Malaria

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Malaria
Quartan malaria; Falciparum malaria; Biduoterian fever; Blackwater fever; Tertian malaria; Plasmodium
Last reviewed: June 9, 2011.
Malaria is a parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anemia.
Causes, incidence, and risk factors
Malaria is caused by a parasite that is passed from one human to another by the bite ofinfected Anopheles mosquitoes. After infection, the parasites (called sporozoites) travel through the bloodstream to the liver, where they mature and release another form, the merozoites. The parasites enter the bloodstream and infect red blood cells.
The parasites multiply inside the red blood cells, which then break open within 48 to 72 hours, infecting more red blood cells. The first symptoms usually occur 10 days to 4weeks after infection, though they can appear as early as 8 days or as long as a year after infection. The symptoms occur in cycles of 48 to 72 hours.
Most symptoms are caused by:
* The release of merozoites into the bloodstream
* Anemia resulting from the destruction of the red blood cells
* Large amounts of free hemoglobin being released into circulation after red blood cells breakopen
Malaria can also be transmitted from a mother to her unborn baby (congenitally) and by blood transfusions. Malaria can be carried by mosquitoes in temperate climates, but the parasite disappears over the winter.
The disease is a major health problem in much of the tropics and subtropics. The CDC estimates that there are 300-500 million cases of malaria each year, and more than 1 millionpeople die from it. It presents a major disease hazard for travelers to warm climates.
In some areas of the world, mosquitoes that carry malaria have developed resistance to insecticides. In addition, the parasites have developed resistance to some antibiotics. These conditions have led to difficulty in controlling both the rate of infection and spread of this disease.
There are four types of commonmalaria parasites. Recently, a fifth type, Plasmodium knowlesi, has been causing malaria in Malaysia and areas of southeast Asia. Another type, falciparum malaria, affects more red blood cells than the other types and is much more serious. It can be fatal within a few hours of the first symptoms.
Symptoms
* Anemia
* Bloody stools
* Chills
* Coma
* Convulsion
* Fever
*Headache
* Jaundice
* Muscle pain
* Nausea
* Sweating
* Vomiting
Signs and tests
During a physical examination, the doctor may find an enlarged liver or enlarged spleen. Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis.
A complete blood count (CBC) will identify anemia if it is present.
Treatment
Malaria, especially Falciparum malaria, is amedical emergency that requires a hospital stay. Chloroquine is often used as an anti-malarial medication. However, chloroquine-resistant infections are common in some parts of the world.
Possible treatments for chloroquine-resistant infections include:
* The combination of quinidine or quinine plus doxycycline, tetracycline, or clindamycin
* Atovaquone plus proguanil (Malarone)
*Mefloquine or artesunate
* The combination of pyrimethamine and sulfadoxine (Fansidar)
The choice of medication depends in part on where you were when you were infected.
Medical care, including fluids through a vein (IV) and other medications and breathing (respiratory) support may be needed.
Expectations (prognosis)
The outcome is expected to be good in most cases of malaria with treatment, butpoor in Falciparum infection with complications.
Complications
* Brain infection (cerebritis)
* Destruction of blood cells (hemolytic anemia)
* Kidney failure
* Liver failure
* Meningitis
* Respiratory failure from fluid in the lungs (pulmonary edema)
* Rupture of the spleen leading to massive internal bleeding (hemorrhage)
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