Malaria

GENERAL INFORMATION:

What is malaria?

• Malaria (mah-LAR-ee-ah) is an infectious disease that is caused by parasites (bugs) and is usually spread through the bite of infected mosquitoes. This infection, which affects people worldwide, is the most important and one of the most common infections caused by parasites. It usually affects people living in warm and humid parts of the world. It may also occur in travelers and migrants who are returning from areas where malaria is common. Malaria may affect many organs in the body, including the brain, lungs, kidneys, and liver. A more severe form of malaria that affects the brain is called cerebral malaria.
  
  
• Malaria is spread by a certain type of female mosquito, which bites at night. This mosquito gets infected with the parasites after sucking the blood of a person infected with malaria. When the infected mosquito bites another person, the parasites may then be passed on to this person. Once in a person's blood, the parasites go to the cells of the liver to make more parasites. When the new parasites leave the liver cells, they then enter the person's red blood cells (RBC). After a few days, the infected RBC bursts and the parasites move to another RBC.

What causes malaria? Malaria is an infection that is caused by the Plasmodium (P.) parasite. There are four different Plasmodium parasites, which include P. falciparum, P. vivax, P. ovale, and, P. malariae. You may get infected by one or more of these bugs at the same time. Infection with P. falciparum is often severe and may be life-threatening. It can affect even those who are healthy. Plasmodium vivax, P. ovale, and P. malariae infections may also be life-threatening, but are usually less severe in healthy people. Plasmodium vivax and P. ovale parasites have the ability to hide in your liver for a long time. These parasites may cause relapses (reappearance) of the infection months to years after the first episode.

How does malaria spread? Malaria is mainly spread through the bite of an infected mosquito. It may also be passed through any of the following:

• Blood transfusions.
  
  
• Infected mother passing the parasite to her unborn child.
  
  
• Organ transplants.
  
  
• Sharing infected needles or syringes.

Who is at risk of getting malaria? People who travel a lot, especially to places where malaria is common, have a high risk of getting malaria. The longer a person stays in these high risk areas, the greater the risk is. Doing outdoor activities at night may also increase your risk. Those with weak immune systems, such as having HIV, may have a greater chance of having a more severe form of malaria. The immune system is the part of the body that fights infection. Children under five years old and pregnant women may also have a decreased ability to fight an infection. Travelers or workers, who come from areas where there is no malaria, are also more at risk of having a severe infection.

What are the signs and symptoms of malaria? Symptoms of malaria may appear days, weeks, or months after the infection. The symptoms you get also depend on the type of parasite that caused your infection and your health condition. With early symptoms of malaria, you may feel like you have the flu. Symptoms may include high fever, sweats, chills, headache, and muscle pain. You may have nausea (upset stomach), vomiting (throwing up), abdominal (stomach) pain, or diarrhea. The severe form of malaria may include one or more of the following:

• Abnormal bleeding, such as bleeding episodes that happen for no reason or are frequent, heavy, or too long.
  
  
• Anemia (decreased RBC) caused by the abnormal bleeding.
  
  
• Confusion (having trouble thinking clearly), being unaware of what is happening around you, or increased sleepiness.
  
  
• Jaundice (yellowing of the skin and whites of eyes).
  
  
• Problems sitting up without help, being more tired than normal, or severe weakness.
  
  
• Seizures (convulsions).
  
  
• Trouble breathing or shortness of breath.

How is malaria diagnosed? Your caregiver will take a detailed health history from you. This includes information about your past travels or activities, exposures and contacts, or diseases you may have had. You may also have the following:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Blood smear: A blood smear may be done to check for parasites in the RBC under a microscope. This test will help caregivers know what kind of bug is causing the malaria. This may also show how bad your disease is based on how much of your blood is infected.

How is malaria treated?

• Antimalarial medicine: Malaria is treated with certain antimalarial medicines, depending on which type of parasite is causing the malaria. The choice of medicine to use may also be based on where you got the infection. Your age, present signs and symptoms, and other diseases or conditions will also be considered. Some medicines may cause problems in certain people. These include people with glucose-6-phosphate (G-6-P) deficiency and women who are pregnant or breast-feeding. Patients diagnosed with P. vivax or P. ovale are often given a second medicine to help prevent relapses.
  
  
• Supportive treatment: If you develop severe signs and symptoms of malaria, you may need to stay in the hospital. Caregivers may treat you with supportive measures to relieve your signs and symptoms or other problems caused by the parasites. You may have one or more of the following:
  
  
  • Aiding devices: These may include respirators and oxygen to help with your breathing.
    
    
  • IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
    
    
  • Medicines: Caregivers may give you medicine to relieve pain, headaches, and fever, or to control seizures. Antibiotic medicine may be given if you have a bacterial infection in addition to your parasite infection.

How can malaria be prevented?

• Avoid mosquito bites:
  
  
  • Apply an insect repellant containing DEET (active ingredient) to your skin and clothing. An insect repellant helps to keep mosquitoes away. Make sure to apply it on your ankles and feet. An insect repellant containing permethrin (active ingredient) may be applied to clothes, bed-nets, tents, blankets, and other equipment. Infants, who are less than 2 months old, should use repellants with 30 percent DEET or less. Always read and follow the instructions on the label when using an insect repellant. Do not use DEET on the hands of young children or on infants who may rub their eyes or mouth.
    
    
  • Do not go outside, especially at night or between dawn (sunrise) and dusk (sunset). Mosquitoes feed most actively during these times. Avoid activities in places where mosquitoes are usually present.
    
    
  • Put screens on all windows and the outside doors of your house. Sleep under a bed-net if the house you are staying in is not screened. Check your bed-net for holes before using it.
    
    
  • Wear long-sleeved shirts and long pants to keep your skin covered. Choose clothes that are light-colored because mosquitoes are attracted to dark clothing.
  
  
• Control mosquito breeding: Mosquitoes lay their eggs and mature in water. It is important not to have any standing water around. Properly storing any open containers that are not in use and draining or pumping out standing water may decrease mosquito breeding.
  
  
• Take antimalarial medicine: Take antimalarial medicine to prevent infection if you plan to travel to areas that have a high-risk of malaria. Visit your caregiver 2 to 3 weeks before your travel. Take your medicine exactly as advised by your physician even if you have had malaria before.

Where can I find more information? Accepting that you have malaria may be hard. You and those close to you may feel scared, sad, or angry. These are normal feelings. Contact the following for more information about malaria:

• Centers for Disease Control and Prevention
  National Center for Infectious Diseases
  Phone: 1-888-4437232
  Web Address: http://www.cdc.gov/ncidod/
  

• National Institute of Allergies and Infectious Diseases
  NIAID Office of Communications & Public Liaison
  6610 Rockledge Drive, MSC 6612
  Bethesda, Maryland 20892-6612
  Phone: 1-301-496-5717
  Web Address: www3.niaid.nih.gov
  

• World Health Organization
  Web Address: www.who.int
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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