Paludisme

It cannot be transmitted from one person to another without the presence of a mosquito, except in the case of an infected blood transfusion or from mother to foetus through the placenta.

Mosquitoes generally bite during hours of low light: dusk, during the night and dawn. They live in urban as well as rural areas. During the rainy season there are more mosquitoes, therefore the risk of being bitten and contracting the disease is higher.

Malaria was eradicated in Europe over 50 years ago, and so cases seen are due to travel to endemic countries for reasons such as immigration, tourism, and business. The majority of cases are seen in immigrants after having returned to their native countries to visit family. This occurs due to the fact that although they should be taking the same measures as tourists, more often than not they do not. 95% of cases are imported from Africa, 3% from Asia and 1% from South America.

Symptoms

The incubation period varies from one week to over a month. As such, symptoms may present themselves shortly after entering an endemic area or several months after having returned from one.

Symptoms generally include high fever, chills, headache, sweating, and generalised joint and muscle pain. Some patients experience symptoms every 2-3 days and others experience a persistent fever. If the disease is not diagnosed and treated accordingly it can develop rapidly and become life-threatening. Alterations in consciousness, convulsions, coma, difficulty breathing and haemorrhaging are signs of a bad prognosis. Requires immediate medical attention.

It is important to keep in mind that any child with a fever and history of travel to an endemic country should be suspected of having malaria unless proved otherwise.

Who is affected by the condition?

Malaria is common in tropical and subtropical areas (both sides of the equator). The countries in which malaria is endemic have been grouped into 4 regions: Africa, America, Asia and the Pacific, and the Middle East and Eurasia. More than 90% of the malaria cases in Africa are caused by Plasmodium falciparum, the most serious and deadly. America and the Middle East and Eurasia are dominated by Plasmodium vivax. A much more common form of malaria with a lower mortality rate.

In Asia and the Pacific, infections are a mix of Pl. vivax and Pl. falciparum with a moderate number of cases of mortality. Generally speaking, the areas with the highest risk for travellers are Sub-Saharan Africa, South East Asia, Papua New Guinea and the Indian subcontinent.

Diagnosis

A diagnosis is reached through detection of the parasite either in the red blood cells, or through processes of molecular biology.

Standard treatment

Early diagnosis is crucial. The pharmaceuticals used in Europe differ from those used in endemic countries in places like Africa. Depending on the severity, certain intravenous drugs may be required immediately. Severe malaria is usually treated in Intensive Care Units in anticipation of serious complications.

Standard tests

In a case of suspected malaria, blood testing is crucial. If there are alterations in any organs, individual exploration of said organs is necessary; for example, brain image scanning in the event of nervous system impairment, which is very common in severe cases of malaria.

Prevention 

With malaria, prevention is crucial. The use of antimalarial medication before travelling to endemic countries is vital, as failure to do so means the probability of contracting the disease is very high due to the fact that it is almost impossible to avoid mosquito bites even by using insect repellent and mosquito nets.

Antimalarial medication, to be prescribed by a doctor in each case, should be started before beginning a trip up until a few days after returning.