Malaria (patient information): Difference between revisions

	Malaria
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
When to seek urgent medical care?
Diagnosis
Treatment options
Where to find medical care for Malaria?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
Malaria On the Web
Ongoing Trials at Clinical Trials.gov
Images of Malaria
Videos on Malaria
FDA on Malaria
CDC on Malaria
Malaria in the news
Blogs on Malaria
Directions to Hospitals Treating Malaria
Risk calculators and risk factors for Malaria

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Latest revision as of 18:00, 18 September 2017

To go to the WikiDoc page for malaria, click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, MBBS [2]; João André Alves Silva, M.D. [3]; Alison Leibowitz [4]

Overview

Malaria is a disease caused by a parasite and transmitted by the anopheles mosquito. Initial symptoms of the disease commonly include: malaise, fever, chills, sweating, headache, nausea, and vomiting. More severe stages of the disease are potentially life-threatening and may manifest with symptoms such as, respiratory difficulties, confusion, and coma. There are five types of parasites that may cause malaria, Plasmodium falciparum, P. vivax, P. oval, P. malaria, and more recently P. knowlesi. Anyone can contract malaria, however, certain individuals are at a higher risk, including those who live in countries where malaria is endemic. The disease may be diagnosed based upon the manifestation of symptoms and by laboratory tests, such as microscopic diagnosis and antigen detection. Malaria may be treated with a combination of several drugs, dependent on the region where the person was infected with the disease. People traveling to regions where malaria is endemic should take preventive medications and follow precautionary measures, such as the use of mosquito repellents and protective clothing over the arms and legs. Most forms of malaria have a good prognosis when adequately treated.

What are the symptoms of Malaria?

Common symptoms of malaria include:

The classically described progression of the disease, is as follows:

Cold stage - where the patient experiences a sensation of chills and shivering
Hot stage - characterized by fever, headaches, and seizures, frequently experienced by children
Sweating stage - characterized by sweating and exhaustion upon the return to normal temperature

Following an infective bite by the Anopheles mosquito, a period of time (the "incubation period") passes before the first symptoms manifest. The incubation period in most cases varies from 7 to 30 days.

What causes Malaria?

Malaria is caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. The disease may be transmitted from one human to another by the bite of infected Anopheles mosquitoes.

Four kinds of malaria parasites have long been known to infect humans:

Plasmodium falciparum
P. vivax
P. ovale
P. malariae

P. knowlesi - a recently recognized type of malaria parasite, naturally infecting macaques in Southeast Asia as well as humans, which results in malaria transmission from animal to human ("zoonotic" malaria).

Falciparum malaria, one of the five different types of malaria, affects a greater proportion of the red blood cells than the other types, making it significantly more serious. It can be fatal within a few hours of the manifestation of the primary symptoms.

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 is inactive over the winter.

In certain areas of the world, mosquitoes that carry malaria have developed resistance to insecticides and some antibiotics. This has led to difficulty in controlling both the rate of infection and subsequent spread of the disease.

Who is at highest risk?

Anyone is at risk to contract malaria.
Most cases occur in people who live in countries where malaria is endemic.
People who live in countries where malaria is not endemic, may also get the disease when they travel to such countries, or through blood transfusions.
Malaria may also be transmitted from an infected mother to her infant before or during delivery.

Who is at Highest Risk of Dying from Malaria?

People who are heavily exposed to the bites of mosquitoes infected with P. falciparum (causes severe and life-threatening malaria) are at the highest risk of dying from malaria.
People who live in African countries south of the Sahara desert, where P. falciparum is common
People who have little or no immunity to malaria, such as young children, pregnant women, and travelers coming from areas without endemic malaria
Individuals in poverty who live in rural areas and lack access to health care

When to seek urgent medical care?

Urgent medical care should be sought when:

Symptoms of malaria manifest while traveling to a country where malaria is endemic
Travelers who become ill with a fever or flu-like illness, either while traveling in a malaria-risk area, or following their return home (for up to 1 year). For this reason, is essential that individuals report travel history to their health-care provider.

Diagnosis

Health-care providers should always obtain a travel history from febrile patients. The manifestation of fever in individual who recently traveled to a malaria-endemic area should be immediately evaluated using the appropriate diagnostic tests for malaria.

Clinical diagnosis is based on the patient's symptoms and physical findings upon examination. The initial symptoms of malaria often are not specific and are characteristic of other diseases (such as the "flu" and common viral infections). Likewise, the physical findings are frequently not specific.

In severe malaria clinical findings are more striking, increasing the index of suspicion for malaria. These may include:

Confusion
Coma
Neurological focal signs
Severe anemia
Respiratory difficulties

Clinical findings should be confirmed with a laboratory test for malaria. these diagnostic tests may include:

Microscopic diagnosis
Antigen detection
Molecular diagnosis
Serology
Drug resistance tests

In addition to ordering the malaria specific diagnostic tests described above, the health-care provider should conduct an initial workup and request:

Complete blood count
Routine chemistry panel

In the event that the person does test positive for malaria, additional tests will be useful in determining whether the patient has uncomplicated or severe manifestations of the infection. Specifically, these tests can detect:

Treatment options

Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as rapidly as possible.

Treatment of malaria is dependent on numerous factors including:

Disease severity
Species of malaria parasite causing the infection
Part of the world in which the infection was acquired

These latter two characteristics help determine the probability that the organism is resistant to certain antimalarial drugs. Patients who have severe P. falciparum malaria, or who cannot take oral medications, should be given treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

Chloroquine
Atovaquone-proguanil
Artemether-lumefantrine
Mefloquine
Quinine
Quinidine
Doxycycline (used in combination with quinine)
Clindamycin (used in combination with quinine)

The choice of medication is dependent upon the location of the patient when he/she was infected. Aggressive supportive medical care, including intravenous (IV) fluids, other medications, and breathing (respiratory) support may be needed.

Where to find medical care for Malaria?

Directions to Hospitals Treating Malaria

Prevention

Most people living in areas where malaria is common acquire some immunity to the disease.
Visitors, who do not possess any immunity, should take preventive medications. It is important to see a health care provider well before a trip, because treatment may begin as long as 2 weeks prior to travel, and continue for a month after you leave the area.
The types of anti-malarial medications prescribed will depend on the area an individual visits. According to the CDC, travelers to South America, Africa, the Indian subcontinent, Asia, and the South Pacific should take one of the following drugs:

Pregnant women should take preventive medications, because the likelihood of the fetus having side-effects from the medications is less than the risk of acquiring a congenital infection.

People on anti-malarial medications can still be infected. Mosquito bites can be avoided by wearing protective clothing over the arms and legs, using screens on windows, and using insect repellent.

Chloroquine has been the drug of choice for prevention of malaria. But because of resistance, it is now only suggested for use in areas where Plasmodium vivax, P. oval, and P. malariae are present. Falciparum malaria is becoming increasingly resistant to anti-malarial medications.

For travelers going to areas where Falciparum malaria is known to manifest, there are several options for malaria prevention, including:

Travelers can call the CDC for further information on the types of malaria in a given geographical area, preventive drugs, and times of the year to avoid travel.

What to expect (Outlook/Prognosis)?

In most cases, the prognosis of malaria is positive with prompt and proper treatment.

The prognosis of Falciparum malaria is poor due to the severity of the disease.

Possible complications

Complications of malaria occur mainly in the more severe forms of the disease. Severe malaria occurs when infections are complicated by serious organ failures or abnormalities in the patient's blood or metabolism. Manifestations of severe malaria include:

Cerebral malaria
Meningitis
Severe anemia
Respiratory failure from fluid in the lungs (pulmonary edema)
Acute respiratory distress syndrome (ARDS)
Abnormalities in blood coagulation
Cardiovascular collapse
Acute kidney failure
Liver failure
Rupture of the spleen leading to massive internal bleeding (hemorrhage)

Alternative Names

Quartan malaria; Falciparum malaria; Biduoterian fever; Blackwater fever; Tertian malaria; Plasmodium

Sources

http://www.nlm.nih.gov/medlineplus/ency/article/000621.htm
CDC Template:WS Template:WH

@@ Line 1: / Line 1: @@
-'''For the WikiDoc page for this topic, click [[Malaria|here]]'''
+__NOTOC__
-{{SI}}
+{{Malaria (patient information)}}
-{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh@perfuse.org]
+'''To go to the WikiDoc page for [[malaria]], click [[Malaria|here]]'''.
+{{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]; {{JS}}; {{AJL}}
 ==Overview==
-Malaria is a parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anemia.
+[[Malaria]] is a disease caused by a parasite and transmitted by the anopheles mosquito. Initial [[symptoms]] of the disease commonly include: [[malaise]], [[fever]], [[chills]], [[sweating]], [[headache]], [[nausea]], and [[vomiting]]. More severe stages of the disease are potentially life-threatening and may manifest with [[symptoms]] such as, [[respiratory]] difficulties, [[confusion]], and [[coma]]. There are five types of parasites that may cause [[malaria]], ''Plasmodium falciparum'', ''P. vivax'', ''P. oval'', ''P. malaria'', and more recently ''P. knowlesi''. Anyone can contract malaria, however, certain individuals are at a higher risk, including those who live in countries where [[malaria]] is [[endemic]]. The disease may be diagnosed based upon the manifestation of [[symptoms]] and by laboratory tests, such as microscopic diagnosis and antigen detection. [[Malaria]] may be treated with a combination of several drugs, dependent on the region where the person was [[infected]] with the disease. People traveling to regions where malaria is [[endemic]] should take preventive medications and follow precautionary measures, such as the use of mosquito repellents and protective clothing over the arms and legs. Most forms of [[malaria]] have a good [[prognosis]] when adequately treated.
+==What are the symptoms of Malaria?==
+Common [[symptoms]] of malaria include:
+* General [[malaise]]
+* [[Fever]]
+* [[Chills]]
+* [[Sweating]]
+* [[Headache]]
+* [[Nausea]] and [[vomiting]]
+* Body pain
+* [[Jaundice]]
+The classically described progression of the disease, is as follows:
+* '''Cold stage''' - where the patient experiences a sensation of [[chills]] and shivering
+* '''Hot stage''' - characterized by [[fever]], [[headaches]], and [[seizures]], frequently experienced by children
+* '''Sweating stage''' - characterized by [[sweating]] and exhaustion upon the return to normal temperature
+Following an infective bite by the Anopheles mosquito, a period of time (the "incubation period") passes before the first [[symptoms]] manifest. The [[incubation period]] in most cases varies from 7 to 30 days.
+==What causes Malaria?==
+[[Malaria]] is caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. The disease may be transmitted from one human to another by the bite of infected [[Anopheles]] mosquitoes.
+Four kinds of [[malaria]] parasites have long been known to infect humans:
+* ''Plasmodium falciparum''
+* ''P. vivax''
+* ''P. ovale''
+* ''P. malariae''
+* ''P. knowlesi'' - a recently recognized type of [[malaria]] parasite, naturally infecting macaques in Southeast Asia as well as humans, which results in [[malaria]] transmission from animal to human ("zoonotic" malaria).
+Falciparum malaria, one of the five different types of malaria, affects a greater proportion of the [[red blood cells]] than the other types, making it significantly more serious. It can be fatal within a few hours of the manifestation of the primary [[symptoms]].
+Malaria can also be transmitted from a mother to her unborn baby (congenitally) and by [[blood transfusion]]s.
+Malaria can be carried by mosquitoes in temperate climates, but the parasite is inactive over the winter.
+In certain areas of the world, mosquitoes that carry [[malaria]] have developed resistance to insecticides and some antibiotics. This has led to difficulty in controlling both the rate of infection and subsequent spread of the disease.
+==Who is at highest risk?==
+* Anyone is at risk to contract [[malaria]].
+* Most cases occur in people who live in countries where [[malaria]] is [[endemic]].
+* People who live in countries where malaria is not [[endemic]], may also get the disease when they travel to such countries, or through [[blood transfusions]].
+* Malaria may also be transmitted from an infected mother to her infant before or during delivery.
+===Who is at Highest Risk of Dying from Malaria?===
+* People who are heavily exposed to the bites of mosquitoes infected with ''P. falciparum'' (causes severe and life-threatening malaria) are at the highest risk of dying from malaria.
+* People who live in African countries south of the Sahara desert, where ''P. falciparum'' is common
+* People who have little or no immunity to malaria, such as young children, pregnant women, and travelers coming from areas without endemic malaria
+* Individuals in poverty who live in rural areas and lack access to health care
+==When to seek urgent medical care?==
+Urgent medical care should be sought when:
+* [[Symptoms]] of malaria manifest while traveling to a country where malaria is [[endemic]]
+* Travelers who become ill with a [[fever]] or [[flu]]-like illness, either while traveling in a [[malaria]]-risk area, or following their return home (for up to 1 year). For this reason, is essential that individuals report travel history to their health-care provider.
+==Diagnosis==
+Health-care providers should always obtain a travel history from [[febrile]] patients. The manifestation of [[fever]] in individual who recently traveled to a [[malaria]]-[[endemic]] area should be immediately evaluated using the appropriate diagnostic tests for malaria.
+Clinical diagnosis is based on the patient's [[symptoms]] and physical findings upon examination. The initial [[symptoms]] of [[malaria]] often are not specific and are characteristic of other diseases (such as the "[[flu]]" and common [[viral infection]]s). Likewise, the physical findings are frequently not specific.
+In severe malaria clinical findings are more striking, increasing the index of suspicion for malaria. These may include:
+* [[Confusion]]
+* [[Coma]]
+* Neurological focal signs
+* Severe [[anemia]]
+* [[Respiratory]] difficulties
+Clinical findings should be confirmed with a laboratory test for [[malaria]]. these diagnostic tests may include:
+* Microscopic diagnosis
+* Antigen detection
+* Molecular diagnosis
+* [[Serology]]
+* [[Drug resistance]] tests
+In addition to ordering the malaria specific diagnostic tests described above, the health-care provider should conduct an initial workup and request:
+* [[Complete blood count]]
+* Routine chemistry panel
-==Causes==
+In the event that the person does test positive for malaria, additional tests will be useful in determining whether the patient has uncomplicated or severe manifestations of the infection. Specifically, these tests can detect:
-Malaria is caused by a parasite that is transmitted from one human to another by the bite of infected Anopheles mosquitoes. In humans, the parasites (called sporozoites) travel to the liver, where they mature and release another form, the merozoites. These enter the bloodstream and infect the red blood cells.
+* Severe [[anemia]]
-The parasites multiply inside the red blood cells, which then rupture within 48 to 72 hours, infecting more red blood cells. The first symptoms usually occur 10 days to 4 weeks after infection, though they can appear as early as 8 days or as long as a year after infection. Then the symptoms occur in cycles of 48 to 72 hours.
+* [[Hypoglycemia]]
-The majority of symptoms are caused by the massive release of merozoites into the bloodstream, the anemia resulting from the destruction of the red blood cells, and the problems caused by large amounts of free hemoglobin released into circulation after red blood cells rupture.
+* [[Renal failure]]
-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.
+* [[Hyperbilirubinemia]]
-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 million people die. It presents a major disease hazard for travelers to warm climates.
+* [[Acid-base disturbances]]
-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. This has led to difficulty in controlling both the rate of infection and spread of this disease.
-Falciparum malaria, one of four different types of malaria, affects a greater proportion of the 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==
+==Treatment options==
-* Anemia
+Malaria can be a severe, potentially fatal disease (especially when caused by ''Plasmodium falciparum'') and treatment should be initiated as rapidly as possible.
-* Chills
-* Coma
-* Convulsion
-* Fever
-* Headache
-* Jaundice
-* Muscle pain
-* Nausea
-* Stools, bloody
-* Sweating
-* Vomiting
-==Exams and Tests==
+Treatment of malaria is dependent on numerous factors including:
-During a physical examination, the doctor may identify an enlarged liver or an enlarged spleen. Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis.
+* Disease severity
+* Species of malaria parasite causing the infection
+* Part of the world in which the infection was acquired
-==Treatment==
+These latter two characteristics help determine the probability that the organism is resistant to certain antimalarial drugs.
-Malaria, especially Falciparum malaria, is a medical emergency requiring hospitalization. Chloroquine is a frequently used anti-malarial medication, but quinidine or quinine plus doxycycline, tetracycline, or clindamycin; or atovaquone plus proguanil (Malarone); or mefloquine or artesunate; or the combination of pyrimethamine and sulfadoxine, are given for chloroquine-resistant infections. The choice of medication depends in part on where you were when you were infected.
+Patients who have severe ''P. falciparum'' malaria, or who cannot take oral medications, should be given treatment by continuous intravenous infusion.
-Aggressive supportive medical care, including intravenous (IV) fluids and other medications and breathing (respiratory) support may be needed.
-==Outlook (Prognosis)==
+Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:
-The outcome is expected to be good in most cases of malaria with treatment, but poor in Falciparum infection with complications.
+* [[Chloroquine]]
-Possible Complications
+* [[Atovaquone]]-[[proguanil]]
-* Destruction of blood cells (hemolytic anemia)
+* [[Artemether]]-[[lumefantrine]]
-* Liver failure and kidney failure
+* [[Mefloquine]]
-* Meningitis
+* [[Quinine]]
-* Respiratory failure from fluid in the lungs (pulmonary edema)
+* [[Quinidine]]
-* Rupture of the spleen leading to massive internal bleeding (hemorrhage)
+* [[Doxycycline]] (used in combination with quinine)
+* [[Clindamycin]] (used in combination with quinine)
+The choice of medication is dependent upon the location of the patient when he/she was infected.
+Aggressive supportive medical care, including [[intravenous]] (IV) fluids, other medications, and breathing (respiratory) support may be needed.
-==When to Contact a Medical Professional==
+==Where to find medical care for Malaria?==
-Call your health care provider if you develop fever and headache after visiting the tropics.
+[http://maps.google.com/maps?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|map+top+hospital+Malaria}}}}&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl Directions to Hospitals Treating Malaria]
 ==Prevention==
-Most people living in areas where malaria is common have acquired some immunity to the disease. Visitors will not have immunity, and should take preventive medications. It is important to see your health care provider well before your trip, because treatment may begin is long as 2 weeks before travel to the area, and continue for a month after you leave the area. The types of anti-malarial medications prescribed will depend on the area you visit. According to the CDC, travelers to South America, Africa, the Indian subcontinent, Asia, and the South Pacific should take one of the following drugs: mefloquine, doxycycline, choroquine, hydroxychoroquine, or Malarone.
+* Most people living in areas where malaria is common acquire some immunity to the disease.
-Even pregnant women should take preventive medications because the risk to the fetus from the medication is less than the risk of acquiring a congenital infection.
+* Visitors, who do not possess any immunity, should take preventive medications. It is important to see a health care provider well before a trip, because treatment may begin as long as 2 weeks prior to travel, and continue for a month after you leave the area.
-People on anti-malarial medications may still become infected. Avoid mosquito bites by wearing protective clothing over the arms and legs, using screens on windows, and using insect repellent.
+* The types of anti-malarial medications prescribed will depend on the area an individual visits. According to the CDC, travelers to South America, Africa, the Indian subcontinent, Asia, and the South Pacific should take one of the following drugs:
-Chloroquine has been the drug of choice for protection from malaria. But because of resistance, it is now only suggested for use in areas where Plasmodium vivax, P. oval, and P. malariae are present. Falciparum malaria is becoming increasingly resistant to anti-malarial medications.
+:* [[Mefloquine]]
-For travelers going to areas where Falciparum malaria is known to occur, there are several options for malaria prevention, including mefloquine, atovaquone/Proguanil (Malarone), and doxycycline.
+:* [[Doxycycline]]
-Travelers can call the CDC for information on types of malaria in a given geographical area, preventive drugs, and times of the year to avoid travel. See: www.cdc.gov
+:* [[Chloroquine]]
+:* [[Hydroxychloroquine]]
+:* [[Malarone]]
+* Pregnant women should take preventive medications, because the likelihood of the fetus having side-effects from the medications is less than the risk of acquiring a congenital infection.
+* People on anti-malarial medications can still be infected. Mosquito bites can be avoided by wearing protective clothing over the arms and legs, using screens on windows, and using insect repellent.
+* [[Chloroquine]] has been the drug of choice for prevention of malaria. But because of resistance, it is now only suggested for use in areas where ''Plasmodium vivax'', ''P. oval'', and ''P. malariae'' are present. Falciparum malaria is becoming increasingly resistant to anti-malarial medications.
+* For travelers going to areas where Falciparum malaria is known to manifest, there are several options for malaria prevention, including:
+:* [[Mefloquine]]
+:* [[Atovaquone]]/[[Proguanil]] (Malarone)
+:* [[Doxycycline]]
+Travelers can call the [[CDC]] for further information on the types of [[malaria]] in a given geographical area, preventive drugs, and times of the year to avoid travel.
+==What to expect (Outlook/Prognosis)?==
+In most cases, the prognosis of malaria is positive with prompt and proper treatment.
+The [[prognosis]] of Falciparum malaria is poor due to the severity of the disease.
+==Possible complications==
+[[Complications]] of malaria occur mainly in the more severe forms of the disease. Severe malaria occurs when infections are complicated by serious organ failures or abnormalities in the patient's blood or metabolism. Manifestations of severe malaria include:
+* [[Cerebral malaria]]
+* [[Meningitis]]
+* Severe [[anemia]]
+* [[Respiratory failure]] from fluid in the [[lungs]] ([[pulmonary edema]])
+* [[Acute respiratory distress syndrome]] ([[ARDS]])
+* Abnormalities in [[blood coagulation]]
+* [[Cardiovascular collapse]]
+* [[Acute kidney failure]]
+* [[Liver failure]]
+* Rupture of the [[spleen]] leading to massive [[internal bleeding]] ([[hemorrhage]])
 ==Alternative Names==
@@ Line 60: / Line 163: @@
 ==Sources==
-http://www.nlm.nih.gov/medlineplus/ency/article/000621.htm
+http://www.nlm.nih.gov/medlineplus/ency/article/000621.htm<br>
+[http://www.cdc.gov  CDC]
+{{WS}}{{WH}}
-[[Category:Patient Information]]
-[[Category:Medicine]]
-[[Category:Infectious diseases]]
-[[Category:Hepatology]]
-[[Category:Insect-borne diseases]]
-[[Category:Malaria]]
-[[Category:Medical emergencies]]
-[[Category:Deaths from malaria]]
 [[Category:Apicomplexa]]
+[[Category:Insect-borne diseases]]
+[[Category:Malaria]]
+[[Category:Parasitic diseases]]
+[[Category:Tropical disease]]
 [[Category:Emergency medicine]]
-[[Category:Parasitic diseases]]
-[[Category:Tropical disease]]
+[[Category:Patient information]]
-{{WH}}
+[[Category:Disease]]
-{{WS}}
+[[Category:Deaths from malaria]]
+[[Category:Ready for Review]]