About one thousand cases of malaria are reported to public health departments in Germany each year. According to hospital discharge statistics, there could be twice as many cases. This makes malaria the most important and dangerous tropical disease worldwide. The most dangerous form of malaria, malaria tropica, results in a completely irregular or even continuous fever. Since many patients also have headache, limb pain or back pain, and some also have diarrhea or cough, many sufferers think of it as the flu or traveler’s diarrhea.
Can German mosquitoes transmit malaria?
As reported by tropical medicine experts led by Prof. Dr. Thomas Löscher of the Technical University of Munich, most diseases in the tropics are acquired through the bite of an infected Anopheles mosquito. Very rarely, the mosquitoes can also bite in Germany, for example if they have entered the country by plane or in their luggage. A rarity is transmission by native mosquitoes. They must first have acquired the malaria parasites from an infected human. In 1997, two such cases were described, but they are absolute exceptions.
Malaria sometimes misdiagnosed as influenza
Usually, patients become infected in central Africa or other malaria areas. In many cases, they only become ill after returning home. The fever episodes that occur every three (malaria tertiana) or four days (malaria quartana) are by no means typical. The most dangerous form of malaria, malaria tropica, leads to a completely irregular or even continuous fever, Löscher and colleagues report. Because many patients also have headaches, aching limbs or back pain, and some have diarrhea or cough, many sufferers think of it as the flu or traveler’s diarrhea.
Early diagnosis is important
But experts like Löscher warn, “Any unexplained fever after spending time in malaria-endemic areas is suspicious for malaria.” Left undiagnosed, malaria can quickly progress to complications including kidney failure, shock lung or brain involvement. If left untreated, tropica ends 20 percent of the time, and in the case of brain infestation, it is almost always fatal. These patients must therefore be treated in an intensive care unit.
Timely diagnosis is important: a few hours decide between life and death. It is not uncommon, therefore, for blood samples to have to be transported by cab or messenger to the nearest tropical clinic. There, the diagnosis is made under the microscope: By detecting the pathogens in a dried drop of blood (“thick drop”). According to Löscher and colleagues, this method is often more reliable than modern genetic tests.
Malaria tropica requires hospitalization
Malaria tertiana and quartana can be treated as outpatients. Tropica generally requires patients to be hospitalized, and complicated cases go to the intensive care unit for monitoring. Doctors are increasingly confronted with resistant pathogens. However, with mefloquine, atovaquone/proguanil or artemether/lumefantrine, effective drugs are available to treat uncomplicated tropica. For complicated cases, infusion treatment with quinine is used. Because of clustered resistance, many malaria patients are transferred to tropical institute wards.
