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Malaria (intermittent fever) What is malaria?

Malaria (intermittent fever, malaria) is a tropical disease. Cause of malaria are tiny parasites: Plasmodium. They are transmitted by Anopheles mosquitoes. More on symptoms, diagnosis and treatment

 

What is malaria?


Malaria is an infectious disease that is widespread in the tropics and subtropics. Malaria occurs in over one hundred countries, mainly in Africa. Worldwide affected are about 300 to 500 million people. Many people die, most notably children.

What are the symptoms?



Malaria usually causes flu-like symptoms such as fever (rarely with typical rhythm, hence the old term intermittent fever), headache , body aches and severe malaise, often diarrhea and vomiting . For details refer to the chapter symptoms .

Important: If you suspect it might be due to malaria, then seek medical attention immediately!

Instruct him out that they were abroad. Malaria can also show even months later - and occur despite correct preventive medication.



There are three major types of malaria:



1. falciparum malaria (pathogen: Plasmodium falciparum)

2. vivax malaria (pathogen: Plasmodium vivax and ovale)

3. quartan malaria (pathogen: Plasmodium malariae)


Especially malaria can cause severe organ complications and is no therapy in non-immune people - so tourists - rapidly fatal. Malaria tertian and quartan malaria run mostly mild and over a longer period. Tertian malaria can also be severe in intensity or death, particularly in elderly or in people with pre-existing conditions. Only in quartan malaria are even after many years (up to 40 years) relapses possible.
What is the treatment for malaria?

Malaria is treated with medication. Various drugs are available, which are selected depending on the shape and resistance of the malaria plasmodium. Examples are mefloquine, lumefantrine, atovaquone, chloroquine and formerly also often nowadays Artemisia-descendants. The drugs are partially used also for prevention. More on this in Chapters therapy and malaria prophylaxis .

 Important note: This article provides only general information and may not be used for self-diagnosis or treatment. He can not replace a doctor's visit. The answer individual questions by our experts is not possible.

Malaria Causes

Cause of malaria are protozoan parasites (Plasmodium). They infect and damage blood cells and internal organs. Will transmit this malaria parasite by Anopheles mosquito






Cause of malaria is an infection with Plasmodium. These are a few micrometers large protozoa. You go through a life cycle in which they form different shapes and multiply simultaneously. The host serves the plasmodium both the man and the Anopheles mosquito. In the mosquito the plasmodium live in the intestines and in the salivary glands. When a mosquito bite, they are transferred to humans. Here the malaria parasite infect initially the liver and eventually to a large extent, the red blood cells ( erythrocytes ). Fever and other symptoms are the result.

Anopheles mosquitoes are found in the tropics and subtropics, but also in Europe and even in the Arctic. You are in rural areas, but also as common in the town, and especially during the rainy season. As the climate warms, the Anopheles mosquitoes and malaria with them can continue to spread. The plasmodia need consistently 15 degrees Celsius for their propagation.

In Germany, Malaria is largely introduced by tropical travelers, especially from West Africa, Kenya, Papua New Guinea and India. Around 600 cases there are per year, mainly malaria. 

Malaria: How to contagion?



In some regions - Malaria-risk areas - the mosquitoes and people are heavily infested by Plasmodium. The plasmodium live in the gut of the mosquito and multiply there sexually. Sticht an infected female mosquito one people, the plasmodia pass through the mosquito's saliva into the human blood.

Rarely malaria is transmitted by contaminated needles (syringes) or direct blood transfusion. Also an infection from mother to the fetus is possible.

In some cases reach Anopheles mosquitoes in an airplane, traveling along and then infect, for example, people at the arrival airport or in its vicinity (the so-called airport malaria or Airport malaria). The airport is located in a region where malaria is not normally found, and had the sick person does not leave the country, it is not easy to quickly come to the correct diagnosis.

Malaria: What happens in the body?



First, the plasmodia pass from the mosquito's saliva in the blood of infected persons to the liver. At this stage the pathogens are called sporozoites. In the liver, they multiply and mature into schizonts zoom that contain multiple merozoites. Some sporozoites remain as calm forms (Hypnozoiten, only in tertian malaria) in the liver back.

The released from the schizont merozoite inundate the blood. They infect the red blood cells (erythrocytes). In them the pathogen ripen further and there are trophozoites that ripen again to schizonts in which merozoites are included. The red blood cells break down and thereby re-released merozoites infect new cells, so the cycle repeats.

The resulting cellular debris cause the body releases chemical messengers (cytokines). This leads to fever . If the pathogen intermittently released into the blood, because they follow a synchronous development cycle, the typical relapsing malaria occurs: The temperature curve rises periodically and falls again (see chapter Symptoms ).

It often occurs through the alteration and destruction of blood cells to an anemia (hemolytic anemia). The red blood cells are sometimes changed by the plasmodia infestation so as to clog the fine vessels (capillaries) in the tissue. Then the blood flow is interrupted and it is possible tissue damage. Spleen and liver build the infected red blood cells from reinforced. The institutions may therefore significantly swell.

Malaria: Who is at risk?



Malaria affects all age groups, but the symptoms are usually very strong and complications more common in children.

Against malaria is after a all-nighter disease not a complete defense protection (immunity). Also, no preventive vaccine is available. But in some people in high-risk areas constitutes a "partial immunity" from. Although they have plasmodia in the blood, but it does not come to the outbreak of malaria. The safe protection is not in this case, however. In malarial areas also an inherited anemia is often the sickle-cell anemia . The red blood cells are formed partially elongated. This form of anemia can protect against severe malaria disease.

Who has no immunity to malaria - such as a tourist from Europe - has a very high risk of severe malaria disease. 


Malaria: Symptoms

Malaria often caused ambiguous symptoms such as fever, headache and body aches, diarrhea and vomiting. If in doubt, seek medical advice immediately!



After infection with malaria takes a few days until the first symptoms appear. This incubation period is depending on malaria, between one to two weeks, but can be as many weeks. Even longer incubation times (up to 18 months or many years in quartan malaria) are still possible - if the person concerned has been infected, for example, while he has taken drugs for malaria prophylaxis (see Chapter malaria prophylaxis ).

When it comes to malaria fever and malaise. Sufferers complain of headache and body aches, and sometimes nausea , vomiting and diarrhea . It can jaundice ( jaundice occur). The symptoms often resemble the flu or a harmless flu - are therefore easily misinterpreted.

Important: Occurs after a stay in a malaria-risk area fever, seek medical attention immediately!

Caution: Infection is sometimes even without stay abroad and outside of known risk areas possible - for example, in airport malaria (more on this in Chapter causes ).

A malaria proceeds without timely therapy usually difficult, leading to organ damage or even ends fatally. Are pregnant women infected with malaria, as well as the unborn child is in danger.
Falciparum malaria: The course of the fever is often irregular. In some cases of malaria there are complications such as an infestation of the nervous system (cerebral malaria). They embark on symptoms such as seizures and impaired consciousness. Also anemia (hemolytic anemia) are blood clots in the small blood vessels and possible. It makes, for example, with performance weakness and shortness of breath. The malaria can also cause a shock with circulatory failure and fatal organ failure. In falciparum malaria can be fatal.
Vivax malaria: first the fever is a nonspecific course, until it sometimes develops into an intermittent fever. In this case, occurs at intervals of 48 hours chills and the body temperature rises to about 40 degrees Celsius. After a few hours the fever drops suddenly, where the person is sweating heavily. But the course of the fever does not need to comply with this classic pattern. Usually, by the vivax malaria is no immediate danger.

Quartan malaria: There can likewise be intermittent fever, the fever attacks occur at a rate of 72 hours. The quartan malaria is relatively rare. You can as a complication to kidney damage ( glomerulonephritis lead) and rarely for ruptured spleen. Several years after infection relapses are possible.

 

Malaria: Diagnostics



Malaria is detectable by blood tests. The medical history and physical examination are important for diagnosis and treatment

Fever for a tropical vacation? Then it says: No time to lose, but seek medical attention immediately! A malaria disease can be rapidly fatal without treatment.

In cases of suspected malaria, the physician asked about the patient's symptoms (see chapter Symptoms ). He also asks for stays in tropical countries (travel history). If the doctor initially not remember the patient should inform him necessarily mean that he recently in the tropics - has stopped - and thus also in malaria areas.



Most occur the first symptoms a few weeks after such foreign travel. Sometimes, however, there are also many months between the tropical vacation and the first symptoms. A malaria infection, in rare cases, even without coming abroad (eg airport malaria, see section causes).

Revealing in malaria: The blood test



The aim of the malaria diagnosis is the detection of pathogens, the plasmodium (see causes ). The doctor takes a blood sample to and examined either himself - or he sends them to the diagnosis of a tropical medicine institute.

In a so-called smear the blood cells are stained. Under the microscope, the malaria parasite can be seen inside the red blood cells. Partially even more blood cells are altered (malaria pigment in granulocytes ). Because in malaria plasmodium often just in the blood can be found, the blood sample prior to the diagnosis must be enriched on a slide. This investigation method is called "thick smear".

Although no plasmodium in the blood can be detected, while malaria may be. Then can bring at a later date clarity renewed blood samples. If it is clear to which plasmodium species is, the treatment is tailored to the type of malaria (see treatment ).

There are rapid tests for malaria . Unfortunately, they have the disadvantage that they sometimes provide a discreet result, although an infection. For a "self-diagnosis" they therefore hardly suitable. Doctors can also use but perhaps to rapidly arrive at a diagnosis.

Further investigations in cases of suspected malaria



To estimate the severity of malarial disease, is a thorough physical examination important. Thus, fever , blood pressure and pulse measured and determines the respiratory rate. The doctor checks the state of consciousness of the person concerned. Sometimes the spleen and liver enlarged palpable.

In an electrocardiography (ECG) heart flows are derived and the function of the heart examined. Other blood tests show how strongly the metabolism and organs are affected by malaria. So the number of can platelets reduces its (thrombocytopenia). In severe cases, blood coagulation is disturbed.

There is a duty to notify arose for malaria - which means that the laboratory that produces evidence to the malaria parasite must report the illness without stating the patient's name to the Robert Koch Institute (RKI).

Malaria Therapy



Malaria is treated with medication. Which active compounds are suitable for the therapy depends on the type of malaria. Rapid treatment is important



There is suspicion of a malaria infection , the doctor will instruct the patient usually immediately to a hospital - preferably one who has experience with the treatment of tropical diseases has (tropical medical facility). Alternatively, doctors can also obtain the supportive advice of their expert colleagues.

Malaria is treated with medication. Which case are used depends on the type of malaria, the severity of the disease and the region in which it was purchased. It is important that the treatment is rapid. A malaria can fatal if left untreated within a few days.



In vivax malaria and quartan malaria the doctor ordered mostly chloroquine. It is administered as a tablet. In vivax malaria primaquine is recommended as a final treatment. In some cases, the plasmodia are resistant to chloroquine. Then another drug must be chosen.

For the treatment of falciparum malaria earlier chloroquine and sulfadoxine-pyrimethamine was added. However, many plasmodium already are resistant to these drugs. As modern alternatives combination products come with atovaquone, proguanil and lumefantrine, respectively with so-called Artemisia derivatives (artemisinin / artesunate) in question. Mefloquine is today and used in special cases only restrained because of its side effects. Relatively new is a combination of artemisinin with piperaquine. With damage to the nervous system (cerebral malaria) quinine and doxycycline are administered or artesunate, which has not yet been officially approved in Germany, but is used more and more because of its good and quick efficacy.

In addition, malaria symptoms are treated. At high fever help as Wadenwickel or antipyretic drugs such as acetaminophen, to reduce body temperature.

In severe cases, may have blood transfusions , intensive medical care or a hemodialysis (dialysis) required. 

Malaria prophylaxis



Mosquito nets, mosquito nets, anti-mosquito agents - mosquito repellent is the most important measure to protect themselves against malaria infection. Whether a drug malaria prophylaxis (chemoprophylaxis) is useful, should be discussed individually with the doctor


Anyone planning a trip to the tropics or subtropics, should find out in advance thoroughly about possible health hazards in their holiday destination. Are helpful, for example, online information of the Foreign Office of the Federal Republic of Germany (see link at the bottom of the page) or offers of tropical institutions. Information on infectious diseases are available on the website of the Robert Koch Institute. The family doctor or the health department to advise individually. Pregnant or toddlers should not in malarial areas if possible traveling .

Very important: mosquito repellent

Who in a malaria travels -Risikogebiet, should pay attention to a comprehensive mosquito repellent. Anopheles mosquitoes bite mainly at dusk and at night. At these times you should therefore stay as little as possible outdoors. A good mechanical defenses provide mosquito nets and mosquito nets. It is important to use fine mesh nets and they also sprayed with suitable anti-mosquito agents or impregnate. In addition, help incense and insecticides to repel or kill mosquitoes. Long-sleeved clothing fortifies against insect bites and stings. On bare skin called repellents can be applied. They contain ingredients that repel mosquitoes. The application time is limited. When selecting suitable preparations the pharmacy can help.

Malaria prophylaxis with drugs

Depending on the travel area can be useful to a malaria-prevention medication (chemoprophylaxis). What kind of prevention in the individual case seems advisable know, for example the specially trained family physician or a specialist in tropical medicine. It is important to strictly assume the active ingredients according to the instructions and do not drop them off at an early stage, as this can lead to delayed onset of a possible malaria infection otherwise. Important to know: A chemoprophylaxis protects not one hundred percent against a malaria infection! This is not also about vaccination. A malaria vaccine is indeed in development, but is not yet widely available.

In exceptional cases possible: emergency self-treatment

In special cases, it may make sense to take so-called stand-by means of emergency self-treatment along for the ride. They should be strictly taken only as directed, if during the stay in a malaria area fever occurs, and no medical care is available. If and when such a stand-by funds are eligible, should be carefully discussed in advance with the advisory doctor.

After returning: Pay attention to symptoms!



If some time after the travel complaints like fever on, immediately a doctor should be consulted. Important: Be sure to past (tropical) travel point! Malaria can sometimes still occur many months after a trip abroad.

Within the framework of international projects malaria has already been partially curbed. The draining of marshes or the use of insecticides (insecticides) are ways to reduce the number of Anopheles mosquitoes in risk areas. A selective treatment of the infected population often fails to economic problems - in many areas malaria prevails poverty. 

Malaria: Advisory expert


Dr. Hinrich Sudeck's internist and specialist in tropical medicine. After completing his training in Hamburg and Liverpool, he from 1990 to 2006 On Bernhard Nocht Institute in Hamburg. From 2002 to 2006 he was senior physician there. From 2006 to 2014 he was senior physician at the Military Hospital in Hamburg and Head of the Department of Tropical Medicine of the Federal Armed Forces at the Bernhard Nocht Institute. Dr. Sudeck worked for several years in West Africa. He is the World Health Organization expert on the management of viral haemorrhagic fevers and was for many years secretary of the German Society for Tropical Medicine and International Health (DTG). Dr. Sudeck specializes in rare and imported diseases. It was the end of 2014 five weeks in Liberia as part of the fight against Ebola. He is now a freelance in the field of tropical medicine worked.
Sources:
German Society for Tropical Medicine and International Health (DTG). Online: www.dtg.org (accessed on 12.02.2014)
DTG: Malaria recommendations. Online: http://www.dtg.org/malaria.html (accessed on 02.12.2014)
Robert Koch Institute: RKI guide for physicians: malaria. Online: http://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Malaria.html#doc2392924bodyText9 (accessed on 02.12.2014)
Classen, Diehl, Kochsieck: Internal Medicine, Elsevier, Urban & Fischer, 6th edition of 2009.

Important note:
This article provides only general information and may not be used for self-diagnosis or treatment. He can not replace a doctor's visit. The answer individual questions by our experts is not possible.