Malaria Health Dictionary

Notifiable disease. The world’s No 1 public health enemy. Affects 108 nations. Still kills millions of people each year. Probably has claimed more lives than all the wars of history. In the 1960s was believed to have been eradicated but has made a dramatic reappearance due to the malaria-carrying mosquito’s resistance to insecticides. Few modern drugs have proved a match for malaria; quinine drugs of proven reliability still used. Quinine (Peruvian bark) has a history of safety and efficacy.

The disease is transmitted by the anopheles protozoa. Old cases present with fever, jaundice, diarrhoea and confusion.

Symptoms: incubation 2-5 weeks. Onset sudden, with shivering and high fever (104°F), headache, vomiting. Symptoms recur every 2-3 days. Blood sample examination confirms.

Treatment. Drugs once useful in the fight against malaria are losing their effectiveness. Drug resistance becomes a major problem; in which case the remedies of antiquity have something to offer.

Alternatives. Yarrow was once regarded as the Englishman’s Quinine. Nettle tea (Dr Compton Burnett). Prickly Ash (Ellingwood). Barberry, Chiretta, Peruvian bark BHP (1983). Mountain Grape (Berberis aquifolium) (Ellingwood). Wild Indigo, cases of extreme prostration (Dr Wm Boericke).

Sweet Wormwood. The Chinese Qing Hao (Artemisia annua) proved beneficial for millennia before Quinine arrived on the scene. Its re-discovery by Professor Nelson is declared ‘very effective’.

Formula. Liquid Extracts: Boneset 1; Yarrow 1; Barberry half; Valerian half. Few drops Tincture Capsicum. Dose: 1-2 teaspoons every 2 hours.

Malaria was rife in parts of America, especially Arkansus. During the Civil War it was difficult to obtain Quinine and various alternatives were tried. Where symptoms of chills and intermittent fever presented, Gelsemium gained considerable reputation as a substitute, also as a preventative. A favourite prescription was three drops tincture in a little brandy every 2-3 hours before the chill, and repeated every hour.

Dr M.H. Grannell, Sinaloa, Mexico. “I do not doubt that I treat more malaria than any other five physicians in the United States. My sole remedy, unless other indications present themselves, is Gelsemium. I give the following with never-failing results: 30 drops Tincture Gelsemium in 4oz water. Dose: 1 teaspoon hourly.” (Ellingwood, June 1920)

Thomas Nuttall, botanist. In 1819, when on tour in Arkansus, relieved a malarial attack with decoction of Boneset.

David Hoffman, MNIMH. 1 teaspoon Peruvian bark in each cup boiling water; infuse 30 minutes. Thrice daily.

Diet. 3-day fast.

Treatment by or in liaison with a general medical practitioner. 

A serious disease caused by parasitic protozoa called plasmodia. The infection is spread by the bite of anopheles mosquitoes and is prevalent throughout the tropics. Malaria causes severe fever, and, in some cases, fatal complications affecting the kidneys, liver, brain, and blood.

There are 4 species of plasmodia that cause malaria: PLASMODIUM FALCIPARUM, PLASMODIUM VIVAX, PLASMODIUM OVALE, and PLASMODIUM MALARIAE. When a mosquito carrying any of these species bites a human, the plasmodia enter the bloodstream. They invade the liver and red blood cells, where they multiply. The red cells then rupture, releasing the new parasites. Some of them infect new red cells, and the others develop into forms that can infect more mosquitoes. Falciparum malaria infects more red cells than the other species and therefore causes a more serious infection. Most cases of this form occur in Africa.Symptoms of malaria include fever, shaking, and chills. There may also be severe headache, general malaise, and vomiting. The fever often develops in cycles, occurring every other day (in vivax and ovale infections) or every 3rd day (in malariae infections).

Falciparum malaria can be fatal within days. Infected red cells become sticky and block blood vessels in vital organs. The spleen becomes enlarged and the brain may be affected, leading to coma and convulsions. Destruction of blood cells causes haemolytic anaemia (see anaemia, haemolytic). Kidney failure and jaundice often occur.

A diagnosis is made by examining a blood sample under a microscope to view the parasites. Chloroquine is the usual treatment for species other than falciparum. Falciparum malaria is treated with quinine, mefloquine, or with proguanil and atovaquone. People with vivax or ovale malaria must also take the drug primaquine. In severe cases, blood transfusions may be needed.

Preventive antimalarial drugs should be taken by all visitors to malarial countries. Doctors should be consulted for up-to-date advice on the choice and dosages of drugs to be taken.

A protozoan disease of humans caused by blood parasites of the species, Plasmodium falciparum, P. vivax, P. ovale or P. malariae and transmitted by anopheline mosquitoes. P. falciparum is most likely to cause death, if untreated,. and can also be a great mimicker in its presentation. Malaria should be suspected in anyone with a fever or who is otherwise unwell and has returned from a malarious area.

A parasitic disease caused by four species of PLASMODIUM: P. falciparum, P. vivax, P. ovale, and P. malariae. Clinically, malaria is characterised by recurrent episodes of high fever, sometimes associated with RIGOR; enlargement of the SPLEEN is common. P. falciparum infection can also be associated with several serious – often fatal – complications (see below): although other species cause chronic disease, death is unusual.

During a bite by the female mosquito, one or more sporozoites – a stage in the life-cycle of the parasite – are injected into the human circulation; these are taken up by the hepatocytes (liver cells). Following division, merozoites (minute particles resulting from the division) are liberated into the bloodstream where they invade red blood cells. These in turn divide, releasing further merozoites. As merozoites are periodically liberated into the bloodstream, they cause the characteristic fevers, rigors, etc.

Malaria occurs in many tropical and subtropical countries; P. falciparum is, however, con?ned very largely to Africa, Asia and South America. Malaria is present in increasingly large areas; in addition, the parasites are developing resistance to various preventative and treatment drugs. The disease constitutes a signi?cant problem for travellers, who must obtain sound advice on chemoprophylaxis before embarking on tropical trips – especially to a rural area where intense transmission can occur. Transmission has also been recorded at airports, and following blood transfusion.

The World Health Organisation (WHO) has listed malaria as one of Europe’s top ten infectious diseases. In 1992, 20,000 cases were reported: this had risen to more than 200,000 by the late 1990s. The resurgence of malaria has been worldwide, in part the result of the development of resistant strains of the disease, and in part because many countries have failed (or been unable) to implement environmental measures to eliminate mosquitoes. Nearly 40 years ago the WHO forecast that by 1980 only four million people would be affected worldwide; now, at the beginning of the 21st century, around 500 million people a year are contracting malaria with about 3,000 people a day dying from the infection – as many as 70 per cent of them children under the age of ?ve, according to WHO ?gures. The apparently steady advance of global warming means that countries with temperate climates may well warm up su?ciently to enable malaria to become established as an ENDEMIC disease. In any case, the great increase in international air travel has exposed many more people to the risk of malaria, and infected individuals may not exhibit symptoms until they are back home. Doctors seeing a recent traveller with unexplained pyrexia and illness should consider the possibility of malarial infection.

Diagnosis is by demonstration of trophozoites – a stage in the parasite’s life-cycle that takes place in red blood cells – in thick/thin blood-?lms of peripheral blood. Serological tests are of value in deciding whether an individual has had a past infection, but are of no value in acute disease.

P. vivax and P. ovale infections cause less severe disease than P. falciparum (see below), although overall there are many clinical similarities; acute complications are unusual, but chronic ANAEMIA is often present. Primaquine is necessary to eliminate the exoerythrocytic cycle in the hepatocyte (liver cell).

P. falciparum Complications of P. falciparum infection include cerebral involvement (see BRAIN – Cerebrum), due to adhesion of immature trophozoites on to the cerebral vascular endothelium; these lead to a high death rate when inadequately treated. Renal involvement (frequently resulting from HAEMOGLOBINURIA), PULMONARY OEDEMA, HYPOTENSION, HYPOGLYCAEMIA, and complications in pregnancy are also important. In complicated disease, HAEMODIALYSIS and exchange TRANSFUSION have been used. No adequate controlled trial using the latter regimen has been carried out, however, and possible bene?ts must be weighed against numerous potential side-effects – for instance, the introduction of a wide range of infections, overload of the circulatory system with infused ?uids, and other complications.

P. malariae usually produces a chronic infection, and chronic renal disease (nephrotic syndrome) is an occasional sequel, especially in tropical Africa.

Gross SPLENOMEGALY (hyper-reactive malarious splenomegaly, or tropical splenomegaly syndrome) can complicate all four human Plasmodium spp. infections. The syndrome responds to long-term malarial chemoprophylaxis. BURKITT’S LYMPHOMA is found in geographical areas where malaria infection is endemic; the EPSTEIN BARR VIRUS is aetiologically involved.

Prophylaxis Malaria specialists in the United Kingdom have produced guidance for residents travelling to endemic areas for short stays. Drug choice takes account of:

risk of exposure to malaria;

extent of drug resistance;

e?cacy of recommended drugs and their side-effects;

criteria relevant to the individual (e.g. age, pregnancy, kidney or liver impairment). Personal protection against being bitten by

mosquitoes is essential. Permethrinimpregnated nets are an e?ective barrier, while skin barrier protection and vaporised insecticides are helpful. Lotions, sprays or roll-on applicators all containing diethyltoluamide (DEET) are safe and work when put on the skin. Their e?ect, however, lasts only for a few hours. Long sleeves and trousers should be worn after dark.

Drug prophylaxis should be started at least a week before travelling into countries where malaria is endemic (two or three weeks in the case of me?oquine). Drug treatment should be continued for at least four weeks after leaving endemic areas. Even if all recommended antimalarial programmes are followed, it is possible that malaria may occur any time up to three months afterwards. Medical advice should be sought if any illness develops. Chloroquine can be used as a prophylactic drug where the risk of resistant falciparum malaria is low; otherwise, me?oquine or proguanil hydrochloride should be used. Travellers to malaria-infested areas should seek expert advice on appropriate prophylactic treatment well before departing.

Treatment Various chemoprophylactic regimes are widely used. Those commmonly prescribed include: chloroquine + paludrine, me?oquine, and Maloprim (trimethoprim + dapsone); Fansidar (trimethoprim + sulphamethoxazole) has been shown to have signi?cant side-effects, especially when used in conjunction with chloroquine, and is now rarely used. No chemotherapeutic regimen is totally e?ective, so other preventive measures are again being used. These include people avoiding mosquito bites, covering exposed areas of the body between dusk and dawn, and using mosquito repellents.

Chemotherapy was for many years dominated by the synthetic agent chloroquine. However, with the widespread emergence of chloroquine-resistance, quinine is again being widely used. It is given intravenously in severe infections; the oral route is used subsequently and in minor cases. Other agents currently in use include me?oquine, halofantrine, doxycycline, and the artemesinin alkaloids (‘qinghaosu’).

Researchers are working on vaccines against malaria.

(ague, marsh fever, periodic fever, paludism) n. an infectious disease due to the presence of parasitic protozoa of the genus *Plasmodium (P. falciparum, P. malariae, P. ovale, or P. vivax) within the red blood cells. The disease is transmitted by the Anopheles mosquito and is confined mainly to tropical and subtropical areas.

Parasites in the blood of an infected person are taken into the stomach of the mosquito as it feeds. Here they multiply and then invade the salivary glands. When the mosquito bites an individual, parasites are injected into the bloodstream and migrate to the liver and other organs, where they multiply. After an incubation period varying from 12 days (P. falciparum) to 10 months (some varieties of P. vivax), parasites return to the bloodstream and invade the red blood cells. Rapid multiplication of the parasites results in destruction of the red cells and the release of more parasites capable of infecting other red cells. This causes a short bout of shivering, fever, and sweating, and the loss of healthy red cells results in anaemia. When the next batch of parasites is released symptoms reappear. The interval between fever attacks varies in different types of malaria: in quartan malaria (or fever), caused by P. malariae, it is three days; in tertian malaria (P. ovale or P. vivax) it is two days (these two types are known as benign malarias). In malignant (or falciparum) malaria (caused by P. falciparum) – the most severe kind – the interval between attacks varies from a few hours to two days (see also blackwater fever). Preventive and curative treatment includes such drugs as *chloroquine, *proguanil, *mefloquine, and *pyrimethamine.