35 year old IS works
somewhere in the Jharkhand-Uttar Pradesh border as a daily wage labourer. 4
days back, he had high grade fever with chills and rigor. He was treated for malaria
by the local quack. As the fever was persisting, he thought of going back home
along with one of his fellow villagers who worked along with him.
IS was brought in an
almost unconscious state to our casualty sometime today afternoon. The look on
his face was enough to tell us that he was gravely ill. The whole of his face
was flushed, the sclera of his eyes very chrome yellow and the conjunctiva was
all congested. The breathing was labored and chest examination revealed that
there was quite a lot of fluid in the lungs. His liver was tender. It looked
more like Weils’ disease than malaria to me.
The investigations
were terrifying – the serum bilirubin came an astounding 51 mg%, the total
count was in the range of 50,000, the platelets 15,000 and a serum creatinine
of 4 mg%. Medically speaking, he cannot survive with the sort of facilities we
have. The saving grace was that his hemoglobin is 8.9 gm%. And of course, his
blood cells was teeming with falciparum malaria.
After reaching his
village in Leslieganj yesterday, IS continued to have fever and he became unconscious
sometime around midnight. IS’s family is very poor. The reason for IS working
so far away from home was to earn a living for his family - 3 little children
and a young wife. IS was brought to NJH by fellow villagers and his elder
brother.
The elder brother and
his villagers were aghast after we pronounced our prognosis and gave them an option
of taking the patient elsewhere. As I write this, IS has pulled through so far.
I’ve asked the people who brought him to arrange for blood.
In addition, I’ve started
him on anti-malarials and treatment for leptospirosis. Many a time, we’ve seen
that presence of malarial parasite in the blood tends to be a red herring.
After the persistant
rains over the last 2 weeks, it has now become very humid – quite a good environment
for the mosquitoes to breed.
We are having quite a
lot of malaria than last year. After the last year, when we had lesser cases –
most probably due to the drought, I have a feeling that people had started to
take possibility of contracting malaria quite lightly. To compound this problem
is the practice of single dose treatment by many quacks – it is not uncommon to
see people who come with persistent fever after having taken a single injection
of artesunate or quinine.
From my experience of
2003-04, one more condition which becomes quite common during high incidence of
malaria is the occurrence of injection abscesses. Giving quinine as deep
intramuscular injections is something practiced by quacks and many of them ultimately
end up as big abscesses. This year, I’ve seen one where the abscess had already
organized, solidified and probably fibrosed– sparing the poor sufferer of an
incision and drainage surgery.
Today evening, I’ve
seen one more patient, a pregnant lady who has come in with fever. Blood
examination shows falciparum.
Deaths which could be
directly attributed to malaria are quite less nowadays. This is mainly because many
of the fever cases come after some form of partial malaria treatment. As far as
I remember, almost all the patients who tested positive by smear for malaria
have recovered completely.
There has been one death
over the last 2 weeks – a 16 year old girl with fever. She had been treated as
malaria elsewhere. She had hemoglobin of 3 gm% and was unconscious since the
day she came in. She never tested positive for malaria. Most of my colleagues
strongly felt thatit was malaria.
Now, this is where we
need to do some sort of research on. Are we only dealing with malaria alone or
are there other infectious diseases which are very similar to malaria – dengue,
leptospirosis, rickettsia etc. I wish we could have help whereby we could explore
more on this . . .
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