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{{Malaria}}
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==Overview==
==Overview==
Malaria parasites are transmitted by female ''[[Anopheles]]'' [[mosquito]]es. The parasites multiply within [[red blood cell]]s, causing symptoms that include symptoms of [[anemia]] (light headedness, [[shortness of breath]], [[tachycardia]] etc.), as well as other general symptoms such as [[fever]], [[chills]], [[nausea]], [[influenza|flu-like illness]], and in severe cases, [[coma]] and death.
The hallmark [[symptom]] of [[malaria]] is [[fever]], which commonly occurs in paroxysms, separated by fever-free time intervals. The classical but rarely observed malaria attack lasts 6-10 hours, and it consists of a cold stage, hot stage, and sweating stage.  Other common [[symptoms]] of [[malaria]] include [[chills]], [[headache]], [[nausea]], [[vomiting]], [[weakness]], [[night sweats]], [[flu]]-like symptoms, and [[myalgia]].  In the presence of a paroxysmal fever, travel history to a country where malaria is endemic is an important alert for the diagnosis.<ref name=Mandell>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref> Most importantly, malaria symptoms must be distinguished as to whether they reflect an uncomplicated or a severe course of infection. While uncomplicated infection is a benign process, severe malaria causes organ damage and is considered a medical emergency.


==History==
In the presence of a paroxysmal fever, travel history to a country where malaria is endemic is an important alert for the diagnosis.<ref name=Mandell>{{cite book | last = Mandell | first = Gerald | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 0443068399 }}</ref>  Following the infective bite by the Anopheles mosquito, a period of time ranging from 7 to 30 days goes by before the first symptoms appear.
[[Fever]] in [[malaria]] is classically described as occurring in paroxysms of a few hours. These may be described as:
* ''Cold stage'': where the patient experiences [[rigors]] and [[chills]]
* ''Hot stage'': characterized by [[fever]], [[headaches]], and children may experience [[seizures]]
* ''Sweating stage'': characterized by [[sweats]], return to normal temperature with a feeling of [[fatigue]]


==History==
The time-interval between [[fever]] paroxysms changes according to the type of [[plasmodium]] causing the disease:
<!--
* "Tertian" fever: paroxysms occur every second day, caused by "tertian" parasites:
The malaria incubation period after an infective mosquito bite includes the time required for the parasites to progress through liver schizogony and produce symptoms by their propagation in the bloodstream. For primary attacks, this period is typically about 8 to 25 days but may be much longer depending on the immune status of the infected person, the strain as well as the species of Plasmodium, the dose of sporozoites, and the possible effects of partially effective chemoprophylaxis. Relapses from latent hypnozoites may develop months or years after mosquito bites. Late-onset or recrudescent P. falciparum malaria may also occur in individuals who have suppressed parasitemia of drug-resistant parasites with chemoprophylactic drugs367 (see Fig. 275-2). Febrile patients presenting within 7 days of entering an endemic area are unlikely to have malaria, unless there has been earlier exposure to infective mosquito bites. As a general rule, and because of the dangers of acute P. falciparum infection, all travelers who have visited a malaria-endemic area in the 3 months prior to onset of fever or other suggestive symptoms should be considered to have malaria until proven otherwise. Even in patients beyond this time frame, it is wise to consider P. falciparum malaria, as illustrated, for example, in the recent report of a symptomatic presentation in an 18-year-old patient with sickle cell disease 4 years after visiting an endemic area.248 Latent attacks from the reactivation of P. vivax or P. ovale hypnozoites usually occur within 3 years and are rare more than 5 years after expo- sure. Recrudescence of P. malariae symptoms in individuals with subclinical parasitemia has been reported decades after initial infection.170,368,369
** [[P. falciparum]]
-->
** [[P. vivax]]
** [[P. ovale]]
* "Quartan" fever: paroxysms occur every third day, caused by the "quartan" parasite:
** [[P. malariae]]


==Common Symptoms==
==Symptoms==
===Common Symptoms===
* [[Fever]]
* [[Fever]]
* [[Chills]]
* [[Chills]]
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* [[Weakness]]
* [[Weakness]]
* [[Night sweats]]
* [[Night sweats]]
* [[Nausea]]
* [[Vomiting]]
* [[Insomnia]]
* [[Insomnia]]
* [[Joint pain]]
* [[Joint pain]]
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* [[Abnormal posturing]] (children)
* [[Abnormal posturing]] (children)


 
===Less Common Symptoms===
==Less Common Symptoms==
* [[Vomiting]]
* [[Diarrhea]]
* [[Diarrhea]]
* [[Abdominal cramps]]
* [[Abdominal cramps]]
* Bloody urine
* Feeling of [[tingling]] in the skin
* [[Bloody urine]]
* [[Convulsions]]
* [[Convulsions]]
* Feeling of tingling in the skin


==Distinguishing Uncomplicated vs. Severe Symptoms==
Malaria may either present as an uncomplicated infection or as a severe infection. While the former follows a benign course, the latter is characterized by target organ damage. More importantly, recognition of the severity of malarial symptoms is important because severity directly alters the management plan and the treatment options for patients with malaria.


The following table compares symptoms of uncomplicated malaria and severe malaria.
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Comparison of Malaria Infections According to Severity''''' <ref>({{cite web |url=http://www.cdc.gov/malaria/about/disease.html |title= Malaria |date= Nov. Feb 8 2010 |website= Center for Disease Control and Prevention|publisher= Center for Disease Control and Prevention (CDC)|accessdate=Jul 24 2014}})</ref>
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Severity}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Clinical Significance}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Uncomplicated'''
| style="padding: 5px 5px; background: #F5F5F5;" |


<!--
Attack lasts 6-10 hours consisting of 3 stages
In other infections, fever may be cyclical, recurring every 48 or 72 hours, depending on the species and synchrony of the replicating parasites. Parasite subpopulations on different cycles in the blood- stream may produce complicated fever patterns. Patients with cyclical fevers may be relatively asymptomatic during afebrile periods.
*Cold stage: Shivering
*Hot stage: Fever, vomiting, and seizure
*Sweating stage: Sweating and fatigue


Cyclical paroxysms of chills and rigors, fever, and drenching sweats are characteristic although not necessarily specific for malaria.


A travel history that reveals risk of exposure months to years before in an endemic region is an alert for malaria and should always be sought in presentations of fever.
Non-specific symptoms
*Chills
*Sweating
*Headache
*Nausea and vomiting
*Body aches
*General malaise


Findings on physical examination may include pallor and hepatosplenomegaly. Rarely, acute Plasmodium infections present with splenic rupture requiring surgery or conservative management.
Findings such as jaundice, diminished consciousness, or convulsions indicate severe malaria (see later). Rash, lymphadenopathy, and signs of pulmonary consolidation are distinctly uncommon.
* The classical symptom of malaria is cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting four to six hours, occurring every two days in ''P. vivax'' and ''P. ovale'' infections, while every three for ''P. malariae''.<ref name=RBMarmenia>[http://www.malaria.am/eng/pathogenesis.php Malaria life cycle & pathogenesis]. Malaria in Armenia. Accessed October 31, 2006.</ref>
* ''P. falciparum'' can have recurrent fever every 36-48 hours or a less pronounced and almost continuous fever.
-->


Physical findings
*Fever
*Tachypnea
*Perspiration
*Weakness
*Hepatosplenomegaly
*Jaundice


|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Severe'''
| style="padding: 5px 5px; background: #F5F5F5;" |
Malaria complicated by organ damage. It is considered a medical emergency that requires prompt hospitalization.
*Cerebral malaria: Altered mental status, seizures, coma, neurologic deficit
*Hemolytic anemia: Hemoglobinuria, jaundice, splenomegaly
*Coagulopathy
*Acute respiratory distress syndrome (ARDS): Dyspnea, cough, hypoxia
*Cardiovascular collapse
*Acute kidney injury
*Metabolic acidosis
*Hypoglycemia
|-
|}


==References==
==References==
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[[Category:Deaths from malaria]]
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Latest revision as of 18:00, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

The hallmark symptom of malaria is fever, which commonly occurs in paroxysms, separated by fever-free time intervals. The classical but rarely observed malaria attack lasts 6-10 hours, and it consists of a cold stage, hot stage, and sweating stage. Other common symptoms of malaria include chills, headache, nausea, vomiting, weakness, night sweats, flu-like symptoms, and myalgia. In the presence of a paroxysmal fever, travel history to a country where malaria is endemic is an important alert for the diagnosis.[1] Most importantly, malaria symptoms must be distinguished as to whether they reflect an uncomplicated or a severe course of infection. While uncomplicated infection is a benign process, severe malaria causes organ damage and is considered a medical emergency.

History

In the presence of a paroxysmal fever, travel history to a country where malaria is endemic is an important alert for the diagnosis.[1] Following the infective bite by the Anopheles mosquito, a period of time ranging from 7 to 30 days goes by before the first symptoms appear.

Fever in malaria is classically described as occurring in paroxysms of a few hours. These may be described as:

  • Cold stage: where the patient experiences rigors and chills
  • Hot stage: characterized by fever, headaches, and children may experience seizures
  • Sweating stage: characterized by sweats, return to normal temperature with a feeling of fatigue

The time-interval between fever paroxysms changes according to the type of plasmodium causing the disease:

  • "Tertian" fever: paroxysms occur every second day, caused by "tertian" parasites:
  • "Quartan" fever: paroxysms occur every third day, caused by the "quartan" parasite:

Symptoms

Common Symptoms

Less Common Symptoms

Distinguishing Uncomplicated vs. Severe Symptoms

Malaria may either present as an uncomplicated infection or as a severe infection. While the former follows a benign course, the latter is characterized by target organ damage. More importantly, recognition of the severity of malarial symptoms is important because severity directly alters the management plan and the treatment options for patients with malaria.

The following table compares symptoms of uncomplicated malaria and severe malaria.

Comparison of Malaria Infections According to Severity [2]
Severity Clinical Significance
Uncomplicated

Attack lasts 6-10 hours consisting of 3 stages

  • Cold stage: Shivering
  • Hot stage: Fever, vomiting, and seizure
  • Sweating stage: Sweating and fatigue


Non-specific symptoms

  • Chills
  • Sweating
  • Headache
  • Nausea and vomiting
  • Body aches
  • General malaise


Physical findings

  • Fever
  • Tachypnea
  • Perspiration
  • Weakness
  • Hepatosplenomegaly
  • Jaundice
Severe

Malaria complicated by organ damage. It is considered a medical emergency that requires prompt hospitalization.

  • Cerebral malaria: Altered mental status, seizures, coma, neurologic deficit
  • Hemolytic anemia: Hemoglobinuria, jaundice, splenomegaly
  • Coagulopathy
  • Acute respiratory distress syndrome (ARDS): Dyspnea, cough, hypoxia
  • Cardiovascular collapse
  • Acute kidney injury
  • Metabolic acidosis
  • Hypoglycemia

References

  1. ↑ 1.0 1.1 Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
  2. ↑ ("Malaria". Center for Disease Control and Prevention. Center for Disease Control and Prevention (CDC). Nov. Feb 8 2010. Retrieved Jul 24 2014. Check date values in: |accessdate=, |date= (help))


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