Elsevier

Medicine

Volume 38, Issue 1, January 2010, Pages 41-46
Medicine

Special situations
Malaria

https://doi.org/10.1016/j.mpmed.2009.09.017Get rights and content

Abstract

Malaria remains a leading cause of mortality worldwide and a substantial cause of morbidity in returning travellers in the UK. The management of malaria, recent advances in diagnosis, guidelines on treatment and prevention, and current areas of controversy, are summarized, being aimed at clinicians in non-endemic countries who do not routinely encounter malaria. The most important message is that malaria is common, so it should be suspected. Early diagnosis and prompt effective treatment prevent unnecessary deaths. Health promotion for travellers to endemic areas is essential to reduce the burden of imported malaria.

Section snippets

Introduction and epidemiology

Despite effective treatments, malaria remains a leading cause of mortality worldwide, killing over 3,000 children every day.1 In parts of Africa, the average person will catch malaria four or more times a year, so the disease is much more common than influenza in the UK. It is a substantial cause of morbidity in returning travellers in the UK, with a case fatality rate of 7.4 per 1000.2, 3 There is around a 1:5 chance that a patient presenting recently returned from sub-Saharan Africa with a

Pathophysiology

Malaria is a disease caused by protozoal parasites of the genus Plasmodium. Five species of Plasmodium cause disease in humans (Table 1); falciparum malaria causes almost all the deaths. In humans it is transmitted by female Anopheles mosquitoes that bite typically after dark. Peak biting time in Africa is from midnight – in Asia and South America it can be earlier in the evening, which has implications for prevention.

The pathophysiology of disease is incompletely understood.5 The virulence of

Clinical manifestations of disease

Symptoms develop from around 6 days after an infected bite. Most falciparum infections present within 1 month, although this can be extended, especially in those on prophylaxis. Vivax, malariae and ovale infection commonly have a longer incubation period (six months to several years have been reported) and vivax and ovale can relapse after an extended period because of persistence of hepatic hypnozoites. This is different from recrudescence where parasites reappear in the blood following

Diagnosis

Diagnostic delay, either because the patient has delayed presentation, or because a doctor has not suspected the diagnosis, is a key factor in mortality from malaria in non-endemic countries.8 Suspecting the diagnosis is paramount; do not be put off by a history of prophylaxis (malaria can occur even with perfect prophylaxis) or apparent localizing symptoms or signs (e.g. jaundice). Whilst malaria can exist with any symptoms, it is very rare for severe malaria to present in patients with a

General principles

Once malaria has been identified the key questions are: is this falciparum or non-falciparum and, if falciparum, is it severe (sometimes called complicated) or non-severe (Table 2)?

To admit or not to admit?

UK guidelines for treatment of malaria recommend that all patients with P. falciparum malaria be admitted to hospital for at least the first 24 hours, including those who do not initially meet criteria for severe disease.10 This is particularly important for children, pregnant women and the elderly, who are at

References (15)

  • World malaria report 2008

    (2008)
  • Health protection report Vol. 2 No. 17

  • A.D. Smith et al.

    Imported malaria and high risk groups: observational study using UK surveillance data 1987–2006

    BMJ

    (2008)
  • P. Chiodini et al.

    Guidelines for malaria prevention in travellers from the United Kingdom

    (January 2007)
  • L.H. Miller et al.

    The pathogenic basis of malaria

    Nature

    (2002)
  • C. Nic Fhogartaigh et al.

    Falciparum malaria as a cause of fever in adult travellers returning to the United Kingdom: observational study of risk by geographical area

    QJM

    (2008)
  • Management of severe malaria

    (April 2000)
There are more references available in the full text version of this article.

Cited by (11)

  • Antiplasmodial activities of a Thai traditional antipyretic formulation, Bencha-Loga-Wichian: A comparative study between the roots and their substitutes, the stems

    2016, Journal of Ethnopharmacology
    Citation Excerpt :

    Although malaria is a curable disease, it remains a major public health problem that causes 300–500 million cases of infection around the world and more than a million deaths annually (Murray et al., 2012). There are five species of human malaria parasites including Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi (Walker et al., 2010). Among these, P. falciparum is the most virulent strain.

  • Anti-plasmodial activity of bradykinin and analogs

    2015, Bioorganic and Medicinal Chemistry Letters
View all citing articles on Scopus
View full text