A Comprehensive Guide to Malaria
Malaria is a parasitic disease spread by infected mosquitoes that affects 350 to 500 million people worldwide. Every year about one million of those infected people die, most of them young children. Most deaths occur in the sub-tropical Sahara Desert in Africa, where mosquitoes flourish. While nearly half of the world’s population is at risk for the disease, poorer, developing countries are most in danger.
The initial symptoms of malaria are flu-like: headaches, fever, chills, and vomiting. The disease can incubate in the liver, multiplying from 10 to 14 days after infection before spreading to the body via the bloodstream. If not treated immediately, malaria can be fatal.
Mosquitoes, the vector or transmitter of malaria parasites have been found in fossils thirty million years old. The ancient Greek physician, Hippocrates, wrote about the ravages of the disease among his patients. Before that, people placed blame of the symptoms on supernatural forces. The Romans began to associate the disease with water stagnancy, the prime breeding ground for the Anopheles mosquito vector, later creating the first drainage systems to alleviate those breeding grounds.
Malaria cannot be spread person to person like a cold or from human to animals or animals to humans. But, a non-infected mosquito can bite an infected person or an infected animal. This mosquito becomes infected and therefore becomes a new carrier, spreading the disease. Malaria can also be spread by illicit needle use, and sharing, by blood transfusion or, passed maternally in pregnancy to the unborn child.
The parasites are called Plasmodium and there are four kinds that cause malaria: vivax, malariae, ovale, and the most fatal, falciparum. They enter the host (the person or the animal who gets bitten by an infected mosquito) and travel through the bloodstream until the parasite reaches the liver. From there it goes back into the bloodstream where it multiplies like weeds, clogging the blood vessels and ravaging blood cells until they burst, keeping the cycle going.
P. vivax, P. malariae and P. ovale take a minimum of eight days for the parasites to enter the bloodstream from the liver, often taking several months. P. falciparum, the most virulent strain, only takes eight to 12 days, in comparison. During the time in the liver when the parasites are multiplying, the infected person feels fine. But once the parasite enters the bloodstream, the flu-like symptoms begin to take hold. Then it’s a cycle of uncontrollable and often violent shivering or chills, fever, and sweats until the fever is broken. That cycle occurs every two to three days wearing down the immune system making you more susceptible to malarial complication. Chronic malaria can occur up to 50 years after being initially infected. Those living in malaria endemic areas sometimes get reinfected so often that they never fully recover.
P. falciparum can cause organ failure as red blood cells are destroyed so quickly that the organs become blocked, brain function is affected, coma and convulsions result, often ending in death.
Diagnosis is usually a result of medical and travel history taken by a doctor who will examine you for flu-like symptoms and an enlarged spleen. If the doctor feels you are at risk or that you are likely to have malaria, a blood test will be ordered. The parasites can be seen under a microscope.
Malaria can be cured if treated early. All but P. falciparum can be treated with an oral drug called chloroquine. Falciparum needs emergency intervention with chloroquine or quinine and the powerful antibiotic tetracycline. If organ failure has begun, the patient may need transfusions, dialysis, oxygen, and IVs. The duration of treatment is dependent on the severity of the disease, the person’s age, and type of malarial parasite. See your physician immediately and insist upon a blood test for malaria if you have flu-like symptoms and have traveled to an area where malaria is endemic.
Prophylaxis of Malaria
A prophylactic is a drug or a barrier used to prevent disease. Drugs used to prevent malaria are also used to treat malaria. Quinine used to be the prophylactic drug of choice, but it has been replaced by more effective drugs that are quinine-based, but combined with other drugs, such as quinacrine, primaquine, and chloroquine. Quinine is still used for P. falciparum if it is chloroquine resistant. Other drugs are mefloquine, doxycycline and Malarone, an expensive, but highly effective combination drug.
Doctors prescribe the specific prophylaxis based on which endemic area the traveler is going to visit. The traveler begins taking the drug a week or two before traveling to the area and then must keep taking the drug a full four weeks after leaving the endemic region. There are 87 countries prone to malaria infection. Malaria is uncommon, but not unheard of in the United States.
Side effects of prophylactics include, but are not limited to: nausea, heartburn, headache, skin rashes and photosensitivity, which are some of the more common side effects. People with certain conditions such as liver and renal disease need to be advised of possible serious side effects by their physician.
- Every 30 seconds a child dies of malaria and its complications.
- Travelers who have no exposure to malaria in their home countries, who travel to malaria endemic regions, are vulnerable to the disease as they have had no previous exposure. Many take prophylactic medications to cut that risk.
- Malaria cuts economic rates in endemic regions by as much as 1.3 percent. A heavy economic toll in already poor or developing countries. Almost 40 percent of public health expenditures, as much as half of all inpatient hospital admissions and close to two-thirds of all outpatient health clinic visits are malaria-related. Poor people who cannot afford health care and/or treatment for malaria, or who have limited access to health care, as well as those who cannot work due to malaria, keep the cycle of poverty spinning.
- Pregnant women can pass the parasite to their unborn child. Non-immune pregnant women are at high risk of malaria in endemic areas. There is a high rate of miscarriage and maternal death. Up to half of all pregnant women who develop the severe form of malaria die as well as their unborn children.
- Pregnant women with partial immunity risk severe anemia and impaired fetal growth even if they show no signs of acute disease. Nearly 200,000 infants die as a result of being infected with malaria during pregnancy.