Summary about Disease
Quotidian fever, also known as tertian malaria, is a type of malaria characterized by fever that recurs approximately every 48 hours. This pattern is most commonly associated with Plasmodium vivax and *Plasmodium ovale* infections. It is a parasitic disease transmitted by the bite of infected *Anopheles* mosquitoes.
Symptoms
Fever (recurring approximately every 48 hours)
Chills
Sweats
Headache
Muscle aches (myalgia)
Fatigue
Nausea and vomiting
General malaise
Enlarged spleen (splenomegaly) (less common)
Mild anemia
Causes
Quotidian fever is caused by infection with malaria parasites, specifically:
Plasmodium vivax (most common cause of tertian malaria/quotidian fever)
Plasmodium ovale (less common cause of tertian malaria/quotidian fever) The parasite is transmitted to humans through the bite of infected female *Anopheles* mosquitoes.
Medicine Used
Treatment for Quotidian fever typically involves antimalarial drugs. Common medications include:
Chloroquine: (Although resistance is becoming increasingly common in some areas) Historically a first-line treatment for P. vivax and *P. ovale*.
Primaquine: Used to eradicate the hypnozoite (dormant liver) stage of P. vivax and *P. ovale*, preventing relapses.
Artemisinin-based Combination Therapies (ACTs): While more commonly used for P. falciparum malaria, some ACTs may be used in certain cases of *P. vivax* and *P. ovale*.
Tafenoquine: Another drug used for radical cure of P. vivax malaria, similar to primaquine. *Important Note:* *The specific medication and dosage will be determined by a healthcare professional based on the patient's age, weight, overall health, severity of infection, geographic location (resistance patterns), and other factors.*
Is Communicable
Quotidian fever (malaria) is not directly communicable from person to person through casual contact. It is transmitted through the bite of an infected *Anopheles* mosquito. However, malaria can be transmitted via:
Blood transfusions: If infected blood is used.
Congenitally: From mother to fetus (rare).
Sharing of contaminated needles: Although rare.
Precautions
Preventing mosquito bites is crucial for preventing Quotidian fever (malaria). Precautions include:
Using insect repellent: Containing DEET, picaridin, IR3535, or oil of lemon eucalyptus.
Wearing long-sleeved shirts and pants: Especially during dawn and dusk when mosquitoes are most active.
Sleeping under mosquito nets: Preferably insecticide-treated nets (ITNs).
Eliminating standing water: Around homes and communities to reduce mosquito breeding sites (e.g., tires, buckets, flower pots).
Using window and door screens: To prevent mosquitoes from entering buildings.
Chemoprophylaxis: Taking antimalarial medications as prescribed by a doctor before, during, and after travel to malaria-endemic areas.
How long does an outbreak last?
The duration of a malaria infection, including Quotidian fever, varies depending on:
Promptness of treatment: With appropriate antimalarial drugs, the acute symptoms can resolve within a few days to a week.
Parasite species: P. vivax and *P. ovale* can cause relapses months or even years after the initial infection if the hypnozoite stage in the liver is not treated with primaquine or tafenoquine. Without treatment relapses can continue for years. Therefore, without appropriate treatment, an "outbreak" (or more accurately, episodes of recurring fever) can last for months or even years due to relapses. With proper treatment including hypnozoite eradication, the infection can be completely cleared.
How is it diagnosed?
Diagnosis of Quotidian fever (malaria) involves:
Microscopic examination of blood smears: This is the gold standard. Thick and thin blood smears are stained and examined under a microscope to identify malaria parasites.
Rapid diagnostic tests (RDTs): These tests detect malaria antigens in a blood sample and provide results within minutes.
Polymerase Chain Reaction (PCR): A more sensitive test that can detect malaria DNA in blood samples. Used for confirmation and species identification.
Patient history and physical examination: Travel history to malaria-endemic areas and clinical symptoms are important considerations.
Timeline of Symptoms
The timeline can vary, but generally:
Incubation period: (Time from mosquito bite to first symptoms): P. vivax and *P. ovale* usually have an incubation period of 12-18 days, but can be much longer (months) if the parasites remain dormant in the liver (hypnozoite stage).
Initial symptoms: (Headache, fatigue, muscle aches) May start gradually a few days before the characteristic fever pattern.
Paroxysms: (Episodes of chills, fever, and sweats) Typically occur every 48 hours (quotidian fever). The paroxysm itself may last 6-12 hours.
Post-paroxysm: (Period between fever episodes) The person may feel relatively well, but fatigue and weakness are common.
Relapses: Without treatment to eradicate the hypnozoites, relapses can occur weeks, months, or even years after the initial infection.
Important Considerations
Drug resistance: Resistance to antimalarial drugs is a growing problem in some regions. Healthcare professionals should be aware of local resistance patterns when selecting treatment.
Severe malaria: While P. vivax and *P. ovale* are generally considered less likely to cause severe malaria than *P. falciparum*, complications can still occur, especially in vulnerable populations (e.g., young children, pregnant women, immunocompromised individuals).
Relapses: P. vivax and *P. ovale* have a unique ability to form hypnozoites in the liver. Radical cure (eliminating both blood and liver stages) with primaquine or tafenoquine is essential to prevent relapses. G6PD deficiency testing must be done before prescribing Primaquine and Tafenoquine
Co-infection: Individuals can be infected with multiple species of malaria parasites.
Travel history: A detailed travel history is crucial for diagnosis and treatment planning.
Prompt diagnosis and treatment: Early diagnosis and appropriate treatment are essential to prevent complications and reduce the risk of transmission.
G6PD deficiency: Primaquine and tafenoquine can cause hemolytic anemia in individuals with G6PD deficiency. Testing for G6PD deficiency is necessary before using these drugs.