Malaria Fever: Causes, Signs and Symptoms, Diagnosis, Drugs, Prevention, and Treatment
Introduction
Malaria is a life-threatening disease caused by parasites transmitted to humans through the bites of infected female Anopheles mosquitoes. Despite significant progress in its control, malaria remains a major public health challenge in many parts of the world, especially in tropical and subtropical regions such as Africa, Asia, and South America. According to the World Health Organization (WHO), there were approximately 249 million cases of malaria worldwide in 2022, with over 600,000 deaths, most of them in children under five years.
This article provides an in-depth overview of malaria fever, including its causes, symptoms, diagnostic methods, commonly used drugs, prevention strategies, and treatment options.
What is Malaria?
Malaria is a vector-borne infectious disease caused by Plasmodium parasites, transmitted to humans through the bite of an infected mosquito. The disease typically causes fever, chills, and flu-like symptoms, and if not treated promptly, it can progress to severe complications and death.
Types of Malaria Parasites
There are five main species of Plasmodium that cause malaria in humans:
1. Plasmodium falciparum – Most deadly and prevalent in sub-Saharan Africa.
2. Plasmodium vivax – Common in Asia and Latin America; can remain dormant in the liver.
3. Plasmodium ovale – Found mainly in West Africa.
4. Plasmodium malariae – Found worldwide but less common.
5. Plasmodium knowlesi – Found in Southeast Asia; can cause severe malaria.
Causes of Malaria
Malaria is primarily caused by the bite of an infected female Anopheles mosquito, which transmits the Plasmodium parasite into the bloodstream.
Other Rare Causes
• Blood transfusion from an infected donor.
• Organ transplantation.
• Sharing infected needles or syringes.
•Congenital transmission (from mother to unborn child).
Once inside the body, the parasites travel to the liver, mature, and then re-enter the bloodstream, where they infect red blood cells and begin to multiply, leading to the characteristic symptoms of malaria.
Signs and Symptoms of Malaria
Malaria symptoms usually appear 10–15 days after the mosquito bite. Early diagnosis and treatment are crucial to prevent complications.
Common Symptoms:
• High fever (often in cycles)
• Chills and sweating
• Headache
• Nausea and vomiting
• Muscle and joint pain
• Fatigue
• Rapid breathing and heart rate
Severe Malaria Symptoms:
• Cerebral malaria (seizures, confusion, coma)
• Severe anemia
• Hemoglobinuria (dark-colored urine)
• Acute respiratory distress syndrome (ARDS)
• Organ failure (kidneys, liver, etc.)
Low blood pressure and shock
Severe malaria, especially caused by P. falciparum, requires immediate hospitalization.
Diagnosis of Malaria
Timely and accurate diagnosis is essential to manage malaria effectively and prevent drug resistance.
Common Diagnostic Methods:
1. Microscopic Examination
• Giemsa-stained blood smear (thick and thin) under a microscope.
• Gold standard for identifying parasite species and parasite load.
2. Rapid Diagnostic Tests (RDTs)
• Detect Plasmodium antigens in the blood.
• Useful in areas without microscopy facilities.
3. Polymerase Chain Reaction (PCR)
• Used for research and confirmation.
• Detects parasite DNA.
• More sensitive but costly and time-consuming.
4. Serology
• Detects antibodies.
• Not useful for acute diagnosis but may be used for epidemiological studies.
Drugs Used in Malaria Treatment
The choice of antimalarial drugs depends on the species, severity, geographic location, and drug resistance patterns.
Common Antimalarial Drugs:
1. Chloroquine
• Effective against P. vivax, P. malariae, P. ovale.
• Widespread resistance in P. falciparum.
2. Artemisinin-Based Combination Therapies (ACTs)
• First-line treatment for P. falciparum.
• Examples: Artemether-lumefantrine, Artesunate-amodiaquine, Artesunate-mefloquine.
3. Quinine and Quinidine
• Used in severe malaria cases.
• Given intravenously or orally depending on the condition.
4. Mefloquine
• Used in chloroquine-resistant areas.
• May cause neuropsychiatric side effects.
5. Primaquine
• Eliminates liver-stage hypnozoites of P. vivax and P. ovale.
• Not used in patients with G6PD deficiency due to risk of hemolysis.
Prevention of Malaria
1. Vector Control
a. Insecticide-Treated Nets (ITNs)
• Reduce contact with mosquitoes during sleep.
• Recommended for all age groups in malaria-endemic areas.
b. Indoor Residual Spraying (IRS)
• Spraying insecticides on walls and ceilings of homes.
• Effective for 3–6 months depending on the insecticide used.
c. Larval Source Management
Eliminating or treating water bodies where mosquitoes breed.
2. Personal Protection
• Wearing long-sleeved clothes.
• Using mosquito repellents (DEET, picaridin).
• Staying indoors during peak mosquito hours (dusk and dawn).
3. Chemoprophylaxis
• For travelers visiting malaria-endemic regions:
• Atovaquone-proguanil
• Doxycycline
• Mefloquine
• These should be started before travel and continued after returning.
4. Malaria Vaccine
The RTS,S/AS01 (Mosquirix) malaria vaccine has been recommended by the WHO for children living in areas with moderate to high P. falciparum transmission.
Treatment of Malaria
1. Uncomplicated Malaria
• Treatment varies based on parasite species and region.
• For P. falciparum:
ACTs are the preferred treatment.
• Examples: Artemether-lumefantrine, Artesunate-amodiaquine.
• For P. vivax, P. ovale:
Chloroquine (if sensitive) + Primaquine (for liver stage).
2. Severe Malaria
• Requires hospitalization and intensive care.
Treatment options:
• Intravenous Artesunate (preferred)
• Intravenous Quinine (if artesunate not available)
• Follow-up with full ACT course after initial parenteral therapy.
3. Supportive Treatment
• Antipyretics (e.g., paracetamol) to manage fever.
• IV fluids to maintain hydration.
• Blood transfusion in case of severe anemia.
• Mechanical ventilation or dialysis in organ failure.
Complications of Malaria
• Cerebral malaria
• Pulmonary edema
• Severe anemia
• Kidney failure
• Jaundice and liver failure
• Hypoglycemia
• Death, if untreated or poorly managed
Malaria in Pregnancy
Pregnant women are at higher risk of severe malaria, miscarriage, premature delivery, and stillbirth.
Prevention in Pregnancy:
Intermittent Preventive Treatment (IPTp) with Sulfadoxine-Pyrimethamine (SP).
• Use of ITNs.
Prompt diagnosis and treatment.
Malaria in Children
Children under five are the most vulnerable. Early diagnosis and immediate treatment are vital to reduce mortality.
Global Malaria Control Strategies
1. WHO Global Technical Strategy (GTS) for Malaria 2016–2030:
• Reduce malaria case incidence and mortality by at least 90%.
• Eliminate malaria in at least 35 countries.
2. National Malaria Control Programs (NMCPs):
Local initiatives by governments to control and eliminate malaria through integrated approaches.
FAQs on Malaria
Q1: Is malaria contagious?
No. Malaria is not spread from person to person like the flu or common cold. It requires a mosquito vector.
Q2: Can malaria recur?
Yes, especially P. vivax and P. ovale, due to dormant liver forms (hypnozoites) which can reactivate weeks or months later.
Q3: Is there a permanent cure for malaria?
Yes, with proper diagnosis and complete course of antimalarial medication, malaria can be cured.
Q4: How long does malaria treatment take?
Uncomplicated malaria usually clears within 3–7 days of starting treatment. Severe cases may require longer hospitalization.
Q5: What is blackwater fever?
It is a complication of falciparum malaria, characterized by hemoglobinuria (dark-colored urine), severe anemia, and kidney failure.
Conclusion
Malaria continues to pose a major global health threat, but it is preventable and treatable with proper awareness, timely diagnosis, and effective treatment. The use of insecticide-treated nets, vector control measures, and antimalarial medications, along with vaccination in children, are key strategies in the fight against this disease. With global efforts, we can move closer to a malaria-free world.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)