The first bite
“Are you serious?” That was my nearly incredulous response when a colleague informed me that there are still numerous malaria cases in the country, particularly in certain municipalities in the province of Palawan. Since Manila is my area of practice, I haven’t attended to a malaria case in nearly two decades, although there have been instances when it was included in the diagnostic work-up and considered in the differential diagnosis for pediatric patients presenting with prolonged fever.
I was shocked by the scale of the numbers, as the cases were in the thousands. Despite a significant decrease, deaths were still occurring, according to published data. As reported by the Philippine News Agency in April 2024, there were 6,248 cases in 2023—almost double the 3,245 recorded in 2022 by the Department of Health’s Research Institute for Tropical Medicine.
I remember my first encounter with malaria vividly, and I couldn’t help but shake my head, recalling how helpless I felt. I was a medical clerk at that time, and within the hierarchy of the medical team, we were the first ones called to a patient’s bedside. We had no other recourse but to secure the patient to the bed because he was already experiencing behavioral changes, along with the other complications of the most severe form caused by the species Plasmodium falciparum.
Our conversation further deepened into other interrelated concerns, such as teenage pregnancies among indigenous tribes who were most affected by malaria, and how climate change has greatly played a role in bringing about the current situation. Pregnant women are most vulnerable to malaria, and if infected, both mother and child may suffer complications. Malaria in pregnancy places a woman at increased risk for anemia and even death, and can result in preterm delivery, miscarriage, stillbirth, or low birthweight infants.
Closely following that shared information was also the rise in dengue cases in the province. This was confirmed via a phone call to our younger colleague. She relayed that they had unfortunate situations wherein they were unable to save patients because they were already in a shock-like state at the time they were brought to the city. Fully aware of the lack of facilities in certain municipalities and the logistical and geographical challenges that exist, we vowed that we would try to help in our own capacities, which sent our neurons into overdrive. We had existing networks that could potentially be tapped.
So can you tell one from the other? If you think that you do not play a role in recognition, let me just say you do. How many times in an ordinary conversation have you urged a friend to seek early and proper consult with the basic knowledge you have of both diseases? Saving lives is not exclusive to the health profession.
As a review of the basics, they are both mosquito-borne. Malaria is caused by a parasite and comes from the bite of an infected Anopheles mosquito, while dengue is caused by a virus transmitted from a female-infected Aedes mosquito. Both infections can be asymptomatic, especially in endemic areas. This is significant because affected individuals can still transmit the virus or parasite via infected mosquitoes, which can hinder elimination efforts.
If symptomatic, fever is common to both. The incubation period is generally shorter for dengue than for malaria. For dengue, symptoms may be nonspecific, which may include body malaise, decreased appetite, rash, orbital pain, nausea, vomiting, or in severe cases, present with intense abdominal pain or overt bleeding. Malaria typically presents with high fever, chills, extreme headache, and if severe, jaundice; hematuria, which can be a sign of renal failure; respiratory distress; coma; shock; or organ failure. There are situations where these manifestations may overlap, causing confusion. For dengue and malaria, some may have even been treated as bacterial sepsis at the onset.
It is essential to maintain a high level of suspicion when considering an initial diagnosis, as other illnesses may present similarly. A complete history and thorough physical examination are vital in this process, as they help inform further investigations. Timely intervention and treatment can be lifesaving. Additionally, surveillance and screening are crucial tools for disease control and management.
In light of the situation described above, instead of feeling overwhelmed or defeated, we all believe that there is hope in addressing these public health concerns. There are existing national programs for both dengue and malaria, and priorities can be realigned at the level of local government units to tackle these issues effectively.
June is recognized as Dengue Awareness Month, while November is designated for Malaria Awareness. However, simply being aware is not enough; we must take proactive steps if we hope to achieve the goal of zero deaths from dengue by 2030 and a 90 percent reduction in cases and deaths from malaria.
Kilos, Pilipinas!
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