Which organ is most affected in malaria?

IGNOU PB Bsc Nsg Entrance-2017

Medical & Surgical Nursing

Easy

Appeared in: IGNOU PB Bsc Nsg Entrance-2017

Explanation

The spleen is the primary organ for filtering blood and removing old or damaged red blood cells (RBCs).
In malaria, the spleen's workload increases dramatically as it must clear billions of parasite-infected RBCs from the circulation.
This constant, high-volume filtering leads to congestion with cellular debris and malarial pigment (hemozoin), causing the spleen to become massively enlarged (splenomegaly).
Splenomegaly is a characteristic and prominent clinical sign of both acute and chronic malaria, reflecting the immense pathological burden on the organ.

Option A: While the liver is the site of the initial, asymptomatic phase of parasite multiplication (exo-erythrocytic stage) and can become enlarged, it does not typically experience the same degree of pathological stress or massive enlargement as the spleen.
Option C: The kidney is not the primary organ affected. Acute kidney injury is a serious complication of severe falciparum malaria (e.g., blackwater fever due to massive hemolysis), but it is not a universal feature of the disease.
Option D: The heart is the least affected organ among the choices. Myocarditis is a very rare complication and not a characteristic feature of malaria.

Clinical Relevance

Nursing practice connection: Knowing Pathophysiology of malaria and its effect on different organs helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Assessment for splenomegaly by palpating the abdomen is a key part of the clinical examination for a patient with suspected malaria.
A massively enlarged spleen is fragile and at high risk of traumatic rupture, which is a surgical emergency causing severe internal hemorrhage. Nurses must ensure patients are handled gently and must avoid vigorous abdominal palpation.
What if? If a patient with malaria has previously had their spleen removed (splenectomy), they are at a much higher risk for severe, overwhelming infection with very high levels of parasites in the blood, as the body's primary filtering organ for infected RBCs is absent.

How to Approach the Question

First, recall the basic life cycle of the malaria parasite (Plasmodium). It involves an initial stage in the liver and a subsequent stage in the red blood cells.
Consider the primary function of each organ listed in the options. The liver is for metabolism, the spleen filters blood, the kidney filters waste, and the heart pumps blood.
Connect the disease process to organ function. The main clinical illness and pathology of malaria are caused by the parasite's presence in red blood cells (the erythrocytic stage).
Reason that the organ responsible for filtering the blood and removing abnormal red blood cells—the spleen—will be under the most stress.
Conclude that this immense workload leads to the most significant pathological changes, namely massive enlargement (splenomegaly), making the spleen the most affected organ.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 397-399

E6 Medicine Harrison 22e Part 1 pp. 1806-1808, 1804-1806