Malaria

What is Malaria?

 

   Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2015, an estimated 214 million cases of malaria occurred worldwide and 438,000 people died, mostly children in the African Region. About 1,500 cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia.

What are the causes of Malaria?

  Malaria can occur if a mosquito infected with the Plasmodium parasite bites you. An infected mother can also pass the disease to her baby at birth. This is known as congenital malaria. Malaria is transmitted by blood, so it can also be transmitted through:

ü   an organ transplant

ü   A blood transfusion (수혈)

ü   use of shared needles or syringes

What are the symptoms?

   The symptoms of malaria typically develop within 10 days to four weeks following the infection. In some people, symptoms may not develop for several months. Some malarial parasites can enter the body but will be dormant for long periods of time. Common symptoms of malaria include:

ü   shaking chills that can range from moderate to severe

ü   high fever

ü   profuse sweating

ü   headache

ü   nausea

ü   vomiting

ü   diarrhea

ü   anemia

ü   muscle pain

ü   convulsions

ü   coma

ü   bloody stools

Prevalence

Malaria infection is still to be considered a major public health problem in those 106 countries where the risk of contracting the infection with one or more of the Plasmodium species exists. According to estimates from the World Health Organization, over 200 million cases and about 655.000 deaths have occurred in 2010. Estimating the real health and social burden of the disease is a difficult task, because many of the malaria endemic countries have limited diagnostic resources, especially in rural settings where conditions with similar clinical picture may coexist in the same geographical areas. Moreover, asymptomatic parasitaemia may occur in high transmission areas after childhood, when anti-malaria semi-immunity occurs. Malaria endemicity and control activities are very complex issues, that are influenced by factors related to the host, to the parasite, to the vector, to the environment and to the health system capacity to fully implement available anti-malaria weapons such as rapid diagnostic tests, artemisinin-based combination treatment, impregnated bed-nets and insecticide residual spraying while waiting for an effective vaccine to be made available.

Malaria Treatment

  Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

ü   chloroquine

ü   atovaquone-proguanil (Malarone®)

ü   artemether-lumefantrine (Coartem®)

ü   mefloquine (Lariam®)

ü   quinine

ü   quinidine

ü   doxycycline (used in combination with quinine)

ü   clindamycin (used in combination with quinine)

ü   artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

  In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

• The type (species) of the infecting parasite
• The area where the infection was acquired and its drug-resistance status
• The clinical status of the patient
• Any accompanying illness or condition
• Pregnancy
• Drug allergies, or other medications taken by the patient

Bibliography

1.        Autino, B., Noris, A., Russo, R. and Castelli, F. (2017). EPIDEMIOLOGY OF MALARIA IN ENDEMIC AREAS.

2.        Cdc.gov. (2017). CDC - Malaria. [online] Available at: https://www.cdc.gov/malaria/ [Accessed 20 Mar. 2017].

3.        Healthline. (2017). Malaria. [online] Available at: http://www.healthline.com/health/malaria?s_con_rec=false&r=00#Diagnosis4 [Accessed 20 Mar. 2017].