Tertian Malaria – Causes, Symptoms, Diagnosis, and Treatment

Tertian malaria is one of the types of malaria that is fairly common and mild although there are still lighter types of this, namely oval malaria. The type of tertian is a malaria condition that has to do with a parasite named Plasmodium vivax. This parasite generally causes infection in young erythrocytes where the diameter is also larger than normal.

When talking about the shape of the Plasmodium vivax parasite, the shape has similarities with Plasmodium falciparum. Only, the shape of Plasmodium vivax then changes to be similar to ameba because it is in line with its maturation process. Also, note that this parasite also has 12 – 24 merozoitovale which is also accompanied by the yellow pigment as its characteristic.

In the process of attack by erythrocyte infection by the parasite, it is also known that there are gametocytes with full mixed oval forms in erythrocytes, yellow pigments, and eccentric chromatin. Tertian type malaria is also known to have periodic symptoms, which is 48 hours. Not only that, the classic symptoms of the malaria triad became his trademark.

With the existence of facts about these symptoms, fever also occurs as a result where periodically 4 days with the peak of fever that occurs in patients every 72 hours. When compared to other types of malaria, tertian is a type that is classified as mild while the tropics are the most severe with a variety of life-threatening complications.

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Causes and Transmission

Plasmodium vivax is a type of parasite that can attack and infect erythrocytes due to the bite of the Anopheles female mosquito. The parasite is the most common infection and is indeed the main cause of tertian malaria with a fever process on every third day. This is because it happens 48 hours periodically.

Female Anopheles mosquitoes are the most dangerous because malaria is caused by the bite of the mosquito. And it is also known that transmission to humans is only by Anopheles female mosquitoes. In this world, there are actually over 400 species of Anopheles, but only 67 have been proven to contain parasites or sporozoites.

Because it contains these sporozoites, malaria can automatically be transmitted more easily due to infection. In our own country, there are 24 Anopheles species found and becoming malaria vectors. There needs to be a little knowledge about this Anopheles mosquito and its characteristics which are part of the cause of tertian malaria.

Many people might wonder where they can find female Anopheles mosquitoes known as spreaders of the disease. The nest is actually quite varied because if we usually know that the mosquitoes are in puddles and swamps, that’s not all. Brackish water, fresh water, and large branches of trees are the nests of Anopheles mosquitoes as well.

To find out what Anopheles mosquitoes are like in more depth, it is important to look at what are their characteristics. Below are common characteristics of Anopheles mosquitoes that we all need to know:

• Mosquitoes live in tropical and sub-tropical areas like in our country and are often found especially in lowland areas.
• This bite from a mosquito usually occurs between dusk or late at night and at dawn.
• The mosquito’s flight distance cannot be more than 2 – 3 kilometers.
• Anopheles mosquitoes can live outside the home, in the house, and are so fond of biting humans.
• Most of these mosquitoes can be found in swampy areas.
• His life cycle is known to take approximately a week.
• When the process of biting, the back of the body of the Anopheles mosquito leads up with a 48-degree angle.

The process of transmission, as well as the spread of malaria in this type of tertian, always occurs naturally from people who have been infected to people who are in good health. Mosquito bites are the source of causes in most cases of tertian malaria.

Mosquitoes can suck the seeds of malaria that are already in someone’s blood and then breed the seeds of the disease in the body of the mosquito. When the mosquito switches to biting other healthy people, the person will automatically be exposed to the seeds of the disease.

There are a number of types of vector or what we call intermediaries in malaria, namely:

• Anopheles Aconites, known as a special malaria intermediary mosquito that lives in rice fields.
• Anopheles Sundaicus, known as an intermediary mosquito specifically in the coastal area.
• Anopheles Maculates, known as an intermediary for malaria mosquitoes, especially in areas of forests, gardens, and mountains.

The process of transmission and spread of parasites or malaria infection through blood transfusions is also potential, except that there are not many malaria cases. The possibility of contracting blood transfusions is also very small.

Pathophysiology

After looking at all the possible causes of tertian malaria and also the process of transmission and spread, it is also necessary to know and learn a little about the life cycle of malaria species, especially in the human body.

Asexual Phase

In this phase, the process occurs in the liver and transmission occurs when female Anopheles mosquitoes that have been infected by parasites bite humans. Sporozoites or parasites will be able to enter the human body which is bitten because the mosquito secretes saliva which can then seep into the blood vessels. When it has entered and permeated, sporozoites will also settle on pre- erythroid cells or the liver parenchyma.

In that place, parasites grow as well as a cleavage process where this process is also known as schizogony that produces schizonts. Schizont will cook about 6 – 9 days later and there are thousands of merozoites released. Another name for the phase that occurs in the liver is also called the primary pre-erythritol.

There are also phrases that are known to occur in the blood and there are approximately 120 days for red blood cells to be in the circulation. Hemoglobin in the blood cell can carry as much as 20 ml of oxygen in the blood as much as 100 ml. Meanwhile, erythrocyte production is carried out by the hormone erythropoietin which is found in the liver and kidneys.

In the spleen, blood cells will go through a process of destruction where the process is released later through a process so that red cells or blood cells in particular new ones can be synthesized along with the pigment bilirubin released at the same time from the small intestine.

The trophozoite is the result of the development of some merozoites that have entered the red blood cells. Some of the other merozoites enter other tissues, namely the liver or spleen, which are called secondary erythrocytes. In just 48 hours, the breakdown of red blood cells occurs and the loose merozoites enter the cycle to restart.

That is why sufferers of tertian malaria will feel the chills and cold that accompany fever. The following fever also feels cold and shivering comes from every time a red blood cell breaks. Of course, the main cause of this is merozoites and foreign proteins through the process of separation.  

Sexual Phase

This phase is clearly different from the one previously explained because this phase occurs in the human body or also known as the following schizogony also in the mosquito’s body or sporogonial. After a number of cycles, merozoites present in erythrocytes or blood cells will be able to develop.

The development of merozoites referred to here is to become female and male sexual forms. Gametocytes are unable to develop and can potentially die if the female Anopheles mosquito does not suck. Meanwhile, the zygote is the result of a combination of female and male gametocytes in the mosquito’s stomach.

The zygote formed will then penetrate the stomach wall. From there he will go through the development process into Oocysts and in just about 3 weeks, the salivary glands or mosquito saliva will be entered by small sporozoites. Then the erythrocyte phase begins.

When the erythrocyte phase begins, merozoite in the blood attacks the erythrocytes that support the formation of the trapezoid. There is still a continuation of the formation which then becomes the trophozoite-schizo merozoite. Later there will be sexual changes in some post-formation merozoites from 2 – 3 generations of merozoites.

The prapaten period is the name or term for the period between the beginning of the onset of infection and the parasite in the blood edge is found. Meanwhile, for the period from the entry of sporozoites into the body until then fever appears as a clinical symptom also called the term shoot or incubation.

In conclusion, all types of Plasmodium have a life cycle that has absolutely no difference. This is because some remain in the body of mosquitoes and some in the human body. 

Symptoms

For tertian malaria, signs and symptoms are indeed not as severe as the symptoms caused by tropical malaria. The attack, in general, is not too visible or occurs vaguely and the sufferer will experience what is called shivering and followed by fever and sweating. The condition of sweating is also usually sweating because of the body temperature that rises but remains cold.

A typical pattern of attacks will be formed in just 1 week where the attack occurs in a lost and arising manner. There are times when sufferers will suffer so much from the body that is not at all the same as when they catch a cold. Headaches also become an inevitable symptom while constantly shivering.

The fever itself will generally disappear and arise and the fever will last for 1-8 hours. After the fever has subsided, the patient appears normal and does not look sick at all until the next fever occurs and makes the body shiver again. The next attack can occur every 48 hours as previously mentioned.

Diagnosis Method

After feeling the symptoms, certainly, you cannot treat it carelessly. Sufferers of tertian malaria need to take a diagnostic method to ensure that the symptoms that occur are symptoms of tertian malaria. Symptoms are a diagnosis factor after the onset of fever and patients with periodic shivering.

When a patient has a fever and also a feeling of shivering with an unclear cause, this can be suspected as tertian malaria. Allegations have the potential to be stronger if, within a year before, it was known that the sufferer had visited an area that was indeed being exposed to a malaria outbreak.

Will strengthen even more when during a physical examination, the patient’s spleen is found to be enlarged. Diagnosis still needs to be strengthened not only by physical examination but also by checking blood so that the parasites can be discovered. There are times when the examination needs to be carried out many times because the levels of parasites in the patient’s blood can vary.

The examination is not enough to do once because the levels of various parasites in the blood are found from time to time. The type of parasite and the cause will be a guide for doctors to be able to determine the method of treatment, the danger of complications and the prognosis of malaria.

Microscopic Malaria Test

Diagnosis performed on patients, in general, is based on clinical manifestations (including history). Not only based on this but also on immunoserological tests and the discovery of parasites or Plasmodium in the patient’s body. The so-called immunoserological test with a variety of targets is recommended to be a complement to microscopic examination in supporting the diagnosis or examination of malaria. Usually, it is also intended for epidemiological surveys where microscopic tests cannot be carried out.

Enforcement of a definitive diagnosis of tertian malaria fever is carried out by the discovery of parasites or Plasmodium in the blood of the patient’s body after experiencing symptoms. When there are negative results from a one-time microscopic examination, this will not be a factor that removes the diagnosis of malaria fever. However, a series of follow-up checks are still needed to support it.

In microscopic tests, there are a number of conditions that need to be followed so that the diagnostic value is higher with a specificity and sensitivity of up to 100 percent. The following are the conditions in question:

• When the sample is taken it must be at the end of the fever period and this is only considered appropriate; at the end of the period, the fever must also occur during the period of sweating. Why should it be at that time? The reason is that in that period the amount of trapezoid in the circulation was maximal and included was considered mature or ripe. Thus, the identification of species from Plasmodium or parasites will be much easier for health workers.
• Sampling must have sufficient volume. To know that the sample volume is sufficient is provided that the volume of capillary blood is 3.0 – 4.0 microliters and this is also intended for thick preparations, while for thin preparations it is different again, namely 1.0 – 1.5 microliters.
• Identification of parasitic species (Plasmodium).
• The high quality is rustic and is guaranteed well so that the identification of species from the parasites in the patient’s body is guaranteed right.
• Morphological identification is also very significant in the process of examining the patient’s symptoms. The purpose of this identification is to determine the Plasmodium species which is then continued for the basis of drug selection.

1. Immunoserological test

This examination is also important in the diagnostic method because it has been well designed so that specific antibodies to the Plasmodium parasite can be detected.

This also applies to Plasmodium-specific antigens that have been exposed to Plasmodium infection. It’s just known that this method of examination is still under development, especially in the use of radioimmunoassay techniques and immunoassay enzymes.

2. QBC or Semi-Quantitative Buffy Coat

In this one diagnostic method, the basic principle is a fluorescence test, namely the presence of proteins on plasmodium where this will cause the binding of acridine orange. The aim is to identify whether Plasmodium has actually infected erythrocytes. This one examination technique is to use a capillary tube with a certain diameter with acridine orange as the coating. But for species differentiation, it cannot be done this way.

3. Biomolecular Test

This one test is used to detect Plasmodium-specific DNA which is thought to have invaded the blood of patients with malaria symptoms. In this test, the implementation clearly requires complete DNA, namely by lysing erythrocytes or the patient’s blood cells so that DNA extracts can be obtained.

Treatment

When he has been diagnosed, it will be determined by the doctor that malaria is indeed tertian malaria and treatment can also be given. There are a number of medicines that the doctor will give to the sufferer. Fever-lowering drugs are most definitely given by doctors, as well as vitamins as a way to increase the patient’s immune system.

When vitamins are given with paracetamol, the vitamin will help so that the body has increased endurance. When the body’s resistance increases again and is normal, the healing of the sufferer becomes faster. In addition, antimalarial drugs are also given depending on the type of Plasmodium that has been found after a series of diagnostic methods. 

Traditional Tertian Malaria Treatment

If you want to treat tertian malaria traditionally, then there are also a series of recommendations for drugs that can be used naturally. If you feel that traditional medicine is better, then for your malaria symptoms, please take a look at the medicines below to try to make it at home.

• Papaya Leaf

Papaya leaves are known to be bitter, but to treat malaria naturally without side effects, the effectiveness is so great. You can prepare just two sheets of papaya leaves, but do not forget to wash them first before starting to mix them so they don’t get dirty. Then continue by boiling with 3 glasses of water.

Make sure that you boil it until it boils and waits until the water is reduced to glass. This cooking water can then be lifted and filtered first, wait until the temperature drops or cools down. It is up to you, wants to drink it warm or cold because it does not affect its effectiveness in curing malaria.

• Sidaguri

In addition to papaya leaves, sidaguri is another medicinal plant that can be relied upon to treat tertian malaria, although it is more famous as a gout drug. This plant has also been very trusted in treating malaria sufferers, so prepare a few leaves. Do not forget to also prepare along with the leaves because you need the flowers also later.

After washing it thoroughly, then you can boil the leaves and flowers into 250 ml of water. Bring the water to a boil and wait until the water is reduced or remaining half the glass. Lift it then and strain it before you can drink it. You can wait for it to cool first before consuming it.

• Neem Leaf

This one shrub is indeed more common in India, but you can also find it here. When you choose neem leaves, there are 2 treatment methods that need to be known, namely external and internal medicine for tertian malaria.

External treatments are used for bathing for tertian malaria sufferers and you just need to take a few leaves. Boil the neem leaves until they finally boil before mixing into your bath water. This mixed water can be used like when you use plain water while bathing; more recommended to use it every morning and evening.

Treatment in using neem leaves can be done by preparing 1 stalk of neem the size of a finger. Wash thoroughly until clean and then boil with 500 ml of water. The water must be left to boil and wait for the remaining half, and then the water is filtered and drinks it twice a day until the symptoms of tertian malaria are completely cured and disappear.

That is the information about tertian malaria ranging from causes to medical and traditional treatments. So as not to get infected with tertian malaria, make sure you always prioritize personal hygiene and living environment. Always use mosquito repellent lotion and do not go out too often, especially at dusk.