Malaria

Jeffrey D. Band Epidemiology

Pathophysiology

ClinicalFeatures Diagnosis Treatment Prevention Chapter, References

With the increase in international travel and the continued shift of travel to tropical locales, it is not surprising that physicians are seeing more patients with infectious diseases acquired in the tropics. Malaria, a protozoan disease transmitted by the bite of the Anopheles mosquito, remains one of the most significant of these. Four species of the genus Plasmodium infect humans: P. vivax, P. ovale, P. malariae, and P. falciparum. Annually, over 250 million persons develop malaria, and more than 2.5 million persons die.1 The incidence of malaria has been increasing in recent years despite worldwide aggressive attempts at control. Not only is the mosquito vector becoming less susceptible to a variety of insecticides, but Plasmodium falciparum—the parasite responsible for the most deadly form of malaria—is becoming increasingly resistant to antimalarial medications.

Malaria, especially disease due to P. falciparum, represents a medical emergency in any nonimmune host. Its early manifestations are largely nonspecific and can mimic other infectious diseases. Failure to diagnose infection rapidly can be disastrous. Likewise, failure to use specific antimalarial agents to which the individual strain is susceptible can result in early death. A diagnosis of malaria must be considered in any person returning from the tropics with an unexplained febrile illness. Questions regarding recent travel should become routine in emergency departments.

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