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Malaria

Feeling sleepy all the time- Doctors say it may be malaria (Daily News & Analysis-28 July 2010)

Mumbai- Fever and shivering - the only two symptoms to watch out for when it comes to malaria? Not
anymore. According to physicians in the city, malaria cases are showing up with varied symptoms,
throwing patients as well as doctors off the diagnosis.

“I see malaria patients with fever, decreased urine output, some respiratory problems, disorientation,
sleepiness, etc. This was not the case earlier,” said Dr Neeraj Uttamani, director, Cumballa Hill Hospital.
“Vivax strain has turned severe, with patients showing cardiac problems and kidney complications as
well,” he added.

“Most of the patients are coming in at a later stage and with very unusual symptoms such as state of shock
and infections. Many have a combination of malaria and dengue, which is even more worrisome,” said Dr
Vinay Joshi, pediatric intensivist from Kokilaben Hospital.

While the blame game continues between the civic body and the builders in the city over the spread of
malaria, the virus seems to have developed a resistance to chloroquine, a traditional drug to treat malaria,
said intensivists in the city.

“While the falciparum strain has been found to be drug resistant in the past two years, this year, the vivax
strain too seems to have developed resistance to chloroquine,” said Dr Khusrav Bajan, consultant,
emergency, critical care and internal medicine, Hinduja Hospital. Bajan said he had seen drug resistance
in 30 % of his vivax malaria patients.

“The organism is getting more virulent — with multi-organ failure, acute lung injury, etc,” said Bajan. “If
the patient is in ICU, we put them on resistant treatment, or give two drugs as opposed to one,” he added.

“Clearly the parasite has undergone mutation. Hence, the unusual symptoms and the drug resistance,” said
another doctor.
Civic hospitals are taking all possible measures to cope with the problem. With the increasing number of
malaria cases in the city, the civic body has short-listed 74 dispensaries for running out-patient
departments (OPD) in the evening.

Authorities claim that a huge number of patients are turning up to the evening OPDs, which are
convenient for working people.

“The response has been good so far. Several people tend to neglect their symptoms as they are busy
during the day,” said Dr Guirish Ambe, executive health officer, BMC, adding that the evening OPDs are
on from 5pm to 8.30pm. Health authorities said the OPDs would help in curbing malaria cases in south
Mumbai where there are no civic-run hospitals.

“Not many like to go for a check-up to a private medical centre and spend huge amount of money. People
keep avoiding doctors and resort to self-medication. The civic dispensaries will help in early diagnosis of
malaria,” said an official from the BMC’s health department.