciparum in countries such as Mexico,
    the Panama Canal and some areas of the Middle East.
   Mefloquine, doxycycline, or combination atovaquone-
    proguanil: Recommended for prevention of P. falciparum
    in countries other the above mentioned ones. These drugs
    are also the preventatives for P. vivax and P. ovale and P.
    malariae infection. (Beers, 2003: 1032)
   “Quinine is indicated if a chloroquine-resistant infection is
    at all likely.” (Boon, Colledge and Walker, 2006: 347)
   Upon suspicion of malaria, immediate referral to the nearest hospital should be made.
   Treatment frames: Moist & Hot- Cold & Moist- Cold & Dry (Pathway 2 condition)
   Medication:
    ◦   Splenogard Tabs (Hot & Moist), 1bd
    ◦   Boosts the function of the spleen, immune booster and it assists in treatment when the liver and spleen are
    ◦   Livotibb Tabs (Hot & Moist), 2 tds (adults) and 1 tds (children)
    ◦   Nourish the liver- anti-malarial drugs are very harsh on the liver. Help with the detoxification from parasitic
    ◦   Blackseed Honey Drops (Hot & Dry), eat on toast, cereal, ect.
    ◦   Or Blackseed Pure Oil (Dry & Hot), maximum of 1 teaspoon (5ml) daily after a meal.
    ◦   Immune Booster
    ◦   Blackseed Vaporub (Dry & Hot), apply where body aches are felt.
    ◦   Used for body aches
   Governing Factors
    ◦   Diet: Increase in Cold and Moist Foods such as broccoli, butternut, coriander and water (8 glasses)
    ◦   Water: Flush the kidneys- especially in Blackwater fever
    ◦   Although garlic and ginger are heating, they also have anti-parasitic effects so should be included.
    ◦   Avoid: Spicy foods, Chicken (Hot & Dry) and animal proteins, alcohol, recreational drugs and smoking.
    ◦   Sleep: Adequate rest is needed even during the day, so no specific amount of hours.
    ◦   Exercise- An occasional walk to relieve him/ herself or only walking short distances is adequate to prevent
        bed sores from developing and also to stretch the muscles.
    ◦   Environmental air and breathing: Keep quarantined area clear from smoke. Do the Tibb Slow and Deep
        Breathing exercise- increase moisture and eventually overcome heat.
    ◦   Emotions: Avoid anger, extreme excitement and stress as they increase heat and dryness.
    ◦   Elimination: Keep bowels clear, drinking more water will cause increased need for elimination- good for
        kidney flushing. The kidneys are often involved, especially in P. falciparum- Blackwater fever.
   Regimental Therapies:

   Cupping:
    ◦ Liver: TH6, A3, B8, B9 (Damage to liver parenchyma due to it being is a site of
      multiplication for parasites.
    ◦ Spleen: A4, A5 (Spleen is usually enlarged in Malaria due to RBC’s being affected)
    ◦ Kidneys: B11, B12, B13 (help with flushing out toxins from parasite as well as
   Breathing Exercises:
    ◦ Tibb Slow & Deep breathing exercises- Cooling effect
    ◦ Tibb Mental/Emotional exercise- stimulates both sides of the brain. Useful for
      rehabilitation in severe cases where the patient was in a coma.
   Colour Therapy:
    ◦ Blue- antiseptic and Moist and Hot (within the Rx frames)
   Therapeutics:
    ◦ Massage should not be done- increase circulation, body aches & fever.
   Aromatherapy:
    ◦ Ylang ylang (Cold & Moist)
    ◦ Lemmongrass (soothing as well as an insect repellent)
Neem tree-
Azadirachta indica
Leaves of the Neem Tree
   Recognized as an effect treatment of bacterial, viral, fungal infections and for the
    treatment of malaria
    Homeopathic formulation- used since the year 2000 for the prevention and
    treatment of malaria and appears to be safe and effective.

   Study done on Neem:
   The purpose of the study was to research whether the daily use of homeopathic
    neem medication decreases the number of malaria attacks within 6 months and up
    to 2 years of treatment in a population of both children and adults. The study was
    carried out in the area of Musoma, Tanzania.

   152 patients were enrolled in the trial: 79 children with a mean age of 11 years
    (4-18) and 73 adults with a mean age of 37 years (19-93).

   The percentage of subjects who reported a decrease of malaria episodes increased
    from 57% at 3 months to 81% after 6 months of treatment.
   The bark of an Enantia chlorantha tree
    growing in a Cameroonian rain forest yields
    easily as a man peels away strips. An extract
    from the bark is used as a traditional remedy
    for the raging fevers that accompany bouts of
   Poor:
   Children, pregnant women, immuno-compromised
   - can kill within 72 h if not treated
    - mortality 25-50% with treatment
    - delay in treatment is major factor contributing to
    poor outcome
   Features indicating poor prognosis in severe malaria
   Mortality in excess of 90% in patients with four or
    more organ failures.
   Better prognosis:
   Younger, healthier persons.
   Persons from higher socio-economic status- better
    access to health care.
   Beers, M.H. (ed.-in-chief) (2003) The Merck Manual of
    Medical Information, 2nd home edition, New York: Pocket
   Boon, N.A., Colledge, N.R., and Walker, B.R (editors) (2006)
    Davidson’s Principles and Practice of Medicine, 20th
    edition, India: Elsevier Limited.
   Chishti G M. (1991) The Traditional Healer’s Handbook. A
    Classic Guide to the Medicine of Avicenna, Rochester,
    Vermont: Healing Arts Press.
   Ibn Sina Institute of Tibb. (2005). Tibb Lifestyle Advisor’s
    Programme. Module 1 : Introduction to Tibb Philosophy
    and Health Promotion, RSA: Author
   Lukens, R. (ed.) (2006) Stedman’s Medical Dictionary, 28th
    edition, Maryland: Lippincot Williams & Wilkins.
   Roberts, M. (2000) A-Z of Herbs, 3rd edition, South Africa:
    Struik Publishers.

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