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 2013 an estimated 198 million cases of malaria occurred worldwide and 500,000 people died.
we are not doctors but bring to you reliable information from sources and give you the link of the source. Please refer to a medical professional if ill or have questions.
- 3.4 billion people live in areas at risk of malaria transmission in 106 countries and territories.
- The World Health Organization estimates that in 2013 malaria caused 198 million clinical episodes, and 500,000 deaths.
- Pregnant women have increased susceptibility to P. falciparum malaria; in malaria-endemic countries, P. falciparum contributes to 8-14% of low birth weight, which in turn decreases the chance of a baby’s survival.
Infection with malaria parasites may result in a wide variety of symptoms, ranging from absent or very mild symptoms to severe disease and even death. Malaria disease can be categorized as uncomplicated or severe (complicated). In general, malaria is a curable disease if diagnosed and treated promptly and correctly.
All the clinical symptoms associated with malaria are caused by the asexual erythrocytic or blood stage parasites. When the parasite develops in the erythrocyte, numerous known and unknown waste substances such as hemozoin pigment and other toxic factors accumulate in the infected red blood cell. These are dumped into the bloodstream when the infected cells lyse and release invasive merozoites. The hemozoin and other toxic factors such as glucose phosphate isomerase (GPI) stimulate macrophages and other cells to produce cytokines and other soluble factors which act to produce fever and rigors and probably influence other severe pathophysiology associated with malaria.
Plasmodium falciparum-infected erythrocytes, particularly those with mature trophozoites, adhere to the vascular endothelium of venular blood vessel walls and do not freely circulate in the blood. When this sequestration of infected erythrocytes occurs in the vessels of the brain it is believed to be a factor in causing the severe disease syndrome known as cerebral malaria, which is associated with high mortality.
Following the infective bite by the Anopheles mosquito, a period of time (the “incubation period”) goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days. The shorter periods are observed most frequently with P. falciparum and the longer ones withP. malariae.
Antimalarial drugs taken for prophylaxis by travelers can delay the appearance of malaria symptoms by weeks or months, long after the traveler has left the malaria-endemic area. (This can happen particularly with P. vivax and P. ovale, both of which can produce dormant liver stage parasites; the liver stages may reactivate and cause disease months after the infective mosquito bite.)
Such long delays between exposure and development of symptoms can result in misdiagnosis or delayed diagnosis because of reduced clinical suspicion by the health-care provider. Returned travelers should always remind their health-care providers of any travel in areas where malaria occurs during the past 12 months.
The classical (but rarely observed) malaria attack lasts 6-10 hours. It consists of
- a cold stage (sensation of cold, shivering)
- a hot stage (fever, headaches, vomiting; seizures in young children)
- and finally a sweating stage (sweats, return to normal temperature, tiredness).
Classically (but infrequently observed) the attacks occur every second day with the “tertian” parasites (P. falciparum, P. vivax, and P. ovale) and every third day with the “quartan” parasite (P. malariae).
More commonly, the patient presents with a combination of the following symptoms:
fever sweats nausea vomiting general malaise chills headaches body aches
In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza, a cold, or other common infections, especially if malaria is not suspected. Conversely, in countries where malaria is frequent, residents often recognize the symptoms as malaria and treat themselves without seeking diagnostic confirmation (“presumptive treatment”).
Physical findings may include:
- Elevated temperatures Weakness mild jaundice increased respiratory rate perspiration enlarged spleen enlargement of the liver
Diagnosis of malaria depends on the demonstration of parasites in the blood, usually by microscopy. Additional laboratory findings may include mild anemia, mild decrease in blood platelets (thrombocytopenia), elevation of bilirubin, and elevation of amino transferases.
Severe malaria occurs when infections are complicated by serious organ failures or abnormalities in the patient’s blood or metabolism. The manifestations of severe malaria include
- Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
- Severe anemia due to hemolysis (destruction of the red blood cells)
- Hemoglobinuria (hemoglobin in the urine) due to hemolysis
- Acute respiratory distress syndrome (ARDS), an inflammatory reaction in the lungs that inhibits oxygen exchange, which may occur even after the parasite counts have decreased in response to treatment
- Abnormalities in blood coagulation
- Low blood pressure caused by cardiovascular collapse
- Acute kidney failure
- Hyperparasitemia, where more than 5% of the red blood cells are infected by malaria parasites
- Metabolic acidosis (excessive acidity in the blood and tissue fluids), often in association with hypoglycemia
- Hypoglycemia (low blood glucose). Hypoglycemia may also occur in pregnant women with uncomplicated malaria, or after treatment with quinine.
Severe malaria is a medical emergency and should be treated urgently and aggressively.
next page about malaria and travel
Counterfeit and Substandard Antimalarial Drugs: Information for Travelers
What Are They?
Counterfeit (fake) antimalarial or other drugs are deliberately made to look like brand name drugs. However, they may have no active ingredients, they may have less than the required amount of active ingredient, or they may contain ingredients which are not what is described on the package label. Counterfeiters tend to focus on the more expensive brands. Substandard drugs are found even among cheaper products, because some manufacturers try to avoid costly quality control and good manufacturing practices.
The quality of commercially available drugs varies greatly in malaria-endemic countries:
- The amount of the active ingredient can vary due to lack of regulations and poor quality control practices in many of these countries.
- Some pills may release very little if any drug due to poor formulation techniques.
- Chemical break-down of some drugs can occur due to poor storage conditions, especially in warm and humid tropical climates.
- Some drugs may be contaminated with other substances.
- Counterfeiters may also obtain expired drugs and repackage them with new expiration dates.
This is wide spread in some parts of SE Asia
When Buying Drugs, Take the Following Precautions
- Travelers should buy in their home country all the medicines they will need before their trip.
- Travelers should write down the drug’s generic and brand names as well as the name of the manufacturer. In case they run out, they can look for the correct product.
- Make sure that the drug is in its original packaging.
- Inspect the packaging because many times poor quality printing indicates a counterfeited product.
- Be suspicious of tablets that have a peculiar odor, taste, or color, or that are extremely brittle.
Based on the risk assessment, specific malaria prevention interventions should be used by the traveler. Often this includes avoiding mosquito bites through the use of repellents or insecticide treated bed nets, and specific medicines to prevent malaria.