Disease: Malaria

    Malaria facts

    • Over 200 million cases of malaria occurred worldwide in 2010.
    • The World Health Organization estimates that 500,000-800,000 people died of malaria in 2010; the vast majority are young children in sub-Saharan Africa.
    • About 1,500 cases are diagnosed in the U.S. each year, usually in travelers returning from endemic areas.
    • Malaria was a serious public-health threat in the U.S. until it was eliminated during the 1920s-1940s. Much of the early work done by the CDC focused on controlling and eliminating malaria in the U.S.

    What is malaria?

    Malaria is a serious, sometimes fatal, disease spread by mosquitoes and caused by a parasite. Malaria was a significant health risk in the U.S. until it was eliminated by multiple programs in the late 1940s. The illness presents with flu-like symptoms that include high fever and chills.

    There are three necessary aspects to the malaria life cycle:

    1. The Anopheles mosquito that carries the parasite and where the parasite starts its life cycle
    2. The parasite (Plasmodium) has multiple subspecies, each causing a different severity of symptoms and responding to different treatments.
    3. The parasite first travels to a human's liver to grow and multiply. It then travels in the bloodstream and infects and destroys red blood cells.

    Is malaria contagious?

    Malaria can spread without a mosquito. This occurs rarely and is usually found in a transmission from the mother to the unborn child (congenital malaria), by blood transfusions, or when intravenous-drug users share needles.

    What causes malaria?

    Parasites of the genus Plasmodium cause malaria. Although there are many species of Plasmodium, only five infect humans and cause malaria.

    P. falciparum: found in tropical and subtropical areas; major contributor to deaths from severe malaria

    P. vivax: found in Asia and Latin America; has a dormant stage that can cause relapses

    P. ovale: found in Africa and the Pacific islands

    P. malariae: worldwide; can cause a chronic infection

    P. knowlesi: found throughout Southeast Asia; can rapidly progress from an uncomplicated case to a severe malaria infection

    What are risk factors for malaria? Is it possible to prevent malaria?

    The prevention of malaria includes several steps.

    First, evaluate if malaria is a concern in the area of travel (CDC malaria information by country table). This table will also indicate which medication to take as chemo prophylaxis.

    If chemo prophylaxis is recommended, discuss the recommended medications with a health-care professional to determine if they are appropriate. Take into consideration any medical conditions, drug interactions with current medication taken on a continual basis, as well as side effects of the recommended medications.

    No medication is 100% effective, and therefore the prevention of mosquito bites is of paramount importance. These preventive measures should include the following:

    • Sleeping under bed nets: These should cover all of the bed down to the floor. These nets are most effective if they are treated with an insecticide.
    • Clothing: Clothing that covers most of the exposed skin and shoes that are closed can reduce the risk of bites. All clothing should be tucked in, and pants should be tucked into socks to avoid exposure around the ankles. In addition, treating clothes with insecticides can prevent bites even further.
    • Apply insect repellent to all exposed skin.

    What are malaria symptoms and signs?

    Malaria has a wide spectrum of symptoms. After the bite by the infected mosquito occurs, it can take between seven and 30 days before symptoms start.

    Malaria is classified as uncomplicated or complicated (severe).

    Uncomplicated malaria

    The most common symptoms are

    • fever and chills,
    • headaches,
    • nausea and vomiting,
    • general weakness and body aches.

    The classic description of a malaria attack (which is rarely observed), would be a six- to 12-hour period of cold and shivering alternating with fever and headaches and then a stage of sweating and tiredness (sometimes divided into the cold and hot stage).

    As these symptoms are very nonspecific, it is important to evaluate if the patient has risk factors for malaria (usual travel in endemic areas).

    Complicated or severe malaria

    This occurs when different body systems are affected by malaria.

    • Severe anemia (due to destruction of red blood cells)
    • Kidney failure
    • Cerebral malaria -- seizures, unconsciousness, abnormal behavior, or confusion
    • Cardiovascular collapse
    • Low blood sugar (in pregnant women after treatment with quinine)

    How do physicians diagnose malaria?

    The symptoms of malaria can mimic many other diseases, including influenza or a viral syndrome. It is therefore important to inquire about a history of recent travel to an endemic area or other possible exposures.

    The definite diagnosis is made by looking at the blood of an infected patient under the microscope (blood smear) and identifying the presence of the parasite. The patients' blood is prepared under a slide with a specific stain to help identify the parasite. This is the most widely performed and accepted test.

    Rapid diagnostic tests (antigen tests) are available that can give the diagnosis in a few minutes. It is recommended that a positive test is followed with a blood smear examination.

    What is the treatment for malaria?

    Besides supportive care, the medical team needs to decide on the appropriate antibiotics to treat malaria. The choice will depend on several factors, including

    • the specific species of parasite identified,
    • the severity of symptoms,
    • determination of drug resistance based on the geographic area where the patient traveled.

    Physicians will administer the medication in pill form or as an intravenous antibiotic depending on above factors.

    The most commonly used medications are

    • chloroquine (Aralen),
    • doxycycline (Vibramycin, Oracea, Adoxa, Atridox),
    • quinine (Qualaquin),
    • mefloquin (Lariam),
    • atovaquone/proguanil (Malarone),
    • artemether/lumefantrine (Coartem).

    What causes malaria?

    Parasites of the genus Plasmodium cause malaria. Although there are many species of Plasmodium, only five infect humans and cause malaria.

    P. falciparum: found in tropical and subtropical areas; major contributor to deaths from severe malaria

    P. vivax: found in Asia and Latin America; has a dormant stage that can cause relapses

    P. ovale: found in Africa and the Pacific islands

    P. malariae: worldwide; can cause a chronic infection

    P. knowlesi: found throughout Southeast Asia; can rapidly progress from an uncomplicated case to a severe malaria infection

    What are risk factors for malaria? Is it possible to prevent malaria?

    The prevention of malaria includes several steps.

    First, evaluate if malaria is a concern in the area of travel (CDC malaria information by country table). This table will also indicate which medication to take as chemo prophylaxis.

    If chemo prophylaxis is recommended, discuss the recommended medications with a health-care professional to determine if they are appropriate. Take into consideration any medical conditions, drug interactions with current medication taken on a continual basis, as well as side effects of the recommended medications.

    No medication is 100% effective, and therefore the prevention of mosquito bites is of paramount importance. These preventive measures should include the following:

    • Sleeping under bed nets: These should cover all of the bed down to the floor. These nets are most effective if they are treated with an insecticide.
    • Clothing: Clothing that covers most of the exposed skin and shoes that are closed can reduce the risk of bites. All clothing should be tucked in, and pants should be tucked into socks to avoid exposure around the ankles. In addition, treating clothes with insecticides can prevent bites even further.
    • Apply insect repellent to all exposed skin.

    What are malaria symptoms and signs?

    Malaria has a wide spectrum of symptoms. After the bite by the infected mosquito occurs, it can take between seven and 30 days before symptoms start.

    Malaria is classified as uncomplicated or complicated (severe).

    Uncomplicated malaria

    The most common symptoms are

    • fever and chills,
    • headaches,
    • nausea and vomiting,
    • general weakness and body aches.

    The classic description of a malaria attack (which is rarely observed), would be a six- to 12-hour period of cold and shivering alternating with fever and headaches and then a stage of sweating and tiredness (sometimes divided into the cold and hot stage).

    As these symptoms are very nonspecific, it is important to evaluate if the patient has risk factors for malaria (usual travel in endemic areas).

    Complicated or severe malaria

    This occurs when different body systems are affected by malaria.

    • Severe anemia (due to destruction of red blood cells)
    • Kidney failure
    • Cerebral malaria -- seizures, unconsciousness, abnormal behavior, or confusion
    • Cardiovascular collapse
    • Low blood sugar (in pregnant women after treatment with quinine)

    How do physicians diagnose malaria?

    The symptoms of malaria can mimic many other diseases, including influenza or a viral syndrome. It is therefore important to inquire about a history of recent travel to an endemic area or other possible exposures.

    The definite diagnosis is made by looking at the blood of an infected patient under the microscope (blood smear) and identifying the presence of the parasite. The patients' blood is prepared under a slide with a specific stain to help identify the parasite. This is the most widely performed and accepted test.

    Rapid diagnostic tests (antigen tests) are available that can give the diagnosis in a few minutes. It is recommended that a positive test is followed with a blood smear examination.

    What is the treatment for malaria?

    Besides supportive care, the medical team needs to decide on the appropriate antibiotics to treat malaria. The choice will depend on several factors, including

    • the specific species of parasite identified,
    • the severity of symptoms,
    • determination of drug resistance based on the geographic area where the patient traveled.

    Physicians will administer the medication in pill form or as an intravenous antibiotic depending on above factors.

    The most commonly used medications are

    • chloroquine (Aralen),
    • doxycycline (Vibramycin, Oracea, Adoxa, Atridox),
    • quinine (Qualaquin),
    • mefloquin (Lariam),
    • atovaquone/proguanil (Malarone),
    • artemether/lumefantrine (Coartem).

    Source: http://www.rxlist.com

    Malaria can spread without a mosquito. This occurs rarely and is usually found in a transmission from the mother to the unborn child (congenital malaria), by blood transfusions, or when intravenous-drug users share needles.

    Source: http://www.rxlist.com

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