The symptoms of malaria and dengue are somehow similar. The treatment of malaria and dengue is possible after a proper diagnosis of the disease.

Doctor, Do I Have Malaria, Dengue, or Something Else?

Doctor, Do I Have Malaria, Dengue, Or Something Else?

Introduction

The human body is a complex system with multiple defense mechanisms to protect against infections. A fever, often a symptom of disease, is actually an indication that the body&#39;s immune system is doing its job of protecting you. However, fever can result from a wide variety of illnesses and diagnosing the disease based on just one symptom is never enough. Moreover, in a country like Pakistan where several deadly mosquito-borne diseases are endemic, a fever can lead to panic among people. Especially during the months of September to December when these diseases are most common.

According to the World Health Organization (WHO), malaria is a major cause of mortality and morbidity in Pakistan. Moreover, the country shares the highest burden of mosquito-borne diseases, such as <a href="https://www.merisehat.pk/disease/dengue">dengue</a>, <a href="https://www.merisehat.pk/disease/malaria">malaria</a>, and Chikungunya<a href="#accordion">[1]</a>. Climate change, urbanization, poor health conditions, lack of accessible healthcare, and natural disasters are all to blame for the increase in these diseases. Although the exact distribution and magnitude of these diseases remain unclear, it is evident that their prevalence will continue to rise in the coming years.&nbsp;

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Understanding Different Mosquito Borne Diseases

As per estimates, malaria and dengue are the most prevalent mosquito-borne diseases with 214 million and 390 million global cases a year respectively<a href="#accordion">[2]</a>.

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Malaria - In Pakistan, malaria accounts for 50,000 new deaths per year<a href="#accordion">[3]</a>. Transmitted by the bite of a female Anopheles mosquito, malarial parasites can cause a wide variety of symptoms in humans. These include fever with chills, sweating, headache, nausea, fatigue, and muscle or joint pain. There are currently four different Plasmodium parasites that cause malaria in humans: P. falciparum, P. vivax, P. ovale, and P. malariae. P. falciparum and P. vivax account for the greatest number of malaria cases in Pakistan.

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Dengue - In contrast, the dengue virus is transmitted by the bite of the Aedes aegypti mosquito. The mosquito is also responsible for causing other mosquito-borne diseases such as Zika, chikungunya, and yellow fever.

Pakistan recorded its first dengue outbreak in 1994 when 1,000 people got infected. Since then, the country has recorded several outbreaks of the disease. In 2021, Pakistan reported a record 48,906 dengue cases and 183 deaths across all provinces<a href="#accordion">[4]</a>. Every year, the country faces seasonal waves of illness with different dengue viruses (DENV-1, DENV-2, DENV-3, DENV-4) causing outbreaks. The most common symptoms include fever, headache, rash, muscle and joint pain, and, in severe cases, internal or external bleeding.

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Chikungunya - The chikungunya virus first emerged in Pakistan in the 1980s, mostly among the rodent population. However, it wasn&#39;t until 2011 that cases began appearing among the human population. The virus typically causes fever, joint pain, skin rash, headache, and nausea.&nbsp;

In 2016, the city of Karachi recorded one of its worst outbreaks which affected approximately 30,000 individuals<a href="#accordion">[5]</a>. Since the overlap of symptoms of dengue causes doctors to often misdiagnose the cases, experts predict that the actual prevalence of chikungunya might be much higher. The rise in cases and the mosquito levels could likely lead to an increase in other mosquito-borne diseases.

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The presence of various mosquito-borne diseases all in one place at one time can make it confusing for both doctors and patients to determine what&#39;s causing the symptoms. Therefore, it&#39;s important to know the similarities and differences between the different illnesses.&nbsp;

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Malaria Symptoms - These usually appear 10-15 days after a mosquito bite and include:

<ul>
	<li>High fever with chills followed by excessive sweating as the body temperature falls</li>
	<li>Body aches</li>
	<li>Headaches</li>
	<li>Nausea and vomiting</li>
	<li>Diarrhea</li>
	<li>Anemia</li>
	<li>Jaundice</li>
</ul>

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Dengue Symptoms - Symptoms of dengue can begin within 4-10 days of a mosquito bite and usually persist for 2-7 days. These include:

<ul>
	<li>High fever</li>
	<li>Severe headache</li>
	<li>Pain behind the eyes, in muscles, and in joints</li>
	<li>Nausea and vomiting</li>
	<li>Skin rash</li>
	<li>Sever dengue can result in severe stomach pain, bleeding from gums, blood in stool or urine, difficulty breathing, and fatigue.</li>
</ul>

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Chikungunya Symptoms - Symptoms begin within a week of a mosquito bite and is characterized by:

<ul>
	<li>Fever</li>
	<li>Joint pain and swelling</li>
	<li>Headache</li>
	<li>Rash</li>
	<li>Fatigue</li>
</ul>

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Fever, headache, joint or muscle pain, and nausea are common symptoms among all three diseases. However, there are also many differentiating features. For example, in dengue pain behind the eyes and a rash is a characteristic feature. While in malaria, a fever is always accompanied by severe chills and then a period of sweating as the person&#39;s body temperature returns to normal. Moreover, the episodes of fever come every 24-72 hours, depending on the type of malarial parasite causing the infection.&nbsp;

Although all three diseases have similar symptoms, laboratory investigations can often prove helpful in differentiating between the three. Therefore, it is advised to immediately consult a doctor if one lives in an endemic region, especially during a period when mosquito-borne diseases are most prevalent.&nbsp;

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Several precautionary measures can prevent infections and help reduce the burden of disease.&nbsp;

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Personal Protection - Various protection measures help prevent mosquito bites. These include:

<ul>
	<li>Using mosquito repellents, especially when stepping out at hours when mosquitoes are most active.</li>
	<li>Wearing clothes that reduce exposure to mosquitoes.</li>
	<li>Sleeping under insecticide-treated bed nets.</li>
</ul>

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Vector Control - These strategies are aimed at reducing the population of mosquitoes. They include:

<ul>
	<li>Spraying of insecticides and larvicides in areas where mosquitoes are frequently present.</li>
	<li>Preventing water from collecting in old tires, empty pots, or stagnate water ponds as these act as breeding grounds for mosquitoes</li>
</ul>

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Along with these preventive strategies, it is also important to increase patient education regarding various mosquito-borne diseases. A lack of information on the causes and manifestations can lead to panic and a delay in seeking help.&nbsp;

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Conclusion

Mosquito-borne diseases are most prevalent in tropical and subtropical countries. The warm climate not only helps the mosquitoes complete their life cycle but also increases mosquito activity. In Pakistan, the changing climate has caused a shift in the mosquito population. With warmer summers and warmer winters, the diseases have also changed their occurrence. In cities like Karachi, where the temperature remains above 15 degrees Celsius in the winter, outbreaks occur more frequently during the winter. Moreover, the heavy monsoon season causes water to collect in the form of pools and puddles, which then act as breeding grounds for mosquitoes. Thus, contributing to the spread of disease.

The increase in natural disasters such as floods in the country has led to the displacement of people to temporary camps. Overcrowding, poor hygiene, lack of clean drinking water, and the lack of healthcare facilities and resources at these camps have also contributed to an increase in outbreaks and mosquito populations.&nbsp;

However, climate change is not the only factor causing the spread of disease. Deforestation, agriculture, urbanization, poor socioeconomic conditions, failed vector control strategies, and drug resistance has also increased infections. Moreover, the destruction of forests and trees has resulted in the mosquito population breeding indoors.

The increase in mosquito population not only heightens the risk of existing diseases, but also others such as the deadly Zika virus. Therefore, there is a need for proper surveillance methods across the country such as the development of screening labs and educating the public on various vector control methods. Since there are no vaccines available in Pakistan for the prevalent mosquito-borne diseases, vector control measures provide the best protection against these diseases. However, current vector control measures are insufficient due to the rising insecticide resistance among viruses and parasites.&nbsp;

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Key points

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Pakistan shares the highest burden of mosquito-borne diseases such as malaria, dengue, and chikungunya.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Mosquitoes thrive more in tropical and subtropical regions. Therefore, Pakistan's warm climate is a significant factor in the prevalence of these diseases.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Malaria is a major cause of mortality and morbidity in Pakistan, causing 50,000 new deaths each year.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The malarial parasite enters humans through the bite of an infected female Anopheles mosquito. This results in symptoms such as fever and chills, sweating, headache, anemia, nausea, and body aches.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The dengue virus is transmitted via the bite of an infected Aedes aegypti mosquito and results in high fever, joint pain, rash, pain behind the eye, and in severe cases external and internal bleeding.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The Aedes aegypti mosquito can also spread Zika, chikungunya, and yellow fever.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">In 2016, Pakistan recorded one of its worst chikungunya outbreaks, with almost 30,000 infections.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Chikungunya typically appears as fever, joint pain, skin rash, headache, and nausea.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Malaria, dengue, and chikungunya continue to be the most common mosquito-borne diseases in Pakistan. However, an overlap of symptoms often makes it difficult to differentiate between the three. The common symptoms include fever, headache, nausea, and joint or muscle pain.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Since the diseases can often be fatal, an early and accurate diagnosis is crucial to recovery. Adequate laboratory testing, a complete history, and patient awareness of all three diseases can help identify the infection.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Vector control strategies, such as destruction of mosquito breeding grounds and protection from mosquito bites, are key to preventing mosquito-borne diseases.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Climate change, urbanization, poor health conditions, lack of accessible healthcare, population rise, and increasing drug resistance has led to an increase in these diseases in recent years.</li></ul>

[1] WHO, n.d. Pakistan: Malaria and other vector-borne diseases. [Online].

[2] Chong, S. E. et al., 2017. The dangers of accepting a single diagnosis: case report of concurrent Plasmodium knowlesi malaria and dengue infection. Malaria Journal, 16(2).

[3] Qureshi, H., Khan, M. I., Ambachew, H. & Ye, D.-Q., 2020. Baseline survey for malaria prevalence in Khyber Pakhtunkhwa Province, Pakistan. Eastern Mediterranean Health Journal, 26(41).

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