Malaria is anacute febrile, mosquito-borne blood disease caused by a Plasmodium parasite. Itis transmitted to humans through the bite of the female Anopheles mosquito. AsP.
falciparum matures the infected erythrocytes adhere to microvascularendothelium, a term coined cytoadherence, they constrain vascular function andreduce perfusion. The extent to which the vital organs are affected determinethe clinical pattern and outcome of severe falciparum malaria. 1 According toWHO, 216 million cases of malaria were reported globally and caused 445,000deaths, thus effectively passing as an alarming epidemic. As per the latestreport of WHO-UNICEF, India is third among 15 countries having the highestcases of morbidity and mortality due to malaria.
2 Somepopulation groups like infants, children under 5 years of age and patients withHIV/AIDS are at a greater risk of contracting malaria.3Pregnantwomen, especially primigravid women, are up to 10 times more likely to contractmalaria. Gravid women also have a greater tendency to develop severe malaria.4 Malaria isconsidered uncomplicated when symptoms are present but there are no clinical orlaboratory signs to indicate severity or dysfunction of organs. Severemalaria typically occurs as a progression of uncomplicated malaria. P. falciparum can cause severe malaria because it multiples rapidly inthe blood, and can thus cause severe blood loss (anemia).
Antimalarialdrugs are used to to curb various symptoms of malaria as well as eradicate theparasite. Current practice in treating cases ofmalaria is based on the concept of combination therapy (e.g., Coartem). This regimenoffers several advantages, some of them being reduced risk of treatmentfailure, reduced risk of developing resistance, enhanced convenience, andreduced side-effects.
5 Parasite clearance rates are chief measures of anti-malarial drugefficacy. They are particularly important in the assessment of artemisininresistance. 6 In the erythrocytic schizogony cycle, artemisinins exert actionon a wide range of stages-from ring forms to early schizonts, thus have thebroadest time window of anitmalarial actions.
7 WHO recommendsartemisinin-based combination therapies (ACTs) for the treatment ofuncomplicated malaria caused by the P.falciparum parasite. By combining 2 active ingredients with differentmechanisms of action. The choice of ACT should be based on the results oftherapeutic efficacy studies aga inst local strains of P. falciparum malaria.
Fever is themost common sign during an acute malarial attack and can be accompanied byother auxillary symptoms such as headache, diarrhea, abdominal pain, vomiting,and nausea. 8 The Indianstudies on fever and parasite clearance on patients receiving ACT isinadequate, hence this study is requisite for establishing a correlationbetween the drug being administered and it’s outcome.