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Malaria (common fever)

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Malaria, also known as intermittent fever or common fever in German, is caused by parasites (so-called plasmodia). The carrier is the female Anopheles mosquito. It stings mainly in the evening at dusk.

© iStock
If an infected anopheles mosquito bites a person, it can transmit the parasites. For the plasmodia, humans represent an intermediate host in their life cycle. First of all, after infection, they enter the liver. There they mature and divide. Depending on the type of plasmodia, some remain in the liver cell and are then responsible for the recurring attacks of malaria.

The parasites infect the red blood cells. After ripening, the blood cells burst, releasing toxins that trigger an inflammatory response. The causative agent of the most dangerous form of malaria, malaria tropica, can also damage the blood vessels. The result is dangerous circulatory disorders.

Depending on the pathogen transmitted, a distinction is made between three main forms of malaria. They each have a specific fever rhythm. However, this rhythm is not a reliable identifier - it can occasionally be missing in all forms. A distinction is made between the following forms of malaria
  • The Malaria tertianacaused by the pathogens Plasmodium vivax or ovale, is a mild form of the disease that can relapse years later.
  • The Quartana malaria is caused by Plasmodium malariae. It is also generally milder, but it can lead to kidney problems. Here, too, relapses are not uncommon after years.
  • The Malaria tropica is caused by Plasmodium falciparum. It is the most dangerous form and, if left untreated, usually leads to death.
Malaria is the most common infectious disease in the world, with 200 million cases per year worldwide. According to the World Health Organization (WHO), 600,000 people die of malaria every year.

Symptoms and course of disease in malaria

All three forms of malaria start suddenly with headache and backache, shivering and feeling hot. Then the typical fever rhythm often sets in, which gave malaria its German name "Wechselfieber".
  • Malaria tertiana: The incubation period is between eight and twenty days. The affected person suffers from classic intermittent fever with a typical three-day rhythm: day one with fever, day two without fever and day three again with fever.
  • Quartana malaria: The incubation period is between three and seven weeks. The person concerned suffers from classic alternating fever with a four-day rhythm: fever on day one, then fever-free for two days and again fever on the fourth day.
  • Malaria tropica: The incubation period is between seven and 14 days. It is typical that it does not have such a noticeable fever rhythm as the other forms of malaria. In addition to the irregular bouts of fever, there are also organ changes, anemia and nerve problems such as seizures.

Diagnosis and treatment of malaria

In the early stages, malaria can hardly be distinguished from flu. In order to be able to assign the symptoms correctly, the attending physician should be informed immediately about a stay in an area prone to malaria. Using a blood analysis, he can then identify the malaria pathogens. Depending on the type, malaria is treated with various drugs against the pathogens. The therapy also depends on the resistance situation in the risk area - this is continuously monitored.

Where does malaria occur?

Malaria occurs mainly in subtropical and tropical areas - often where there is flooding and water retention, in which the Anopheles mosquitoes can reproduce well.
© vitapublic / WHOLountries and regions with malaria occurrence., As of 2016

Possible vaccinations against malaria

There is currently no vaccination.

The vaccine RTS, S / AS01, which is currently being tested, has not yet been completely convincing. Its protective effect is only about 48 months. Approval is currently being examined.

Another form of malaria vaccination is also currently being investigated. The vaccine is based on fully viable, non-weakened malaria pathogens given at the same time as a malaria drug. A study on volunteers showed 100% vaccination protection after the vaccine was administered three times. The malaria vaccine is now being tested for effectiveness over a period of several years as part of a clinical study in Gabon.

prevention

Travelers to malaria areas should ask their doctor or a tropical institute about the drug options that are suitable for them: For a rather short vacation trip, so-called chemoprophylaxis is an option - with a drug that is used during the trip and for some time before and after is taken. Alternatively, there is also the option of taking a medication for “stand-by therapy” with you on the trip, which is taken at the first signs of malaria. However, this is only to be regarded as emergency therapy. Medical treatment should be initiated as soon as possible.

In order not to be infected, you should provide suitable mosquito repellent. This includes suitable clothing - for example long trousers and shirts - as well as mosquito repellants. A mosquito net over the bed should also be included.
  • Author: vitanet.de; medical quality assurance: Cornelia Sauter, doctor
  • Swell: Robert Koch Institute: Advice for Doctors - Malaria, http://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Malaria.html;jsessionid=6D032CFB3BD481081DB168AFF060CE8E.2_cid372
  • German Society for Tropical Medicine and International Health (DTG): Guideline: Diagnostics and Therapy of Malaria, http://www.awmf.org/uploads/tx_szleitlinien/042-001l_S1_Malaria_Diagnostik_Therapie_2016-08.pdf
  • World Health Organization: World malaria report 2016, http://apps.who.int/iris/bitstream/10665/252038/1/9789241511711-eng.pdf
  • The Lancet: Efficacy and safety of RTS, S / AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomized, controlled trial, 2015.

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