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Malaria

more about Malaria


  • 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.

  • 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:
    1. Fatigue
    2. Dizziness
    3. Headache
    4. Dry cough
    5. Nausea/vomiting
    6. Loss of appetite
    7. Abdominal cramps
    8. Mild Diarrhea
    9. Joint aches
    10. Muscle aches
    11. Backache

  • Examination:
    1. Enlarged spleen
    2. Mild liver enlargement
    3. Jaundice in severe falciparum infections
  • Laboratory findings:
    1. Appropriate staining, such as Giemsa, thin/thick, etc., will determine diagnosis
    2. During paroxysm, there can be transiently elevated white blood cell count (WBC), but between attacks there is decrease.
    3. In severe Malaria caused by Plasmodium, falciparum liver functions tests may be abnormal, severe anemia may present, decreased platelets, and reticulocytosis.

  • All species except Chloroquine-resistant Plasmodium falciparum --
    • Oral treatments
      1. Chloroquine phosphate for P. falciparum or P. Malariae
      2. Chloroquine phosphate plus primaquine phosphate for P. vivax and P. ovale
    • Intravenous treatments (for severe attacks)
      1. 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.
      2. 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
    1. Quinine sulfate, plus one of the following:  1) Doxycycline, 2) Clindamycin, 3) Pyrimethamine, and Sulfadiazine, 4) Tetracycline, or 5) Pyrimethamine and Sulfadoxine.
    2. Mefloquine
    3. Halofantrine
    4. Atovaquone/Proguanil
    5. Atrovaquone/Doxycycline
    6. Artesunate followed by Mefloquine
  • Severe infections of Chloroquine-resistant Plasmodium falciparum
    1. Intravenous quinine dihydrochloride or quinidine gluconate plus intravenous Doxycycline or Clindamycin.  This is followed by oral quinine sulfate.
    2. Artemether intravenously followed by Mefloquine

  • Seek immediate emergency medical treatment.  This is a life-threatening medical condition.

  • Chloroquine-sensitive Plasmodium falciparum and Plasmodium Malariae

- Chloroquine

  • Chloroquine-resistant Plasmodium falciparum
    1. Mefloquine
    2. Doxycycline
    3. Malarone
    4. Chloroquine plus Progaunil
  • Plasmodium ovale and Plasmodium vivax

- Primaquine



  • Special Considerations
    1. 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.
    2. If you are traveling to an area known to have Malaria:
    3. 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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