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Malaria: From excellent prognosis to deadly disease

D. Alwinsky, M.D. |
Malaria is a serious tropical disease: One mosquito bite can be fatal.

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Now, being told that malaria is a tropical disease, we must know that it is present in other parts of the world, so we must be aware of it everywhere.

Malaria happens when an infected female Anopheles mosquito bites you and you get infected with Plasmodium protozoa.

There are two problems with malaria. When we are talking about a disease, we naturally first search for symptoms. They may develop in 7 to 18 days after an infected mosquito bites a person.

However, a person may be free of symptoms for a whole year, not knowing it has any problem.

The second problem is that symptoms are often mild and as such may point to some other health conditions, not so serious, and that's a problem for a doctor who must find a correct diagnosis.

Typical symptoms are 38C temperature or higher, headaches, muscle pain, diarrhea, feeling unwell, feeling hot and shivery. You can see that there are no hard symptoms that we could connect to malaria just like that.

A first sign that may lead us to that direction is a hot-cold cycle. There can be a period of cold and shivering that patient feel, and then high temperature with sweating. That happens in two days cycle and those symptom can last up to 12 hours.

Now, there are several types of malaria caused by the Plasmodium parasite. There are many of them but fortunately just 5 types cause malaria.

Plasmodium falciparum is mainly found in Africa. This is the most common type, responsible for most malaria deaths in the world. If not treated within 24 hours, it can progress to severe illness, often leading to death.

Plasmodium vivax is mainly found in Asia and South America. The good thing is it causes milder symptoms than Plasmodium falciparum. The bad thing is it can stay in the liver for up to three years, which means the disease can appear again easily.

Plasmodium ovale may be found in West Africa. This nasty creature can remain in your liver for several years without symptoms. Bad for diagnosing.

Plasmodium malariae is a rare type, usually only found in Africa.

Plasmodium knowlesi is another very rare type from southeast Asia.

What happens when a mosquito bites?

The parasite enters the bloodstream and travels straight to the liver where the infection develops. It then goes into the blood where it attacks red blood cells. And now things get nasty.

In the red blood cells, the parasites grow and multiply. When there are too many of them, a blood cell burst and realese those parasites into blood. That happen every 2 to 3 days and that's exactly when the patient feels fever, chills and sweating. Then you know that infected blood cells exploded and released a new number of parasites.

Malaria can't be spread directly from person to person and there is a very very small chance to get it sharing the needle or through blood transfusions.

So, what can we do about it?

If you plan to visit an area where you could get malaria, antimalarial tablets can reduce your risk of malaria by about 90%. So, not 100% but you will have some good protection. The type of pills depends on the region you plan to visit and your health condition, so check with your doctor what to take.

And you should remember to write down the name of the antimalarial medicine you took because that's very important.

If you get malaria, again the antimalarial medicines can also be used to treat the disease. But it should not be the same type you took before your travel, so that's why it's important to know what you took because you have to tell that to your doctor.

Good thing is, if the treatment is started as soon as a blood test confirms it, the outcome may be excellent.

Bad thing is, malaria can be deadly. So, what can happen?

Obviously, as parasites destroy red blood cells, severe anaemia can develop. So, no red blood cells, no oxygen, and the patients fells weak and faint. Since the blood is affected, a sudden drop in blood pressure and shock may be expected.

Malaria can attack the brain. In those cases the brain swells and there may be: seizures, coma, and permanent brain damage.

We said that liver plays a big role in malaria, so liver failure is a possibility which leads to jaundice.

Then a range of bad conditions may follow: a build-up of fluid in the lungs, respiratory problems, low blood sugar, or rupturing of the spleen. So, a whole range of conditions may appear and it may be very difficult to treat them all or some in a combination.

The treatment depends on a parasite you caught up along the way and health condition, and the doctor may mix several drugs to heal you well.

One note: If a woman is pregnant, there are medicine for protection but the best advice is "Do not travel." Malaria can cause serious problems for a pregnant woman and her baby. Some 1,700 cases of malaria are diagnosed in the United States, and that's not a small number. The cause is travel: travelers and immigrants from Africa and South Asia may carry the disease.

In recent years, 9 countries have been certified by the WHO as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018) and Uzbekistan (2018).

In 2017, Africa was home to 92% of malaria cases and 93% of malaria deaths. The highest burden of the disease carry: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania.

South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are also at risk.

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