Malaria is one of the most important and dangerous tropical infectious diseases. Due to this disease, travelers to tropical countries are at particular risk. Any fever during or up to one year after a tropical visit should be considered malaria. Seek detailed advice about malaria risks from a physician or at your city’s tropical institute before traveling.
What is malaria?
Malaria is one of the most important tropical diseases worldwide and is notifiable. It occurs predominantly in the tropics and subtropics. It is now believed that just under half of the world’s population lives in malaria-endemic areas. Malaria is transmitted by the bite of the female Anopheles mosquito, which is infected with a malaria pathogen. Human-to-human infection is virtually impossible. Malaria can be caused by four different types of pathogens. Of the three currently existing forms of malaria, malaria tropica is the most dangerous. While malaria tertiana and malaria quartana are usually benign, malaria tropica often leads to life-threatening complications. Despite large-scale control programs, the spread of malaria has increased in recent years. In addition, the pathogens causing malaria tropica in large parts of South, Southeast and East Asia, in sub-Saharan Africa and in tropical South America are less sensitive to the usual drugs and have developed resistance. Preventive measures must therefore be tailored to regional risks. They may vary seasonally, also differ from country to country, and depend on the type of travel (hotel vacation in major cities vs. safari expedition in the interior).
Causes
Malaria is caused by single-celled blood parasites called plasmodia that infect red blood cells. These malaria pathogens are transmitted locally by certain mosquitoes (Anopheles mosquito). There they multiply and cause the blood cells to burst after their development is complete. The released pathogens in turn seek new blood cells and the cycle begins again. Strong attacks of fever are typical of all forms of malaria. They occur about every three days in malaria tertiana and every four days in malaria quartana. The febrile episodes in malaria tropica repeat at irregular intervals.
Symptoms, complaints, and signs
The first symptoms of malaria infection appear after a few days, weeks, or months. This depends on the form of malaria. Malaria tropica has the shortest incubation period here, ranging from six days to three weeks. Malaria tertiana or Malaria quartana have incubation periods of several days and sometimes months or years. The first symptoms correspond to those of a severe flu infection. Thus, there is a high fever with over 38.5 degrees Celsius. In addition, there is a general feeling of illness with headache, fatigue and weakness. Affected persons often suffer from chills and heavy sweating. There is nausea, muscle pain and circulatory problems. Occasionally, diarrhea and general intestinal discomfort occur. The symptoms rarely all occur together and vary in severity. Fever occurs periodically in the latter types of malaria. Malaria tropica, on the other hand, has irregular episodes of fever. Malaria tropica rarely leads to other symptoms without fever or feeling sick. Instead, there are circulatory problems (especially microcirculatory problems), confusion, and fainting due to the circulatory problems. Overall, however, fever and a general feeling of illness are the leading symptoms of malaria and should make one think directly of this disease if there is a possible risk for it. It is true that even up to two years after being in a tropical area, symptoms are considered evidence of malaria infection.
Disease progression
The incubation period of malaria ranges from about seven to as long as 40 days, depending on the type of pathogen. Febrile attacks occur rapidly in malaria quartana and suddenly in the other two forms of malaria. Malaria tertiana and Malaria quartana are cured after 12 to 20 fever attacks. Malaria tropica is often fatal if left untreated. This form of the disease can lead to pulmonary edema, kidney failure or circulatory collapse. The symptoms of an outbreak of malaria are often confused with those of a cold or gastrointestinal complaints.Those affected do not always associate fever, headache, nausea or vomiting with their trip to malaria areas. Especially not if some time has already passed between the trip and the onset of symptoms. Therefore, it is important to know that a period of up to a year can pass from the onset of the disease to the appearance of symptoms.
Complications
Due to malaria infection, there is a risk of various complications. These can sometimes have severe consequences. The risk of complications is highest with malaria tropica. Thus, almost all deaths are caused by it. A typical consequence of malaria tropica is impaired consciousness, which can even lead to the death of the patient. It is not uncommon for an abrupt change in consciousness to occur without any signs. Cerebral malaria also carries the risk of neurological complications such as seizures and paralysis. Pregnant women and children are often at risk of hypoglycemia. This sometimes leads to a fall into coma. Because the spleen enlarges in the course of malaria, a rupture of the organ is within the realm of possibility. In severe infections, anemia (anemia) also becomes apparent. Babies and small children are particularly affected. In most cases, this is due to hemolytic anemia, in which the red blood cells are destroyed. Another conceivable complication is hemoglubinuria. In this case, the hemoglobin level in the blood increases and the iron-containing protein complex hemoglobin is excreted via the kidneys, which is noticeable by a dark urine coloration. Furthermore, acute kidney failure is possible due to circulatory disorders. Complications of the lungs occur in about ten percent of all malaria patients. These range from mild discomfort to pulmonary edema (water lung).
When should you see a doctor?
If flu-like symptoms occur and increase in extent and intensity within a short period of time, a visit to the doctor should be made. A doctor should be consulted if there is fever, headache, pain in the limbs, and a marked decrease in performance. If the symptoms occur during or after a stay in tropical or subtropical regions, a doctor should be consulted immediately. This applies in particular if the bite of a mosquito is noticed on the body. Since malaria can be fatal in severe cases, medical attention is needed as soon as possible. In case of a further increase of fever, chills or disturbances of consciousness, a doctor must be consulted. A particular characteristic of malaria is a changing course of the fever curve. It should therefore always be checked whether an ambulance should be alerted if the patient’s health deteriorates further. If there are seizures, digestive disorders, abnormalities when going to the toilet or pain in the kidney area, a doctor should be consulted. The affected person is at risk of organ failure if he or she does not seek treatment. Diarrhea, disturbances of blood circulation, dizziness and signs of paralysis are further warning signs of the organism. A visit to the doctor is necessary so that a determination of the cause can be made. Ravenous appetite, internal weakness, an acute feeling of illness as well as irritability should be clarified by a doctor.
Treatment and therapy
On the basis of a blood test, malaria can be diagnosed very quickly and easily, since the pathogens can be easily seen under the microscope. The severity of the disease can be determined by the parasite count and the leukocyte count (number of inflammatory cells). Malaria is treated by using agents that kill the pathogen. One of the best-known antimalarial drugs is quinine. In most cases, treatment is carried out on an outpatient basis. Only malaria tropica should be treated as an inpatient because of the severity of the disease and the possible complications. The chances of cure for malaria tertiana as well as quartana are good, and in the case of malaria tropica detected at an early stage, the mortality rate in Germany is currently less than one percent. Infographic on the transmission cycle of malaria by the Anopheles mosquito. Click to enlarge. To prevent contracting malaria, travelers should first find out whether their destination is in a malaria area. The most common malaria infections occur in Africa. South of the Sahara to the north of South Africa, the majority of mosquitoes are infected with plasmodia.But there are also various risk areas in Indonesia, India and South America. The mosquitoes are crepuscular and nocturnal and live near wetlands. Malaria can be effectively prevented by taking medication and avoiding mosquito bites. Vaccination against malaria is not yet available. Protective measures include protection from mosquito bites and taking tablets for malaria prophylaxis. The drugs for malaria prophylaxis largely protect against severe malaria disease. Nevertheless, even with prophylaxis, contracting malaria is not one hundred percent impossible.
Outlook and prognosis
If left untreated, the tropical disease leads to the premature death of the affected person. The complications of malaria are severe without medical care. Organic disorders, loss of consciousness, and seizures and paralysis occur. The affected person is no longer able to regulate his life independently. Ultimately, death occurs due to multiple organ failure. Nevertheless, the disease is curable with today’s medical possibilities in our regions. The earlier medical treatment is initiated, the better the further prospects. If the diagnosis is made quickly and therapy is started quickly, the prognosis for malaria is favorable. It is therefore important to pay attention to where the affected person is currently staying. Medical care in an African area is less well structured than in the European area. For this reason, sufficient precautions should be taken before traveling to a malaria area. In addition, a doctor should be consulted on the spot for prognosis at the first signs. Immediate medical care must be taken to prevent the spread of the pathogens. In poor health, transport of the affected person from Africa to the home area cannot always be guaranteed. These developmental possibilities must be planned for and considered prior to travel.
Prevention
Practical prevention of malaria includes the above-mentioned malaria prophylaxis and active protection against mosquito bites. The fewer bites, the lower the risk of infection. So what specifically can you do in your vacation country? :
- Sleep in rooms with air conditioning or secure windows and doors with mosquito nets.
- Spray bedrooms with insect sprays or use plug-in vaporizers or fumigators, respectively, before sleeping at night. Be careful in bedrooms with small children.
- Sleep under mosquito nets at night (important for infants and young children). The netting should not have holes, the free hems should be pulled under the mattress.
- Malaria mosquitoes bite mainly at dusk and at night. When outdoors, wear clothing that is as light-colored as possible, not tight-fitting and covering the entire body (long pants, long shirts, socks, shoes).
- Rub unclothed skin (for example, hands, feet and face) with mosquito-repellent lotions. Avoid large-area application on children.
Aftercare
Infectious diseases such as malaria often need good aftercare after they are cured. It is aimed at strengthening the immune system and the regeneration of those affected and, above all, to prevent further complications. This requires close monitoring by the attending physician. In the area of internal infections, which mainly affect the gastrointestinal tract or the respiratory tract, the immune system can be strengthened by a number of measures that are in the hands of the patients themselves. These include a balanced diet, sufficient drinking and enough sleep. It is also important not to start sporting activities too early if the patient is not yet fit enough to do so. This should be done in consultation with the doctor. Often the intestine is impaired in its function by medications given as part of the infection. This is especially true when antibiotics have been given. In this case, a non-stressful diet helps in the aftercare. Yogurt products are often able to rebuild a disturbed intestinal flora. In general, with tropical diseases such as malaria, care should be taken to ensure that recovery is complete to prevent relapse or further symptoms.
What you can do yourself
In the case of malaria, medical treatment is necessary in any case.Medical therapy can be supported by a number of self-help measures and home remedies. First of all, it is advisable to take it easy on the body and drink plenty of fluids. During a bout of malaria, the diet should consist of light foods such as chicken broth, rusks or soft-boiled rice. After the disease is over, fruits and vegetables as well as foods rich in minerals are recommended. A proven natural remedy is the Artemisia plant. The herb can be taken either dried or in the form of tea and relieves the typical symptoms of malaria fever. The use of this remedy should be discussed with a doctor beforehand. If medical help cannot be found, self-treatment is also possible as a temporary solution. When traveling to malaria areas, an appropriate malaria emergency medication should therefore be carried. However, in some cases a doctor must be consulted. In the case of complicated malaria, for example, hospitalization is required in any case, as functional disorders of the lungs or heart may occur. To be able to return to everyday life early, bed rest and compliance with medical recommendations apply.