Malaria – मलेरिया
मलेरिया paludism एनॉफ्लीज वंश के संक्रमित मादा मच्छर के कटाने से संचारित प्लाज्मोडियम नामक एक कोशकीय परजीवी की लाल रक्त कोशिकाओ में विदमता से उत्पन्न होने वाला एक संक्रामक रोग है जिसमे समय समय पर जाड़ा लगता है और तेज बुखार आता है और शरीर में लाल रक्त कोशिकाओ की कमी होने लगती है, अगर टाइम से सही इलाज न कराया गया तो मरीज को रक्त की कमी और प्लीहा बढ़ जाता है आगे चलकर मरीज की मौत का कारण बनता है
Symptoms for malaria fever – रोग के लक्षण
- एनॉफ्लीज वंश के संक्रमित मादा मच्छर के काटने एवं बुखार चढ़ने के बीच 7 से 10 दिन का अतर रहता है।
- इस अवधि में रोगी को भूख नहीं लगती,
- सिर दर्द रहता है और थकावट बनी रहती है।
- ठंड की अवस्था शरीर की कंपकंपाहट के कारण रोगी अत्यधिक ठिठुरने लगता है।
- इसके साथ ही उल्टियाँ होने लगती हैं। सिरदर्द बना रहता है।
- इसके बाद बुखार चढ़ना शुरू होता है।
- रोगी को जलन के साथ अत्यधिक गर्मी अनुभव होती है।
- सूखी एवं जलती त्वचा। बुखार 104° से 106° तक। लगभग 1-2 घंटे बाद पसीना आना प्रारंभ होता है एवं बुखार कम होने लगता है।
- बुखार एक निश्चित समयबद्धता के साथ ही परिलक्षित होता है। यह समयबद्धता 12, 24, 48,72 घंटे हो सकती हा एकतरा बुखार 1 दिन छोड़कर आता है। हर तीसरे दिन और चौथे दिन और हर सप्ताह आता है
रोग का परिणाम
मलेरिया में न्यूमोनिया, टाइफॉइड, क्षयरोग, अरक्तता, यकृतशोथ, पित्ताश्मरी, वृक्कशोथ, प्लीहा विदार, कालमेह ज्वर, मानसिक विकार, नपुंसकता आदि रोग उपद्रव स्वरूप हो सकते हैं। इस ज्वर में प्लीहा और यकत बढ़ जाते हैं। और चिकित्सा न करने पर पाण्डु रोग (Jaundice) तथा पेचिस आदि हो जाती है।
Type of malaria – मलेरिया रोग निम्न प्रकार का होता है
- सेरिब्रल मलरिया (Cerebral Malaria) प्लाज्मोडियम फैल्सीपेरम मलेरिया परजीविया के मस्तिष्क में जमा हो जाने से उत्पन्न मस्तिष्क का मलेरिया जिसमें बेहोशी हो जाता है तथा बहुत तेज बुखार हो जाता है (तापमान 107°F स ऊपर हो जाता है अथवा आक्षेप (दार पड़न) आने लगते हैं। या ‘पक्षाघात’ (Paralysis) हो जाता है। कभी-कभी मृत्यु भी हो जाती है।
- फल्सीपरम मलेरिया (Falciparum Malaria) प्लाज्मोडियम फल्सापरम द्वारा उत्पन्न मलरिया जो सबसे अधिक गंभीर होता है, इसमें तीव्र लक्षण होत हैं एवं इसस कभी-कभी मृत्यु भी हो जाती है।
- लेटेन्ट मलेरिया (Latent Malaria) ऐसा मलेरिया रोग जिसमें परजीवी रक्त म विद्यमान रहते है। परन्तु इससे कोई लक्षण उत्पन्न नहीं होता। इस प्रकार के मलेरिया का रोगी रोग का भण्डार होता है।
- ओवेल मलेरिया (Ovale Malaria) मलेरिया परजीवी प्लाज्मोडियम ओवेल द्वारा उत्पन्न एक मृदु प्रकार का मलेरिया रोग जिसमें बार-बार तृतीयक ज्वर का आक्रमण होता है तथा जो स्वयं ही रोगमुक्ति में समाप्त हो जाता है।
- क्वार्टन मलेरिया (Quartan Malaria) प्लाज्मोडियम मलेरी द्वारा उत्पन्न मलेरिया रोग जिसमें ज्वर प्रत्येक 72 घंटे में अथवा चौथे दिन आता है तथा लक्षण इतने तीव्र नहीं होते, चतुर्थक मलेरिया कहलाता है।
- क्योटीडियन मलेरिया (Quotidian Malaria)– प्लाज्मोडियम वाइवैक्स द्वारा उत्पन्न मलेरिया जिसमें प्रतिदिन ज्वर हो जाता है और तापमान एकदम से बढ़ जाता एवं नीche गिर जाता है। इसे ‘दैनिक मलेरिया’ भी कहते हैं।
- टर्शियन मलेरिया (Tertian Malaria) मलेरिया जिसमें ज्वर तीसरे दिन आता है तथ प्रवेग जाड़ा, बुखार एवं पसीना आना इन अवस्थाओं में विभाजित रहता है। तृतीय मलेरिया (तिजारी) कहलाता है।
वाइवेक्स मलेरिया (Vivax Malaria)-प्लाज्मोडियम वाइवेक्स द्वारा उत्पन्न मलेरिया का सबसे अधिक मिलने वाला रूप जिसमें ज्वर तीसरे दिन आता है, जो अक्सर आता रहता है
Life cycle malaria
मलेरिया का जीवाणु अपना जीवन-चक्र 3 स्थानों म पूरा करता है
- मनुष्य में अमेथुनी चक्र (Asexual cycles)|
- मादा एनोफिलीज मच्छर में मैथुनी चक्र (Sexual cycle) | मनुष्य के यकृत में।
- अमैथुनी चक्र (Asexually cycle) को पूरा करने में जीवाणु अलग-अलग समय लेते हैं।
Mosquito that causes malaria
- प्ला. वाईवेक्स एवं प्ला. ओवेल नामक जीवाणु 48 घंटे।
- प्ला. फेलसीपेरम 36 से 48 घंटे।
- प्ला. मलेरी 2 घंटे का समय लेते हैं।
एनॉफ्लीज वंश के संक्रमित मादा मच्छर के कटाने से तृतीयक ज्वर (Tertian Fever) 1 दिन छोड़कर, चतुर्थ ज्वर 2 दिन छोड़कर और सततक प्रतिदिन आता है। मलेरिया/ विषम ज्वर सावधान-यह आषधि रोगी के यकृत पर कप्रभाव डालती हा अतः इसका प्रयाग मलेरिया के पॉजीटिव (+) Well diagnosed रोगियों में ही करना चाहिए।
मलेरिया में नैदानिक अनिवार्यताएँ थकावट, भूख न लगना, सिर दर्द एवं ठंड लगना। शीतावस्था 12 घंटे तक रहती है। रोगी को ठड़ लगती है और वह कांपता है कभी कभी टाँत भी किट-किटाता है और अपने आप को कंबल आदि से ढक लेता है। उसको तेज सिर दर्द एवं वमन होने लगता है। बुखार बढता जाता है। उष्णावस्था 1-6 घंटे तक रहती है। इस दौरान वह दहकता-सा हो सकता है और प्रलाप कर सकता है। वमन जारी रहता है ।
उसका चेहरा फीका, त्वचा शुष्क एवं जलती हुई सी होती है। ज्वर 41°C तक बढ़ सकता है। 0 स्वेदावस्था- इस दशा में खूब पसीना आता है, बुखार कम हो जाता है. रोगी को चैन आ जाता है और वह सो जाता है। सामान्यतः तिल्ली (Spleen) बढ़ी हुई होती है, लेकिन बच्चों में जिगर (Liver) भी छूने से दर्द रोग की पहचान
ज्वर आना और पसीना आकर उतर जाना, साथ में खून की कमी एवं प्लीहा वृद्धि भी हो तो रोग निर्णय आसानी से हो जाता है। विशिष्ट प्रकार का ज्वर, स्थान, ऋतु, रक्त एवं मूत्र परीक्षाओं तथा मलेरियानाशक औषधियों के प्रभाव से इसका निदान होता है। रक्त परीक्षण में ‘मलेरिया पैरासाइटस’ मिलना इसका निश्चयात्मक निदान है।
पथ्यापथ्य एवं सहायक चिकित्सा
साधारण दशा में तुलसी की चाय अच्छी रहती है। पानी ताजा भी दिया जा सकता है। बेदाना, अगूर, सेब, पपीता, परवल. साबूदाना, नींबू, चौलाई का शाक, मेथी और गेहूँ की रोटी देनी चाहिए।
प्रतिदिन दस्त साफ होते रहने के लिए दूध-मुनक्का जैसी मधुर रेचक चीजें अवश्य दें। ज्वर के आक्रमण के समय पसीना लाने वाली चीजें, गरम जल, सोंठ का चूर्ण आदि लाभप्रद हैं। मुँह में बर्फ की डेली रख दें और सिर पर बर्फ की पोटली रखें। रोगी को अनिच्छापूर्वक उपवास नहीं करना चाहिए।
सहयोगी उपचार (Supportive Treatment) के रूप में
सेरीब्रल मलेरिया में स्टीरॉयड्स।
तीव्र ताप होने पर-शीतल जल से स्पंज/पंखे की निरन्तर हवा आदि की व्यवस्था।
वृक्कपात की स्थिति में हीमोडायलिसिस (Haemodialysis) करना चाहिए।
स्तब्धता की स्थिति में-शिरामार्ग से ग्लूकोज, स्टीरॉयड्स प्लाज्मा आदि दें।
रोग निरोध के लिए-क्लोरोक्वीन 300 मि. ग्रा. सप्ताह में 1 बार। नोट-मलेरिया का सही निदान (Diagnose) करने के बाद सही ट्रीटमेंट कराये
How is malaria treated
मलेरिया का इलाज क्लोरोक्वीन’ अथवा कैमोक्वीन’ से की जानी चाहिए। क्लोरोक्वीन फास्फेट 250 मि.ग्रा. या क्लोरोक्वीन सल्फेट 10 टिकिया निम्न प्रकार दे सबसे पहले पैरासिटामोल जेसे केल्पोल या मेटासिन देकर टेम्परेचर कम कर ले। उसके बाद क्लोरोक्वीन 2 टिकिया आरंभ में, तत्पश्चात् 2-2 टिकिया 6-6 घंटे बाद लगातार 3 दिन तक दें। अगर आराम न मिले तो अस्पताल भेजे मलेरिया का इलाज अच्छे डॉक्टर के देख रेख में होना चाहिए अगर नार्मल दवाओ से आराम न मिले तो मरीज को जल्दी से किसी अस्पताल में भर्ती करना चाहिए
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