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- Malaria is a disease caused by four species of intracellular parasites of the genus plasmodium, comprised of Plasmodium vivax, Plasmodium Malariae, Plasmodium ovale, and Plasmodium falciparum. Malaria is commonly found in the tropics, subtropics, parts of Mexico, Central, and South America, Dominican Republic, Haiti, Middle East, Africa, Southeast Asia, Indian subcontinent, China, and Oceana.
- Malaria is transmitted from human to human by mosquito bite. Once injected into the bloodstream of a human host (via bite), the parasite travels to the liver, undergoes alteration, after which it is released back into the bloodstream to invade the red blood cells (RBC).
- In the RBC, the parasites multiply and cause the red blood cells to rupture. The incubation time from mosquito bite to infection ranges from 6 to 60 days, with variances depending on the specific Malaria infection.
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- Attacks of the following symptoms
every other day or every third day, with sequences lasting
4-6 hours in the following order -- shaking chills, fever up
to 41degrees Celsius (103 degrees Fahrenheit), and severe
sweating.
- Additional symptoms:
- Fatigue
- Dizziness
- Headache
- Dry cough
- Nausea/vomiting
- Loss of appetite
- Abdominal cramps
- Mild Diarrhea
- Joint aches
- Muscle aches
- Backache
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- Enlarged spleen
- Mild liver enlargement
- Jaundice in severe falciparum
infections
- Appropriate staining, such as
Giemsa, thin/thick, etc., will determine diagnosis
- During paroxysm, there can be
transiently elevated white blood cell count (WBC), but
between attacks there is decrease.
- In severe Malaria caused by
Plasmodium, falciparum liver functions tests may be
abnormal, severe anemia may present, decreased platelets,
and
reticulocytosis.
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- All species except
Chloroquine-resistant Plasmodium falciparum --
- Chloroquine phosphate for P. falciparum or P. Malariae
- Chloroquine phosphate plus
primaquine phosphate for P. vivax and P.
ovale
- Intravenous treatments (for severe attacks)
- Quinine dihydrochloride or
quinidine gluconate, then begin oral Chloroquine.
If the cause is P. vivax or P. ovale, treatment also
needs to be followed with Primaquine.
- Artemether followed by Chloroquine by intramuscular injection, then begin oral Chloroquine. Primaquine intramuscular injection should follow if the cause is P. vivax or P. ovale.
- Chloroquine-resistant P. falciparum
- Quinine sulfate, plus one of the
following: 1) Doxycycline, 2) Clindamycin, 3)
Pyrimethamine, and Sulfadiazine, 4) Tetracycline, or 5)
Pyrimethamine and Sulfadoxine.
- Mefloquine
- Halofantrine
- Atovaquone/Proguanil
- Atrovaquone/Doxycycline
- Artesunate followed by
Mefloquine
- Severe infections of
Chloroquine-resistant Plasmodium falciparum
- Intravenous quinine
dihydrochloride or quinidine gluconate plus intravenous
Doxycycline or Clindamycin. This is followed by oral
quinine sulfate.
- Artemether intravenously followed by Mefloquine
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- Seek immediate emergency medical treatment. This is a life-threatening medical condition.
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- Chloroquine-sensitive Plasmodium falciparum and Plasmodium Malariae
- Chloroquine
- Chloroquine-resistant Plasmodium
falciparum
- Mefloquine
- Doxycycline
- Malarone
- Chloroquine plus
Progaunil
- Plasmodium ovale and Plasmodium
vivax
- Primaquine
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- When traveling to Malaria-infested regions, the above are
general guidelines. Review the current Center for
Disease Control's (CDC) up-to-date bulletins for Malaria
prevention in a given area. Likewise, the above are
general guidelines for treatment of Malaria and are subject
to change. Management of Malaria treatment
usually involves an infectious disease specialist.
- If you are traveling to an area known to have
Malaria:
- See your physician and consider contacting the Centers for Disease Control (they have an excellent web site). There are often physicians who specialize in travel medicine.
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