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Quartan fever is one of the four types of
malaria Malaria is a mosquito-borne infectious disease that affects humans and other animals. Malaria causes symptoms that typically include fever, tiredness, vomiting, and headaches. In severe cases, it can cause jaundice, seizures, coma, or death. S ...
which can be contracted by humans. It is specifically caused by the ''
Plasmodium malariae ''Plasmodium malariae'' is a parasitic protozoan that causes malaria in humans. It is one of several species of ''Plasmodium'' parasites that infect other organisms as pathogens, also including ''Plasmodium falciparum'' and ''Plasmodium vivax'' ...
'' species, one of the six species of the
protozoa Protozoa (singular: protozoan or protozoon; alternative plural: protozoans) are a group of single-celled eukaryotes, either free-living or parasitic, that feed on organic matter such as other microorganisms or organic tissues and debris. Histo ...
n genus ''
Plasmodium ''Plasmodium'' is a genus of unicellular eukaryotes that are obligate parasites of vertebrates and insects. The life cycles of ''Plasmodium'' species involve development in a blood-feeding insect host which then injects parasites into a vert ...
''. Quartan fever is a form of malaria where an onset of fever occurs in an interval of three to four days, hence the name "quartan". It is transmitted by bites of infected female mosquitoes of the genus ''
Anopheles ''Anopheles'' () is a genus of mosquito first described and named by J. W. Meigen in 1818. About 460 species are recognised; while over 100 can transmit human malaria, only 30–40 commonly transmit parasites of the genus ''Plasmodium'', which c ...
''. Symptoms include fevers which range from approximately and occur periodically in 72 hour intervals. Although cases of malaria have occurred throughout the world, quartan fever typically occurs in the
subtropics The subtropical zones or subtropics are geographical and climate zones to the north and south of the tropics. Geographically part of the temperate zones of both hemispheres, they cover the middle latitudes from to approximately 35° north and ...
. Quartan fever is considered to be a less severe form of malaria fever that can be cured by anti-malarial medication, and prevention methods can be taken in order to avoid infection.


Cause

The female ''Anopheles'' mosquito is a vector which transmits quartan fever to people. Mature mosquitoes carry uninucleate
sporozoites Apicomplexans, a group of intracellular parasites, have life cycle stages that allow them to survive the wide variety of environments they are exposed to during their complex life cycle. Each stage in the life cycle of an apicomplexan organism i ...
in their salivary glands; these sporozoites enter a human's bloodstream when mosquitoes puncture human flesh during feeding.  Sporozoites attack and inhabit liver parenchymal cells, called
hepatocytes A hepatocyte is a cell of the main parenchymal tissue of the liver. Hepatocytes make up 80% of the liver's mass. These cells are involved in: * Protein synthesis * Protein storage * Transformation of carbohydrates * Synthesis of cholesterol, b ...
, in order to develop further. Once the uninucleate sporozoites have matured, the sporozoites then develop into uninucleate merozoites. Uninucleated merozoites mature into an erythrocytic stage called schizonts which contain merozoites. The schizonts, an infected
erythrocyte Red blood cells (RBCs), also referred to as red cells, red blood corpuscles (in humans or other animals not having nucleus in red blood cells), haematids, erythroid cells or erythrocytes (from Greek ''erythros'' for "red" and ''kytos'' for "holl ...
, then rupture to release these merozoites; leading to more infections in the red blood cells. Uninucleated merozoites can also mature into uninucleate
gametocyte A gametocyte is a eukaryotic germ cell that divides by mitosis into other gametocytes or by meiosis into gametids during gametogenesis. Male gametocytes are called ''spermatocytes'', and female gametocytes are called ''oocytes''. Development ...
s which can invade and infect other female ''Anopheles'' mosquitoes during feeding, thus spreading the disease onto a wider population of humans.


Diagnosis

Fevers in intervals of 72 hours distinguish quartan fever from other forms of malaria where fevers range in 48 hour intervals or fever spikes that occur sporadically. Early indications of quartan fever include having irritated spots, welts, hives and burning skin, however this is dependent on individual's tolerance to mosquito bites and may not be evident on some people. With the ''Anopheles'' malaria mosquitoes, the welts are most likely to not appear unless there are severe allergic reactions. The prepatent period is the time interval for when parasites infect a host and when they can be detected on a thick blood film. For quartan fever, ''P. malariae'' has a prepatent period ranging from 16 to 59 days. Specifically in the case of quartan fever, the rupturing of liver stage schizonts releases merozoites. This stage of the ''P. malariae'' life cycle is known as the "ring stages" and are the first stages which can be detected in human blood for diagnosis.


Medical procedures that diagnose a patient with quartan fever

* Blood smears can be used to detect the parasites within red blood cells, thick blood smears are typically used initially to detect the parasites, then it is followed by thin blood smears which can detect the parasites as the morphology of erythrocytes is maintained through the process. *Peripheral blood films stained with
Giemsa stain Giemsa stain (), named after German chemist and bacteriologist Gustav Giemsa, is a nucleic acid stain used in cytogenetics and for the histopathological diagnosis of malaria and other parasites. Uses It is specific for the phosphate groups of ...
are a method of blood examination used to diagnose the presence of ''Plasmodium malariae'', and detect quartan fever. * Rapid diagnostic tests can detect the
antigen In immunology, an antigen (Ag) is a molecule or molecular structure or any foreign particulate matter or a pollen grain that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune response. ...
s which cause malaria, a sample of blood is collected from the patient and placed on a test card. After 15–20 minutes bands show up on the test card which indicate the specific species of malaria the patient is infected with. * Serological tests are used in general to detect whether a patient has developed
antibodies An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of the ...
to specific microorganism, therefore serological tests are used to detect past encounters with ''Plasmodium'' virus rather than acute cases where a patient has just been infected with ''P. malariae'' and has quartan fever. *
Polymerase chain reaction The polymerase chain reaction (PCR) is a method widely used to rapidly make millions to billions of copies (complete or partial) of a specific DNA sample, allowing scientists to take a very small sample of DNA and amplify it (or a part of it) t ...
s (PCR) are used to diagnosis ''Plasmodium malariae'' (cause of quartan fever) as well as to distinguish mixed infections with different species of ''Plasmodium''.


Treatment

*
Chloroquine Chloroquine is a medication primarily used to prevent and treat malaria in areas where malaria remains sensitive to its effects. Certain types of malaria, resistant strains, and complicated cases typically require different or additional medi ...
is an anti-malarial medication administered in the form of a tablet for ingestion. *Chloroquine is a water-soluble drug which is used to treat quartan fever. It is ingested in a compressed tablet form and is absorbed by the gastrointestinal tract. *
Hydroxychloroquine Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine. Other uses include treatment of rheumatoid arthritis, lupus, an ...
, another anti-malarial, is used to treat quartan fever. Hydroxychloroquine is also typically administered to patients with
lupus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...
flares. * Both hydroxychloroquine and chloroquine have a side effect of retinal toxicity when administered to infected patients. * Adverse effects of the drug chloroquine include agitation, anxiety, confusion, gastrointestinal discomfort, blurring vision and/or irreversible retinopathy. *
Sulfadoxine-pyrimethamine Sulfadoxine/pyrimethamine, sold under the brand name Fansidar, is a combination medication used to treat malaria. It contains sulfadoxine (a sulfonamide) and pyrimethamine (an antiprotozoal). For the treatment of malaria it is typically used al ...
(SP) is administered to pregnant women. Two to three doses of SP has been proven to reduce the levels of placental malaria and had a reduced risk of moderate to severe anemia.


Prevention

Ways to minimise exposure to the ''Anopheles'' mosquito include: * Indoor residual sprays are one of the most utilised methods of malaria prevention by the Global Malaria Eradication Campaign. Spraying is a method used to control malaria epidemics. *Nets treated with insecticide are effective at preventing mosquito contact for three years. The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) specifically protects younger children and pregnant women in order to reduce the risk of spreading quartan fever within the population. *Sulfadoxine-pyrimethamine (SP) administration to pregnant women is also a source of prevention in order to reduce the risks of maternal anaemia, low birth rate, and perinatal mortality. SP reduces the impact quartan fever may have on newborns and decrease the mortality rate. This method of prevention is known as "
chemoprevention Chemoprevention (also chemoprophylaxis) refers to the administration of a medication for the purpose of preventing disease or infection. Antibiotics, for example, may be administered to patients with disorders of immune system function to prevent b ...
." * House improvement is also a method of prevention. Traditional houses consisting of natural materials are susceptible to gaps which allow entry to ''Anopheles'' mosquitoes. House improvements including sealed windows and doors reduce the risk of coming in contact with the infected mosquitoes. * Larval source management is the control and monitoring of aquatic environments in order to prevent ''Anopheles'' mosquitoes from fully developing. Mosquitoes require aquatic environments in order to fully mature and develop. Once the mosquito eggs hatch, the larva must live in the water and develop into pupa. The pupa stage then matures into a fully developed mosquito and emerges from its aquatic habitat. When removing any water-filled containers from the surrounding area the mosquito life cycle is halted and acts as a method to reduce mosquito population within the surrounding area. * Clothing can act as a physical barrier to prevent exposure of flesh for mosquitoes to feed on, treating beds and clothing with insecticides/repellents can further reduce chances of infected mosquitoes from biting and passing quartan fever to individuals. * Avoiding areas which have high mosquito populations, specifically for quartan fever the ''P. malariae'' strain. * Avoiding travelling to regions which have a subtropical climate to prevent infection and developing quartan fever. *Implementing the sugar baiting method aids in reducing the population of Anopheles mosquitoes, and ultimately reducing the likelihood of catching quartan fever. Both male and female mosquitoes feed on the attractive toxic sugar bait (ATSB) and ingest low-risk oral toxins e.g. boric acid. This leads to mosquito death and reduces population.


References

{{Epidemiology Epidemiology Malaria