Acute fevers: influenza, malaria and COVID-19
Influenza, malaria and COVID-19 are short, high fevers. All need extra energy, protein and fluid in small soft feeds; malaria adds anaemia and low blood sugar.
At a glance
| Disease | Cause and spread | Symptoms | Nutrition problems |
|---|---|---|---|
| Influenza | Influenza virus; coughing and sneezing (droplets) | Sudden fever, chills, body ache, sore throat, cough, tiredness | Poor appetite, dehydration, weakness |
| Malaria | Plasmodium (vivax, falciparum and others) through the bite of an infected female Anopheles mosquito | Intermittent fever with chills, shivering and sweating; headache, vomiting; fever every 48 hours in vivax malaria | Anaemia (red cells destroyed), low blood sugar (especially falciparum), dehydration, jaundice, enlarged spleen |
| COVID-19 | SARS-CoV-2 virus; droplets and aerosols | Fever, cough, sore throat, loss of taste and smell, tiredness, breathlessness in severe cases | Poor appetite, muscle loss, high blood sugar on steroids, long-lasting tiredness (long COVID) |
Dietary principles
| Nutrient | Recommendation | Why |
|---|---|---|
| Energy | High: add about 13% per 1 °C of fever; easy carbohydrates (glucose, kanji, rice, fruit juices) | Fever raises BMR; carbohydrate spares protein |
| Protein | High: about 1-1.5 g/kg from milk, curd, egg, dal, fish, paneer | Prevents muscle loss and supports immunity |
| Fat | Moderate; avoid fried food | Fried food worsens nausea |
| Fluid and electrolytes | 2.5-3 litres or more: ORS, soups, tender coconut water, buttermilk | Sweating, vomiting and fever cause dehydration |
| Glucose (malaria) | Frequent sweet drinks; never skip feeds | Malaria parasites and some drugs lower blood sugar |
| Iron and folate (malaria) | Iron- and folate-rich foods during recovery: greens, ragi, dates, egg, meat, dals | Replace red cells destroyed by the parasite |
| Vitamins and zinc | Fruits and vegetables rich in vitamins C and A; zinc from pulses, nuts, meat | Support immunity; no single food or supplement cures these infections |
| Blood sugar (COVID-19) | Check sugar in diabetics and patients on steroids; spread carbohydrate across small meals | Steroids raise blood sugar |
Foods to include and avoid
| Food group | Include | Avoid or limit |
|---|---|---|
| Cereals | Rice kanji, idli, soft rice, khichdi, ragi porridge, upma | Heavy, oily breads and fried snacks |
| Protein foods | Milk, curd, egg, moong dal, steamed fish, chicken soup, paneer | Fatty, spicy meat curries |
| Fruits and vegetables | Sweet lime, orange, papaya, banana, guava; cooked vegetables, vegetable soups | Cut fruit from roadside stalls |
| Fluids | ORS, tender coconut water, buttermilk, warm soups, ginger-tulsi water | Alcohol, very sugary soft drinks |
Sample one-day menu (malaria)
| Meal | Menu |
|---|---|
| 6 am | Glucose water or sweet lime juice |
| 8 am | Ragi porridge with milk and jaggery; boiled egg |
| 10 am | Tender coconut water; papaya |
| 12 noon | Soft rice, dal, spinach (keerai) kootu, curd |
| 3 pm | Fruit juice; marie biscuits |
| 5 pm | Vegetable soup; idli (2) |
| 8 pm | Moong dal khichdi, steamed fish or paneer, buttermilk |
| 10 pm | Warm milk with sugar |
In a malaria ward, a drowsy patient who has missed meals may have low blood sugar, not just fever; the dietitian makes sure sweet drinks reach the bedside every 2-3 hours. For COVID patients on steroids, sugar checks guide the meal plan.
2 marks: “Why are patients with malaria prone to anaemia?” The Plasmodium parasite multiplies inside red blood cells and destroys them.
5 marks: “Explain the dietary management of malaria.” High energy with frequent glucose drinks, high protein, 2.5-3 L fluid, iron and folate foods in recovery, soft small feeds, a short menu.
10 marks: “Discuss the dietary management of acute fevers such as influenza, malaria and COVID-19.” Cause and symptoms of each in a table, metabolic changes, common principles, disease-specific points (glucose and iron in malaria, sugar checks in COVID), foods, menu.
Acute fever plate: sweet, soft, sip often. Malaria adds sugar and iron; COVID adds sugar checks.