Malaria

Malaria is an infectious disease that is transmitted from person to person through the bites of an infected mosquito. This article looks at malaria causes, symptoms, cures and treatment.

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Malaria still remains a major health problem in many parts of the world especially in the tropical and subtropical regions. According to the World Health Organisation, there are about 500 million cases of malaria each year. Without treatment, the infection can be fatal and life-threatening.

Malaria Causes and Risk Factors

Malaria is a parasitic disease transmitted through the bite of infected female Anopheles mosquitoes. Once the parasites (of the genus Plasmodium) enter the human body, they travel through the bloodstream to the liver. In the liver, they mature, then re-enter the bloodstream, infect red blood cells and multiply inside them. Within 48 to 72 hours of becoming infected, the red blood cells rupture, releasing more parasites (merozoites) which in turn infect more red blood cells.

The malaria parasite finds its way inside the red blood cells of an infected person. Therefore, besides the bite from an infected mosquito, infection can also occur through blood transfusion, sharing of needles contaminated with blood, organ transplantation and mother-to-baby transmission before or during delivery ("congenital" malaria).

There are four types of plasmodium parasite that infect humans. Of the four types, infections caused by Plasmodium falciparum and Plasmodium vivax are the most common, with the former being more serious because of multiple drug resistance.

The life cycle varies according to the species of Plasmodium. For P. vivax it is 48 hours, P. malariae 72 hours, and P. falciparum 36 to 48 hours. Malaria causes anaemia, the result of the infection’s destruction of red blood cells and the problems caused by large amounts of free haemoglobin released into the circulation after the red blood cells rupture.

Signs and Symptoms of Malaria

The symptoms of malaria occur in cycles of 48 to 72 hours, due to the massive release of merozoites into the bloodstream. They include:
Fever, chills and sweating
Muscle pain
Headache, nausea and vomiting
Jaundice
Anaemia and bloody stools
Convulsions
Coma

Malaria Complications

Malaria, especially due to P. falciparum infection, can cause serious complications such as:
Extensive destruction of red blood cells (haemolytic anaemia)
Swelling of the brain due to the blockage of small blood vessels
Liver failure
Kidney failure
Dehydration
Enlarged spleen

Malaria Screening and Diagnosis

Diagnosis of malaria is made through a blood smear where the malarial parasites are seen under a microscope. This is obtained after your doctor has taken your travel history and has examined you. To confirm malaria, two blood samples are taken at six- and 12-hour intervals to detect the presence of the parasite and its type.

Malaria Treatment

In treating malaria, there are many factors to consider such as:
The type of Plasmodium infecting the person
The location where the infection was acquired to predict its drug resistance status
The condition of the person at the time of diagnosis
Accompanying conditions (including pregnancy) or other illnesses
Presence of drug allergies

In most cases, malaria is treatable and curable. Antimalarial drugs are readily available at hospitals in Singapore. Drugs used include chloroquine, quinine and primaquine. The drug regimen used for treatment depends on factors such as age, where the malaria was acquired (since the malarial parasite from certain areas may be resistant to common antimalarial drugs), and drug allergies. Seek medical advice early if you are returning from abroad with any symptoms suggesting malaria.

In severe cases, the person suffering from malaria may require treatment in the intensive care unit of a hospital, especially if there are complications involving the brain or kidneys.

Prevention

There is no effective inoculation against malaria, but antimalarial drugs may be given prophylactically to people travelling to areas where the disease is widespread, or to pregnant women in areas in which the disease is endemic.

Antimalarial drugs can be prescribed for visitors to areas where malaria is prevalent. They should begin taking the medicine two weeks before entering the area, and continue for four weeks after leaving the area. The types of antimalarial medications prescribed will depend on the drug-resistance patterns in the areas to be visited. It is very important to know the countries and areas you will be visiting to obtain appropriate preventive support for malaria.

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Malaria

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