with no fever and the cycle of chills, fever, and sweating is repeated each day, every other day, or every third day. If untreated, a primary attack continues from 1 week to more than a month.
The diagnosis can be established by the identification of malaria parasites in stained smears of patient blood on microscope slides (blood films). To find the parasites, it may be necessary to repeat the blood films.
Malaria occurs in many tropical and subtropical areas worldwide including Central and South America, Asia, and Africa.
The infectious agents for the human malarias are, Plasmodium vivax, P. falciparum, P. malariae, and P. ovale. Mixed infections frequently occur. Man is the reservoir for human malaria. Malaria is transmitted by the bite of the female Anopheles mosquito and by injection, blood transfusion, and contaminated needles and syringes.
The incubation period depends on the particular Plasmodium species, and it may range from days to months. Humans are infectious to mosquitoes as long as gametocytes are in their blood. The period of time that gametocytes are in the blood varies with the species, strain, and medication.
Preventive measures include (1) eliminating or reducing anopheline mosquito breeding places by draining or filling impounded water; (2) applying effective approved residual insecticide to surfaces where anopheline mosquitoes rest; (3) in endemic areas, spraying sleeping quarters with pyrethrum and/or using other approved insect repellents on exposed skin; (5) obtaining an accurate history of blood donors concerning malaria and possible malaria exposure before accepting blood; (6) locating and treating all acute and chronic cases of malaria that have occurred in the same area as the index case; and (7) practicing the regular use of chemosuppressive drugs in malarious areas. Chloroquine is the most commonly used drug for this,
Patients should be isolated by blood precautions. However, no concurrent disinfection measures are required. No quarantine measures are required and immunization of contacts is not applicable.
An increase in malaria cases may be expected with wars, other social upheavals, and any climactic changes that increase breeding areas for vectors in endemic regions.
International measures are extremely important. Aircraft, ships, and other transportation vehicles going into and coming out of malarious and mosquito populated areas should be properly disinfected by health authorities. Finally, consider the use of antimalarial drugs when there is a mass movement of migrants from areas where malaria is endemic to malaria free areas.
Measles is an acute viral disease with signs and symptoms of fever, conjunctivitis, rhinitis, cough, and small irregular bright red spots with a bluish white center (Kopliks spots) located inside the mouth on the cheeks. A red blotchy rash characteristically begins on the face between the third and seventh day and then spreads to the trunk. Measles is most serious in adults and infants; otitis media, pneumonia, and encephalitis may occur as complications. In the United States and Canada, since the onset of childhood immunization programs, measles now occurs primarily in preschool children, adolescents, young adults, and those refusing vaccination. In temperate climates, most cases occur in late winter or early spring. In the tropics, most children acquire measles at an early age as soon as the maternal antibody lowers.
The infectious agent is the measles virus. Man is the reservoir. Measles is spread by nasal or throat secretions through droplets, direct contact, and less frequently by airborne methods or fomites. The incubation period averages about 10 days from exposure until the onset of fever and may vary from 8 to 13 days. The rash usually appears 14 days after exposure. Measles is communicable from just prior to the onset of fever to about 4 days after the appearance of the rash.
Susceptibility is general except for those persons who have recovered from the disease or those who have been immunized. Recovery usually gives permanent immunity. Infants whose mothers are immune are usually immune for the first 6 to 9 months of their lives.
The primary preventive measure is vaccination with the live attenuated measles vaccine. It is recommended for all individuals susceptible to measles,
For patient management, isolation is not practical for an entire community; however, it is recommended that children be kept home from school until at least 4 days after the appearance of the rash. For hospitalized patients, practice respiratory isolation from the onset of fever until after the fourth day of rash to reduce exposure of other high risk patients.