What is the Treatment for Malaria?

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Malaria is one of the leading killers among infectious diseases, although basically eradicated in countries with moderate climates it is still all too common in tropical and subtropical countries.

Malaria is usually contracted from a mosquito carrying a plasmodium, a one-celled parasite. There are approximately 170 species of plasmodium but only four cause malaria in humans, P. falciparum, P. vivax, P. malariae, and P. ovale. It can also be transmitted from a pregnant mother to her unborn child and through blood transfusions.

Those who are most at risk for severe illness as a result of malaria are children and infants, visitors from areas where malaria is not found, (no acquired immunity) and pregnant women and their unborn children.

The early symptoms of malaria might appear to be a flu-like illness. If you live in or have visited (within the past twelve months) any high-risk malaria region it is important to seek medical attention if you develop an illness with a fever. Aside from flu-like symptoms recurring shaking chills, high fever, profuse sweating as body temperature falls, and a general feeling of unease and discomfort can be expected as the disease progresses. In severe cases you could experience confusion, coma, neurologic focal signs, severe anemia, and respiratory difficulties.

Confirming a diagnosis of malaria is relatively simple, however in countries unfamiliar with the disease such as the United States it is not uncommon for it to be misdiagnosed in the early stages. For this reason, if you believe you have been exposed to malaria it is important to tell your doctor. They will need to know your symptoms and your travel history. If this information leads your doctor to believe it could be malaria simple blood tests can usually confirm the diagnosis. Viewing blood smears, usually stained with Giemsa stain, through a microscope can identify the parasites.

Malaria requires prompt treatment once confirmed, particularly malaria caused by P. falciparum. The CDC offers a complete guide to treating malaria in the United States. Determining the proper treatment depends on three factors:

1) The infecting Plasmodium species: P. falciparum can progress rapidly leading to severe illness and possibly death whereas P. vivax, P. ovale, or P. malariae rarely result in severe cases. Cases caused by P. vivax and P. ovale will require treatment to rid the kidneys of the hypnozoite forms that are dormant and can cause relapses.

2) The condition of the patient: malaria cases are defined by two classifications, uncomplicated or severe. Taking anti-malarial drugs orally can effectively treat uncomplicated cases; severe cases will require aggressive parenteral anti-malarial treatment.

3) The geographic location where the disease was contracted: This helps determine the drug resistance of the parasite; this is necessary to determine the proper course of treatment and drug combination.

There are several drugs that either alone or in combination can effectively treat malaria, they are:

Chloroquine

sulfadoxine-pyrimethamine (Fansidar®)

mefloquine (Lariam®)

atovaquone-proguanil (Malarone®)

quinine

doxycycline

artemisin derivatives (not licensed for use in the United States)

These drugs can be administered either orally or intravenously depending on how sick the patient is when treatment begins. The choice of medications will depend on where you contracted malaria, the type of malaria, your age, and how sick you are at the time treatment begins. It is not uncommon to feel week and tired for a few weeks following treatment.

In the United States it is recommended that all cases of Malaria should be treated under observation. In countries where malaria is common, cases deemed uncomplicated will most likely be treated on an outpatient basis. Severe cases will require hospitalization.

There is no effective vaccine for malaria, in countries where malaria is endemic prevention will involve the use of insecticide-treated mosquito netting and spraying interior walls with insecticides whenever possible.

If you are planning to travel to a malaria prone region contact your doctor or a tropical disease specialist several months in advance. Most medications used to treat malaria can also be used to prevent it if taken properly. In most cases you will need to begin taking it up to two weeks before traveling and continue to take it for four weeks after returning. If you are pregnant it is not advisable to travel to such areas.

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