Malaria is one of the most important and dangerous tropical infectious diseases. Travelers to tropical countries are particularly at risk from this disease. Malaria should be considered with any fever during or up to a year after a stay in the tropics. Before you travel, get detailed advice about malaria risks from a doctor or from the tropical institute in your city.
What is malaria?
According to Foodanddrinkjournal, Malaria is one of the most important tropical diseases worldwide and is notifiable. It occurs mainly in the tropics and subtropics. It is now assumed that almost half of the world’s population lives in malaria areas. Malaria is transmitted by the bite of the female Anopheles mosquito infected with a malaria pathogen. An infection from person to person is almost impossible.
Malaria can be caused by four different types of pathogens. Of the three forms of malaria currently in existence, malaria tropica is the most dangerous. While tertian malaria and quartana malaria are usually benign, tropical malaria often leads to life-threatening complications.
Despite large-scale control programs, the spread of malaria has increased in recent years. In addition, the pathogens that cause malaria tropica are less sensitive to the usual drugs in large parts of southern, southeastern and eastern Asia, in sub-Saharan Africa and in tropical South America; they have developed resistance. The preventive measures must therefore be tailored to the regional risks. They can vary depending on the season, they also vary from country to country and depend on the type of trip (hotel vacation in big cities vs. safari expedition inland).
Causes
Malaria is caused by a unicellular blood parasite called Plasmodium, which infects red blood cells. These malaria pathogens are transmitted locally by certain mosquitoes (Anopheles mosquitoes).
There they multiply and cause the blood cells to burst after their development is complete. The released pathogens look for new blood cells and the cycle begins again.
Strong fever episodes are typical for all forms of malaria. They occur about every three days in tertian malaria and every four days in quartana malaria.
The fever episodes in the case of malaria tropica are repeated at irregular intervals.
Symptoms, Ailments & 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 at six days to three weeks. Malaria tertiana or malaria quartana involve incubation periods of a few days and sometimes months or years.
The first symptoms correspond to those of a severe flu infection. This leads to a high fever of over 38.5 degrees Celsius. In addition, there is a general feeling of illness with headaches, exhaustion and weakness. Those affected often suffer from chills and profuse sweating. It comes to nausea, muscle pain and circulatory problems. Diarrhea and general intestinal problems occasionally occur.
Symptoms rarely occur together and vary in severity. The fever occurs periodically in the latter types of malaria. In the case of malaria tropica, on the other hand, there are irregular bouts of fever. Malaria tropica rarely causes other symptoms without fever or malaise. Instead, there are circulatory problems (especially microcirculatory disorders), confusion and fainting spells due to the circulatory problems.
Overall, however, fever and a general feeling of illness are the main symptoms of malaria and should be immediately considered in the event of a possible risk of this disease. It is true that even up to two years after staying in a tropical region, the symptoms are considered indications of a malaria infection.
course of the disease
The incubation period for malaria is between seven and 40 days, depending on the type of pathogen. The fever attacks occur quickly in quartana malaria and suddenly in the other two forms of malaria. Malaria tertiana and malaria quartana are cured after 12 to 20 fever attacks. If left untreated, tropical malaria is often fatal. 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 problems. Those affected do not always associate fever, headache, nausea or vomiting with their trip to malarial regions. Especially not if some time has passed between the trip and the appearance of the symptoms. It is therefore important to know that it can take up to a year between the onset of the disease and the onset of symptoms.
Complications
Due to a malaria infection there is a risk of various complications. These can sometimes have serious consequences. The risk of complications is highest for malaria tropica. Almost all deaths are caused by them.
A typical consequence of malaria tropica is impaired consciousness, which can even cause the patient to die. It is not uncommon for there to be an abrupt change in consciousness without any warning. Cerebral malaria also carries the risk of neurological complications such as seizures and paralysis. Pregnant women and children are often at risk of low blood sugar (hypoglycemia). This sometimes leads to a fall into a coma.
Because the spleen enlarges as part of malaria, a rupture of the organ is a possibility. Severe infections also show anemia (low blood count). Babies and small children are particularly affected. In most cases, there is hemolytic anemia, in the course of which the red blood cells are destroyed.
Another conceivable complication is hemoglobinuria. The hemoglobin level in the blood rises and the iron-containing protein complex hemoglobin is excreted via the kidneys, which is noticeable by a dark urine colour. Furthermore, acute kidney failure is possible due to circulatory disorders. Lung complications occur in about ten percent of all malaria patients. These range from mild symptoms to pulmonary edema (water lung).
When should you go to the doctor?
If flu-like symptoms occur that increase in scope and intensity within a short period of time, a doctor should be consulted. A doctor should be consulted in the event of fever, headaches and body aches as well as a significant decrease in performance. If the symptoms occur during or after a stay in tropical or subtropical regions, a doctor must be consulted immediately. This is especially true if the bite of a mosquito is noticed on the body. Since malaria can be fatal in severe cases, medical care is needed as soon as possible. If the fever increases further, chills or disturbances of consciousness, a doctor must be consulted.
A special feature of malaria is a changing course of the fever curve. It is therefore always necessary to check whether an emergency service needs to be alerted in the event of an increasing deterioration in health. A doctor should be consulted if seizures, digestive disorders, abnormalities when going to the toilet or pain in the kidneys occur. Those affected are at risk of organ failure if they do not undergo treatment. Diarrhea, circulatory disorders, dizziness and symptoms of paralysis are further warning signs of the organism. A doctor’s visit is necessary so that the cause can be clarified. Ravenous hunger, inner weakness, an acute feeling of illness as well as irritability must be examined by a doctor.
Treatment & Therapy
Malaria can be diagnosed very quickly and easily on the basis of a blood test, since the pathogens can be seen well 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 using drugs 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 hospitalized because of the severity of the disease and the possible complications.
The chances of recovery for malaria tertiana and quartana are good and if malaria tropica is detected early, the mortality rate in Germany is currently less than one percent.
In order to prevent contracting malaria, travelers should first find out whether their travel destination is in a malaria area. The most common malaria infections occur in Africa.
From sub-Saharan Africa to northern South Africa, the majority of mosquitoes are infected with Plasmodium. 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 possible. Protective measures are protection against mosquito bites and taking tablets for malaria prophylaxis.
The drugs used to prevent malaria largely protect against severe malaria disease. Nevertheless, even with prophylaxis, malaria cannot be completely ruled out.
Outlook & Forecast
If left untreated, the tropical disease leads to the premature death of those affected. The complications of malaria are very pronounced without medical care. Organic disorders, loss of consciousness, seizures and paralysis occur. The affected person is no longer able to regulate his or her lifestyle independently. Ultimately, death occurs from multiple organ failure.
Nevertheless, the disease can be cured with today’s medical possibilities in our regions. The earlier medical treatment is initiated, the better the future prospects. If the diagnosis is made quickly and treatment is started quickly, the prognosis for malaria is good. It is therefore important to pay attention to where the person concerned is currently staying. Medical care in an African area is less well structured than in Europe. For this reason, adequate precautions should be taken before traveling to a malaria area.
In addition, a doctor must be consulted on site at the first sign of the disease in order to make a prognosis. Medical care must be taken immediately to prevent the spread of the pathogens. In a poor state of health, the transport of the person concerned from Africa to their home area cannot always be guaranteed. These development opportunities must be planned and taken into account before the start of a trip.
Prevention
Practical prevention against malaria includes the above-mentioned malaria prophylaxis and active protection against mosquito bites. The fewer bites, the lower the risk of infection. So what can you do specifically in the holiday country?:
- Sleep in rooms with air conditioning or secure windows and doors with mosquito nets.
- Spray the bedrooms with insect spray before going to sleep or use socket vaporizers or incense coils. Be careful in dormitories with small children.
- Sleep under mosquito nets at night (important for infants and young children). The mesh fabric must not have any holes, the free seams should be pulled under the mattress.
- Malaria mosquitoes bite mainly at dusk and at night. When outdoors, wear light-colored clothing that is not tight-fitting and covers the entire body (long pants, long shirts, socks, shoes).
- Rub unclothed skin (e.g. hands, feet and face) with mosquito repellent lotions. Avoid large-scale application in children.
Aftercare
Infectious diseases such as malaria often need good follow-up care once they have healed. It is aimed at strengthening the immune system and regenerating those affected, and above all with the aim of avoiding further complications. This requires close checks by the doctor treating you.
In the area of internal infections, which mainly affect the gastrointestinal area or the respiratory tract, the body’s defenses can be strengthened by a number of measures that are in the hands of the patient. This includes eating a balanced diet, drinking enough water and getting enough sleep. It is also important not to start sporting activities too early if the person concerned is not fit enough for it. This should be done in consultation with the doctor.
The function of the intestine is often impaired by medication given as part of the infection. This applies in particular to the administration of antibiotics. A non-stressful diet helps with follow-up care. Yoghurt 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 in order to prevent a relapse or further problems.
You can do that yourself
Medical treatment is always required for malaria. 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 a lot. The diet during a malaria fever should consist of light foods such as chicken broth, rusks or soft-boiled rice. After the illness has been overcome, fruit 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 a tea and relieves the typical symptoms of malaria fever. The use of this remedy should be discussed with a doctor beforehand.
If no medical help can be found, self-treatment is also possible as a temporary solution. When traveling to malaria areas, appropriate malaria emergency medication should therefore be carried with you. However, in some cases it is essential to consult a doctor. In the case of complicated malaria, for example, a hospital stay is necessary in any case, since functional disorders of the lungs or heart can occur under certain circumstances. In order to be able to return to everyday life early, bed rest and compliance with medical recommendations apply.