Introduction

Malaria is an infectious disease caused by a parasite, Plasmodium, which infects red blood cells.
Malaria is characterized by cycles of chills, fever, pain, and sweating. Historical records suggest
malaria has infected humans since the beginning of mankind. Out of the four common species
that causes malaria, the most severe type is Plasmodium falciparum malaria. It can be lifethreatening.
The other three common species of malaria (P. vivax, P. malariae, and P. ovale) are generally
less serious and are usually not life-threatening. It is possible to be infected with more than one
species of Plasmodium at the same time.
Currently, about 2 million deaths per year worldwide are due to Plasmodium infections. The
majority occurs in children under 5 years of age in sub-Saharan African countries
(http://www.mayoclinic.com). There are about 400 million new cases per year worldwide. Most
people diagnosed in the U.S. obtained their infection outside of the country, usually while living
or traveling through an area where malaria is endemic.
While the disease is uncommon in temperate climates, malaria is still prevalent in tropical and
subtropical countries. World health officials are trying to reduce the incidence of malaria by
distributing bed nets to help protect people from mosquito bites as they sleep. A vaccine to
prevent malaria is currently under development.

If you're traveling to locations where malaria is common, take preventive medicine before,
during and after your trip. Many malaria parasites are now immune to the most common drugs
used to treat the disease.
How is malaria transmitted?

The life cycle of the malaria parasite (Plasmodium) is complicated and involves two hosts,
humans and Anopheles mosquitoes. The disease is transmitted to humans when an infected
Anopheles mosquito bites a person and injects the malaria parasites (sporozoites) into the blood.
This is shown in Figure 1, where the illustration shows a mosquito taking a blood meal (circle
label 1 in Figure 1).
Sporozoites travel through the bloodstream to the liver, mature, and eventually infect the human
red blood cells. While in red blood cells, the parasites again develop until a mosquito takes a
blood meal from an infected human and ingests human red blood cells containing the parasites.
Then the parasites reach the Anopheles mosquito's stomach and eventually invade the mosquito
salivary glands. When an Anopheles mosquito bites a human, these sporozoites complete and
repeat the complex Plasmodium life cycle. P. ovale and P. vivax can further complicate the cycle
by producing dormant stages (hypnozoites) that may not develop for weeks to years.

Figure 1: CDC illustration of the life cycles of malaria parasites,

Plasmodium spp. SOURCE: CDC

Mosquito transmission cycle

Uninfected mosquito. A mosquito becomes infected by feeding on a person who has

malaria.

Transmission of parasite. If you're the next person this mosquito bites, it can transmit
malaria parasites to you.

In the liver. The parasites then travel to your liver where they can lie dormant for as
long as a year.

Into the bloodstream. When the parasites mature, they leave the liver and infect your red
blood cells. This is when people typically develop malaria symptoms.

On to the next person. If an uninfected mosquito bites you at this point in the cycle, it will
become infected with your malaria parasites and can spread them to the next person it
bites.

Other modes of transmission

Because the parasites that cause malaria affect red blood cells, people can also catch malaria
from exposures to infected blood, including:

From mother to unborn child

Through blood transfusions

By sharing needles used to inject drugs

Symptoms:
A malaria infection is generally characterized by recurrent attacks with the following signs and
symptoms:
Moderate to severe shaking chills
High fever
Profuse sweating as body temperature falls
Other signs and symptoms may include:

Headache

Nausea

Vomiting

Diarrhea

Malaria signs and symptoms typically begin within a few weeks after a bite from an infected
mosquito. However, some types of malaria parasites can lie dormant in your body for months, or
even years.
Tests and diagnosis
Blood tests can help tailor treatment by determining:
Whether you have malaria
Which type of malaria parasite is causing your symptoms
If your infection is caused by a parasite resistant to certain drugs
Whether the disease is affecting any of your vital organs
Meanwhile, some blood tests can take several days to complete, while others can produce results
in less than 15 minutes.
Treatments and drugs
The types of drugs and the length of treatment will vary, depending on:
Which type of malaria parasite you have
The severity of your symptoms
Your age
Whether you're pregnant

Medications
The most common antimalarial drugs include:

Chloroquine (Aralen)

Quinine sulfate (Qualaquin)

Hydroxychloroquine (Plaquenil)

Mefloquine

Combination of atovaquone and proguanil (Malarone)

The history of antimalarial medicine has been marked by a constant struggle between evolving
drug-resistant parasites and the search for new drug formulations. In many parts of the world, for
instance, resistance to chloroquine has rendered the drug ineffective.
When can you see a doctor?
Talk to your doctor if you experience a high fever while living in or after traveling to a high-risk
malaria region. The parasites that cause malaria can lie dormant in your body for months. If you
have severe symptoms, seek emergency medical attention.

Prevention
If you're going to be traveling to a location where malaria is common, talk to your doctor a few
months ahead of time about drugs you can take before, during and after your trip that can
help protect you from malaria parasites.

In general, the drugs taken to prevent malaria are the same drugs used to treat the disease. Your
doctor needs to know where you'll be traveling so that he or she can prescribe the drug that will
work best on the type of malaria parasite most commonly found in that region.

No vaccine yet
Scientists around the world are trying to develop a safe and effective vaccine for malaria. As of
yet, however, there is still no malaria vaccine approved for human use.

Reducing exposure to mosquitoes

In countries where malaria is common, prevention also involves keeping mosquitoes away from
humans. Strategies include:

Spraying your home. Treating your home's walls with insecticide can help kill adult
mosquitoes that come inside.

Sleeping under a net. Bed nets, particularly those treated with insecticide, are especially
recommended for pregnant women and young children.

Covering your skin. During active mosquito times, usually from dusk to dawn, wear
pants and long-sleeved shirts.

Spraying clothing and skin. Sprays containing permethrin are safe to use on clothing,
while sprays containing DEET can be used on skin

References:
http://www.mayoclinic.com/health/malaria/DS00475
http://www.medicinenet.com/chronic_cough/article.htm