Malaria

Introduction

  • Malaria is a life-threatening disease caused by Plasmodium parasites, transmitted to humans through the bite of infected female Anopheles mosquitoes.
  • Five species cause malaria in humans: P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi.
  • Malaria remains a global health challenge, particularly in tropical and subtropical regions.
  • Effective management includes early diagnosis, prompt treatment, and preventive measures.

Causes and Transmission of Malaria

  1. Parasite
    • Plasmodium species, with P. falciparum being the most severe.
  2. Vector
    • Transmitted by the bite of Anopheles mosquitoes.
  3. Modes of Transmission
    • Mosquito bites (primary mode).
    • Blood transfusions or organ transplants.
    • Congenital transmission from mother to fetus.

Symptoms of Malaria

  1. Uncomplicated Malaria
    • Fever, chills, and sweating (cyclical).
    • Headache, muscle aches, and fatigue.
    • Nausea, vomiting, and diarrhea.
  2. Severe Malaria
    • High fever and severe anemia.
    • Cerebral malaria: Seizures, confusion, or coma.
    • Respiratory distress and kidney failure.
  3. Recurrent Malaria
    • Relapses with P. vivax or P. ovale due to dormant liver stages (hypnozoites).

Complications of Malaria

  • Cerebral Malaria: Seizures, neurological damage, or coma.
  • Severe Anemia: Due to destruction of red blood cells.
  • Acute Respiratory Distress Syndrome (ARDS): Severe breathing difficulties.
  • Kidney Failure: Blackwater fever (dark urine due to hemolysis).
  • Death: If untreated, particularly in P. falciparum infections.

Diagnosis of Malaria

  1. Clinical Assessment
    • Fever in individuals who have traveled to or live in malaria-endemic areas.
  2. Microscopy
    • Blood smears to detect and quantify parasites.
  3. Rapid Diagnostic Tests (RDTs)
    • Detect Plasmodium antigens; useful in resource-limited settings.
  4. Molecular Tests
    • Polymerase Chain Reaction (PCR) for species-specific diagnosis.

Treatment Options for Malaria

1. Antimalarial Medications

MedicationBrand NameManufacturerCost Range
Artemisinin-Based Combination Therapy (ACT)Artemether-LumefantrineCoartemNovartis
Artesunate-AmodiaquineASAQSanofi
ChloroquineAralenSanofi$10–$20 per course
PrimaquinePrimaquine PhosphateVarious$5–$15 per course
QuinineQuinine SulfateVarious$10–$30 per course
Atovaquone-ProguanilMalaroneGSK$50–$100 per course
DoxycyclineVibramycinPfizer$10–$25 per course

2. Severe Malaria Management

  • Intravenous Artesunate: First-line treatment for severe malaria.
  • Quinine IV: Alternative in areas without artesunate.
  • Supportive Care: Oxygen, blood transfusions, and fluid management.

3. Relapse Prevention

  • Primaquine or Tafenoquine
    • Targets liver hypnozoites in P. vivax and P. ovale infections.

Prevention of Malaria

  1. Vector Control
    • Use of insecticide-treated bed nets (ITNs).
    • Indoor residual spraying (IRS).
    • Elimination of mosquito breeding sites.
  2. Chemoprophylaxis
    • Medications for travelers to endemic areas:
      • Atovaquone-Proguanil.
      • Doxycycline.
      • Mefloquine.
  3. Vaccination
    • RTS,S/AS01 (Mosquirix): The first malaria vaccine approved for use in children.
  4. Personal Protection
    • Long-sleeved clothing and mosquito repellents (DEET-based).

Monitoring Parameters

  • Regular monitoring of parasitemia levels during treatment.
  • Symptoms improvement (fever resolution within 48–72 hours).
  • Liver function tests for patients on primaquine or tafenoquine.
  • Monitoring for side effects of medications, such as gastrointestinal upset or hemolysis.

Patient Counseling Points

  • Emphasize adherence to the full course of antimalarial treatment.
  • Educate travelers on the importance of chemoprophylaxis and vector control.
  • Highlight early warning signs of severe malaria, such as confusion or difficulty breathing.
  • Advise on the need for follow-up blood tests to confirm parasite clearance.

Use in Children

  • Lower dose formulations of ACTs or other medications based on weight.

Use in Pregnancy

  • Quinine with clindamycin or ACTs (e.g., artesunate-lumefantrine) after the first trimester.

Use in Elderly

  • Monitor for comorbidities that may complicate treatment.

FAQs About Malaria

Q1: What causes malaria?

  • Malaria is caused by Plasmodium parasites transmitted through mosquito bites.

Q2: What are the first signs of malaria?

  • Fever, chills, headache, and muscle pain.

Q3: How is malaria treated?

  • With antimalarial medications such as ACTs, chloroquine, or primaquine.

Q4: Can malaria be prevented?

  • Yes, through mosquito control, chemoprophylaxis, and vaccination.

Q5: Is malaria curable?

  • Yes, with prompt and appropriate treatment.

Q6: What is severe malaria?

  • A life-threatening condition involving complications such as cerebral malaria or kidney failure.

Q7: Can malaria recur?

  • Yes, especially with P. vivax or P. ovale, which have dormant liver stages.

Q8: Who is most at risk for malaria?

  • Young children, pregnant women, and travelers to endemic areas.

Q9: How long does it take to recover from malaria?

  • Uncomplicated malaria resolves within 1–2 weeks with treatment.

Q10: What foods are good during malaria?

  • High-calorie, easily digestible foods such as fruits, rice, and soups.

Q11: Can malaria spread person-to-person?

  • No, except through blood transfusions, needle sharing, or congenital transmission.

Q12: Are there side effects to malaria medications?

  • Yes, including nausea, headache, or dizziness; severe side effects are rare.

Q13: How effective is the malaria vaccine?

  • RTS,S/AS01 provides moderate protection against P. falciparum.

Q14: How can travelers protect themselves from malaria?

  • Take preventive medications, use insect repellents, and sleep under ITNs.

Q15: What should I do if I suspect malaria?

  • Seek medical attention immediately for diagnostic testing and treatment.