It is transmitted to humans through the bite of the Anopheles mosquito.
Once an infected mosquito bites a human, the parasites multiply in the host's liver before infecting and destroying red blood cells.
In some places, malaria can be treated and controlled with early diagnosis. However, some countries lack the resources to do this effectively.
Currently, no vaccine is licensed for use in the United States or globally, although one is available in Europe.
Malaria was eliminated from the U.S. in the early 1950s, but between 1,500 and 2,000 cases still occur each year, mostly in those who have recently traveled to malaria-endemic areas.
Here are some key points about the malaria. More detail is in the main article.
- Malaria is typically spread by mosquitoes.
- Symptoms resemble those of flu, but, without treatment, the effects can sometimes be long-term and fatal.
- Travelers, hikers, and campers can protect themselves with medication, pest control, clothing, and nets.
What is malaria?
Malaria is passed on by the Anopheles mosquito.
Over 100 types of Plasmodium parasite can infect a variety of species. They replicate at different rates, and this affects how quickly the symptoms escalate, and the severity of the disease.
Five types of Plasmodium parasite can infect humans. They are found in different parts of the world. Some cause a more severe type of malaria than others.
Malaria symptoms can be classified into two categories: uncomplicated and severe malaria.
This is diagnosed when symptoms are present, but there are no signs to indicate severe infection or dysfunction of the vital organs.
This form can become severe malaria if left untreated, or if the host has poor or no immunity.
Symptoms of uncomplicated malaria typically last 6 to 10 hours and recur every second day. Some strains of the parasite can have a longer cycle or cause mixed symptoms.
As symptoms resemble those of flu, they may be undiagnosed or misdiagnosed in areas where malaria is less common.
In uncomplicated malaria, symptoms progress as follows, through cold, hot, and sweating stages:
- a sensation of cold with shivering
- fever, headaches, and vomiting
- seizures sometimes occur in younger people with the disease
- sweats, followed by a return to normal temperature, with tiredness
In areas where malaria is common, many patients recognize the symptoms as malaria and treat themselves without visiting a doctor.
In severe malaria, clinical or laboratory evidence shows signs of vital organ dysfunction.
Symptoms of severe malaria include:
- fever and chills
- impaired consciousness
- prostration, or adopting a prone position
- multiple convulsions
- deep breathing and respiratory distress
- abnormal bleeding and signs of anemia
- clinical jaundice and evidence of vital organ dysfunction
Severe malaria can be fatal without treatment.
Malaria happens when a bite from the female Anopheles mosquito infects the body with Plasmodium. Only the Anopheles mosquito can transmit malaria.
The successful development of the parasite within the mosquito depends on several factors, the most important being humidity and ambient temperatures.
When an infected mosquito bites a human host, the parasite enters the bloodstream and lays dormant within the liver.
The host will have no symptoms for an average of 10.5 days, but the malaria parasite will begin multiplying during this time.
The new malaria parasites are then released back into the bloodstream, where they infect red blood cells and multiply further. Some malaria parasites remain in the liver and are not released until later, resulting in recurrence.
An unaffected mosquito becomes infected once it feeds on an infected individual. This restarts the cycle.
Early diagnosis is critical for a patient's recovery.
Anyone showing signs of malaria should be tested immediately.
The World Health Organization (WHO) strongly advise confirmation of the parasite through microscopic laboratory testing or by a rapid diagnostic test (RDT), depending on the facilities available.
No combination of symptoms can reliably distinguish malaria from other causes, so a parasitological test is vital for identifying and managing the disease.
In some malaria-endemic areas, such as sub-Saharan Africa, the disease's severity can cause mild immunity in a large proportion of the local population.
As a result, some people carry the parasites in their bloodstream but do not fall ill.
Treatment aims to eliminate the Plasmodium parasite from the patient's bloodstream.
Those without symptoms may be treated for infection to reduce the risk of disease transmission in the surrounding population.
Artemisinin-based combination therapy (ACT) is recommended by the WHO to treat uncomplicated malaria.
Artemisinin is derived from the plant Artemisia annua, better known as sweet wormwood. It is known for its ability to rapidly reduce the concentration of Plasmodium parasites in the bloodstream.
ACT is artemisinin combined with a partner drug. The role of artemisinin is to reduce the number of parasites within the first 3 days of infection, while the partner drugs eliminate the rest.
Expanding access to ACT treatment worldwide has helped reduce the impact of malaria, but the disease is becoming increasingly resistant to the effects of ACT.
In places where malaria is resistant to ACT, treatment must contain an effective partner drug.
The WHO has warned that no alternatives to artemisinin are likely to become available for several years.
There are several ways to keep malaria at bay.
Research to develop safe and effective global vaccines for malaria is ongoing, with one vaccine already licensed for use in Europe. No vaccine is yet licensed in the U.S.
It is essential to seek medical attention for suspected symptoms of malaria as early as possible.
Prevention: Advice for travelers
Travelers to places where malaria is prevalent should take precautions, for example, using mosquito nets.
While malaria is not endemic to the U.S., travel to many countries around the world entails a risk.
Travelers are advised to:
- find out what the risk of malaria is in the country and city or region they are visiting
- ask their doctor what medications they should use to prevent infection in that region
- obtain antimalarial drugs before leaving home, to avoid the risk of buying counterfeit drugs when away
- consider the risk for individual travelers, including children, older people, pregnant women, and the existing medical conditions of any travelers
- ensure they will have access to insect repellants, insecticides, pre-treated bed nets, and appropriate clothing
- be aware of the symptoms of malaria
In emergency situations, local health authorities in some countries may carry out "fogging," or spraying areas with pesticides similar to those used in household sprays.
The WHO points out that these are not harmful for people, as the concentration of pesticide is only strong enough to kills mosquitoes.
While away, travelers should, where possible, avoid situations that increase the risk of being bitten by mosquitoes. Precautions include taking an air-conditioned room, not camping by stagnant water, and wearing clothes that cover the body at times when mosquitoes are most likely to be around.
For a year after returning home, the traveler may be susceptible to symptoms of malaria. Donating blood may also not be possible for some time.
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Malaria is regarded as one of the world's deadliest tropical parasitic diseases. It claims more lives than any other communicable disease except tuberculosis. In Africa and other developing countries, it also accounts for millions of dollars in medical costs. Malaria, however, is a curable disease if promptly diagnosed and adequately treated.
Malaria is a mosquito-borne disease caused by the parasite plasmodium. In recent years, most cases in the U.S. have been in people who have acquired the disease after travelling to tropical and sub-tropical areas. Over 200 million cases worldwide are reported each year.
Estimates of deaths caused by malaria exceed 1 million each year, with the majority being African children. Other groups at risk include pregnant women, foreign travelers, refugees, and laborers entering endemic areas. Malaria is prevalent in over 100 countries around the world, the most of which located in Africa and South America.
Predominance of Malaria
Today, malaria is a public health problem in more than 90 countries. Worldwide prevalence of the disease is estimated to be over 200 million cases each year. More than 90% of all malaria cases arise from sub-Saharan Africa.
The geographical area affected by malaria has shrunk considerably in the past 50 years. Yet measures to control this epidemic are becoming less and less effective. Increased risk of the disease is linked with expansion projects in undeveloped areas, particularly in the Amazon basin and in Southeast Asia.
The rise of malaria is also linked to factors such as global warming, poor health services, political upheavals and armed conflicts. Other causes of this spread include growing resistance of the parasites that cause the disease to new drugs. And with the growing popularity international travel, malaria is now showing up in developed countries. It is also re-emerging in areas where it has previously been under eradicated.
Symptoms of malaria vary depending on the specific type of parasite involved. These symptoms include high fever, chills, sweats, vomiting, and headaches. This would explain why malaria is often misdiagnosed as the flu.
In severe cases the illness can progress to lethargy, respiratory failure, coma and death. If left untreated, the symptoms may persist for weeks or even months. With some types of malaria, relapses may occur for years after treatment.
Malaria symptoms usually appear from 12 to 30 days after infection. Some strains may not cause symptoms for 10 months or even longer.
Areas Stricken with the Disease
Malaria strikes poverty-stricken with the hardest blow. Malaria prevalent areas include some of the world's poorest nations. In Africa, medical costs and related expenses have been estimated at 1-5% gross domestic product.
Farming communities are particularly affected as well. In rural areas, the rainy season is a time of intense agricultural activity, when poor families earn most of their income. When malaria strikes at this time, these families are unable to make a living.
Malaria and Children
Malaria claims the life of a child every 30 seconds. This disease has reached epidemic proportions in many regions of the world, and continues to grow unchecked. Malaria kills 3,000 children under five years of age every day. This rate exceeds the mortality toll from AIDS.
Young African are chronic victims of malaria, suffering an average of six bouts a year. Too often, severely afflicted children die less than 72 hours after developing the symptoms. Of the children who survive, malaria also drains vital nutrients, impairing their physical and intellectual development.
Malaria is also particularly dangerous pregnant women. It causes severe anemia, and is a major factor contributing to maternal deaths in malaria infected areas. Pregnant mothers who have malaria and are HIV-positive are more likely to pass on their HIV status to the unborn child.
The estimated economic costs of malaria are enormous. In affected countries, up to 30% of beds in hospitals are occupied by victims of malaria. In Africa, where malaria reaches a peak at harvest time, a single case of the disease costs an estimated equivalent of 10 working days.
Research indicates that affected families clear only 40 percent of their land for crops compared to healthy families. Knowledge about malaria is markedly low among affected populations. In a recent survey in Ghana, half the respondents did not know that mosquitoes transmit malaria.
Prevention and Cure
Prevention of malaria includes a variety of measures that may protect against infection or against progression of the disease in infected individuals. Initiatives that protect against infection are directed against the mosquito. These measures can be at the individual or household level including protective clothing, repellents and bed nets. Or they may be community programs that include the use of insecticides or environmental management.
Despite growing drug resistance of parasites, malaria is a curable disease. Although only a limited number of drugs exist, if these are used properly and directed to those at greatest risk, malaria infections and casualties can be profoundly reduced.
Disease management through early diagnosis and prompt treatment is a vital step to controlling malaria. It is a basic right of affected populations and needs to be available wherever malaria occurs. Children and pregnant women, on whom malaria has its greatest impact in most parts of the world, are especially important.
When traveling to areas of the world where malaria is common, specific preventive medicine is prescribed depending on which countries will be visited. Mosquito repellents, bed nets, screens and protective clothing are used in many countries to protect against infection from mosquitoes. Health departments assist travelers in determining what precautions are needed.
Drug and Vaccine Development
Drugs designed to treat malaria are available on a very limited basis. Because of increasing resistance to drugs in many parts of the world, adequate treatment of malaria is becoming increasingly difficult. Although a few new drugs have appeared in the last 20 years, they are not economically available to many people who need them.
In the last decade, considerable progress has been made in the search for a malaria vaccine. An effective vaccine would create a powerful addition to malaria control. More than a dozen candidate vaccines are currently in development, some of them in clinical trial. The hope is that an effective vaccine will be available within the next 7-15 years.
A bibliography on the behavioral, social, and economic aspects of malaria and its control. c1978. World Health Organization. Geneva, Switzerland.
(April 2000). Malaria Foundation International. [On-line]. Available: http://www.malaria.org/
(April 2000). Travel health online. [On-line]. Available: http://www.tripprep.com/travinfo/timala.html
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