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Malaria

Malaria affects 500 million people worldwide and kills at least 2 million per year.

Over one million Africans die yearly (mostly children).

30,000 Europeans and North Americans are affected.

Anopheles mosquitoes are responsible.

Infection caused by a parasite that is transmitted through the bite of an infected Mosquitoes.

Malaria enters the body through the blood stream, once in the blood stream parasites travel to the liver and destroy red blood cells. Other complications include anemia caused by blood cell destruction, and clumping of blood cells that may cause brain and kidney damage.

They carry malarial parasites, (plasmodium falciparum, vivax, ovale, or malaria), which are four different species.
Anopheles mosquitoes are sometimes identifiable by the way they bite (head downward when biting), compared with culex mosquitoes that stand parallel.

Female mosquitoes of Anopheles type bite at night or twilight.

Urbanization may create areas where mosquitoes may breed close to people (stagnant water).

Mosquitoes usually don't travel more than two miles from where they are bred.

Weird exceptions are airport malaria acquired by passengers being bitten by mosquitoes indoors during stopovers.

Wind could also blow mosquitoes further away.

Only female mosquitoes drain blood. Males eat nectars and fluids.

Malaria is caused by a parasite transmitted by certain species of mosquito.

Once a mosquito bites a parasite, a gamocyte enters the mosquito and breeds internally creating oocytes and then sporocites, which travel to the salivary glands of the mosquito.

These sporocites can penetrate the liver of an infected human within 45 minutes.

Within 9-16 days the sporocites differentiate into merozites, which invade red blood and liver cells.

Blood cells rupture, releases gametocytes and merozites, which cause the cycle of fevers and chills.

Different malarial species have different severity of diseases all of which are bad.

Sometimes malaria may be easy to recognize, but also sometimes difficult.

Symptoms of malaria may be very subtle - flu like attack, fever and chills which may lead to multi-organ failure and death.

Important to note that malaria medication will lessen symptoms of malaria but does not guarantee immunity. Malaria chemoproplylaxis helps prevent life threatening malaria that will kill people before seeking medical attention.

Any symptoms should be investigated with thick and thin malarial smear.

This can still lead to misdiagnosis, as a smear may not "catch" parasites on microscopic analysis.

If malaria is suspected, one normal smear does not rule it out.

It is generally assumed that any returning traveler with fever has malaria until proven otherwise.

Many other infectious diseases may also manifest as flu like symptoms but malaria is the one diagnosis not to miss.

Many other mosquitoes co-exist with the Anopheles mosquito-Aedes aegypti, Culex, Haemogogus, Sabethes, and Masonia, which cause other diseases like yellow fever, filariasis, viral encephalitis, dengue and other hemorrhagic fevers.

Other insects (tse-tse flies, black flies, deerflies, sand flies, lice, ticks and mites) cause a variety of illnesses many of which have no known vaccine or medication to prevent illness as well as no good treatment.

General recommendations are to avoid all insects similarly to malarial mosquitoes.

Prevention is best accomplished by avoiding being bitten.

Wear long sleeved shirts and long pants.

Use insect repellent, sleep under a mosquito net, use mosquito coils, don't sleep on ground, and check for ticks and insect bites daily.

Be knowledgeable of the signs and symptoms of the disease you may likely encounter where you are traveling.

Malaria Medication
Types of medication to prevent malaria (chemoproplylaxis) include

Chloroquine: (Aralen): Cheap, well tolerated but bitter taste, can upset stomach and blur vision. There are many areas resistant to chloroquine. Medication is started one week prior to travel, and taken weekly during and for four weeks after trip.

Mefloquine: (larium): More expensive, but 2-5% of people reported side effects (anxiety, nausea, hair loss, poor sleep, irritation). It is used where chloroquine resistance. Medication is also weekly, starting one week before, during trip and for four weeks after trip.

Doxycycline: Daily medication used where mefloquine resistance or as alternative to above. Side effects include stomach irritation and photosensitivity. It is started four days prior to trip, and continues for four weeks after leaving area.

Chloroquine, mefloquine and doxycycline should be taken for 4 additional weeks after leaving the malarious area because they are only effective for malaria in the blood. Since the parasite may be in the liver for 4 weeks, they must also be taken for that long. Long- term use should be monitored for adverse effects but has been used for years in expatriates

Malarone: (Atoraquine/Proquinil): Is new, but expensive and can cause nausea and vomiting. This drug may be started 1-2 days before the trip. It is taken daily and then discontinued 7 days after the trip. It is discontinued sooner than mefloquine because it is effective at killing malaria in the liver. So there is no need to take this medication as long as mefloquine, chloroquine or doxycycline.

Malaria Self Treatment
Self-treat malaria kits are available. Many travelers would do self-testing and then treat themselves. Also large doses of malaria drugs in a sick person are not without side effects. Self-treatment is not recommended. Instead preventative measures are best and to seek medical attention if ill. 90% of travelers with malaria do not become ill until after they return home. This illusion of good health may foster urban myths among travelers on laxity of mosquito precautions. Taking medications to prevent malaria is not a perfect solution but is still the over all best way to prevent malaria. All the malaria medications have some type of side effects but the benefits of them preventing malaria far outweigh these effects.

Summary of Signs & Symptoms of malaria
1. Headaches
2. Shakes and chills caused by fever
3. Fatigue
4. Rapid breathing
5. Nausea
6. Extremes sweating with a drop in temperature

Prevention of malaria:
1. Anti-malarial drugs
2. While in mosquito infested areas use mosquito netting
3. Avoid crowded or unsanitary conditions
4. Wear long pants and long sleeved shirts

Treatment:
Anti-malarial drugs are needed to kill the parasites

References: See our separate section on malaria this website

Malaria Foundation International http://www.malaria.org/

WHO http://www.who.int/health_topics/malaria/en/

CDC http://www.cdc.gov/travel/malinfo.htm

Royal Perth Hospital http://www.rph.wa.gov.au/labs/haem/malaria/

Malaria Journal http://www.malariajournal.com/home/

Malaria Vaccine Initiative http://www.malariavaccine.org/

Global Fund to fight Aids, Tuberculosis and Malaria
http://www.theglobalfund.org/en/

Malaria Homepage (French and English) http://www.chez.com/malaria/

Malaria and Health http://www.malariaandhealth.com/

Malaria Site http://www.malariasite.com/

WHO roll back malaria http://www.rbm.who.int/

For your reference a downloadable version of this text can be found at these links.
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