BUPA GLOBAL

Malaria - the disease

This factsheet is for people who have malaria, or who would like information about it.

Malaria is an infectious disease found in tropical areas such as Sub-Saharan Africa, Central and South America, the Indian subcontinent, South East Asia and the Pacific islands (these are known as malarious regions). It's caused by a parasite called Plasmodium, which is passed to people through bites from mosquitoes carrying the parasite.

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Published by Bupa's Health Information Team, March 2010.

About

About

About malaria


There are two categories of malaria.

  • Malignant malaria causes symptoms within three months of infection and can be mild or severe. It's caused by one type of malaria parasite, Plasmodium falciparum.
  • Benign malaria is mild but may have a dormant stage of up to a year and can cause relapses. This is caused by the other three types of malaria parasite.
Around 250 million people a year get infected with malaria worldwide.

Causes of malaria


Malaria is caused by infection with a parasite called Plasmodium that is passed to people through mosquito bites.

Malaria parasite 

You can catch malaria if a female of the Anopheles mosquito bites someone carrying the malaria parasite and then bites you, passing the parasite on to you.

There are four different types of Plasmodium parasite. Each type of Plasmodium parasite causes a slightly different type of illness.

  • Plasmodium falciparum - this is the only parasite that causes malignant malaria. It causes the most severe symptoms and results in the most fatalities.
  • Plasmodium vivax - this causes benign malaria with less severe symptoms than P. falciparum. P. vivax can stay in your liver for years and can lead to a relapse.
  • Plasmodium ovale - this causes benign malaria and can stay in your blood and liver for many years without causing symptoms.
  • Plasmodium malariae - this causes benign malaria and is relatively rare.
There is some overlap in the areas of the world in which the parasites are usually found. However, P. falciparum is most common in Africa, Hispaniola and Papua New Guinea and P. vivax is more common in the Indian subcontinent and Central America. South America and South East Asia have both species. The other two species, P. ovale and P. malariae, are relatively uncommon worldwide.

It is possible to be infected with more than one type of parasite at the same time, but the treatment is the same as for infection with P. falciparum.

Parasite lifecycle 

The malaria parasite passes through your blood into your liver, where it grows and develops.

After it has completed its development, it travels back into your bloodstream and eventually attacks your red blood cells, which you need to carry oxygen around your body. You will then get symptoms of malaria.
 

Complications of malaria


If you get infected with P. falciparum, your malaria can progress to a more severe form (also called complicated malaria). Complications can affect your brain, kidneys, blood and lungs. They can develop within hours or days of your first malaria symptoms and can be fatal within 24 hours.

Symptoms of severe malaria can include:

  • jaundice - yellow skin and eyeballs
  • difficulty breathing
  • feeling light-headed or shaky (symptoms of low blood sugar)
  • bleeding - eg under the skin (showing as pin pricks or bruises) or from the nose or gums
  • pale or blueish skin
  • fast heart beat
  • fast breathing
  • fits
  • loss of consciousness
It's important to seek urgent medical advice if you suspect you have severe malaria. Always tell your doctor if you have recently travelled. Complications are likely to be more severe in pregnant women, children and the elderly.

Symptoms and diagnosis

Symptoms and diagnosis

Symptoms of malaria


The first symptoms of malaria are like having the flu. You may have:

  • a headache
  • aching muscles
  • tummy ache, diarrhoea and vomiting, especially in children
  • weakness or lack of energy
A day or so later, your temperature may rise. Some people have malaria attacks with three stages: shivering, hotness, and sweating. You may feel or be sick during the hot phase.

Symptoms can appear any time from six days after you are bitten by a mosquito carrying the malaria parasite. The time it takes your symptoms to appear - the incubation period - can vary with the type of parasite that the mosquito was carrying.

  • If a mosquito carrying the P. falciparum parasite bites you, symptoms usually appear within three months of the bite, and most commonly start between seven and 30 days.
  • If a mosquito carrying the P. vivax, P. ovale or P. malariae parasite bites you, symptoms can appear a year or more after the bite. This is because the parasite can lay dormant in your liver and become active months later. These parasites may also cause you to have repeat symptoms.
If you have an illness with a fever and have travelled to a malarious region within the last year, you should visit a doctor. You can still catch malaria even if you have taken antimalarial medicines correctly.

Diagnosis of malaria


The doctor will ask you about your symptoms and examine you. He or she will ask about your medical history and will need to know which countries or regions you have visited within the last year, including any stopovers.

Your doctor will do a blood test to see if you have malaria. This may need to be repeated as the levels of malaria parasite in your blood can vary. For example, if you have taken antimalarial medicines, the levels of parasite may be too low to detect. Repeating the test can help to confirm if you have malaria.

Please note that availability and use of specific tests may vary from country to country.

Treatment

Treatment

About treatment of malaria


There are a number of medicines that can treat malaria if you start taking them soon after your symptoms appear. Certain medicines don't work for malaria from some parts of the world - your doctor will ask where you have been and take this into account.

Some of the medicines that are used to treat malaria are the same ones used to help prevent the infection. But if you have taken a medicine to prevent malaria, you can't take the same one again as treatment. So it's important to tell your doctor about any medicines you have taken. It might help to take the packaging along with you if you can.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Medicines

Treating mild to moderate P. falciparum malaria


Depending on which country you are in and the likelihood of resistance to the medicine by the parasite, you will probably be treated with an antimalarial combination therapy. This is two medicines that can be used to kill the malaria parasite in different ways. By taking the two medicines at once, the parasite’s resistance to the medicine is reduced and the treatment works better.

Your doctor may recommend:

  • artemether + lumefantrine
  • artesunate + amodiaquine
  • artesunate + mefloquine
  • artesunate + sulfadoxine–pyrimethamine
Artemether can cause side-effects such as feeling sick, vomiting and abdominal pain but you generally only have to take them for a short time (around three days).

If you have recently travelled to a malarial region but have returned to a country without a malaria risk, your doctor may prescribe:

  • atovaquone-proguanil
  • artemether-lumefantrine
  • quinine plus doxycycline or clindamycin
Common side-effects of quinine include feeling sick and ringing in your ears (tinnitus), but these should stop when you stop taking it. Side-effects from atovaquone-proguanil and artemether-lumefantrine can include skin rashes, tummy pain and fever.

If you have P. falciparum malaria, you will usually need to stay in hospital for at least 24 hours for monitoring. This is because it can rapidly progress to a more severe infection.

Treating other forms of malaria


The treatment for non-P. falciparum malaria is chloroquine tablets. You can take chloroquine if you're pregnant. Side-effects of chloroquine can include vomiting, diarrhoea, tummy pains and itching.

If you have malaria caused by P. vivax and P. ovale, you will need longer-term treatment to stop the infection coming back, because parasites can stay in your liver. Primaquine is the usual medicine. Side-effects of primaquine can include vomiting, diarrhoea and tummy pains. It isn't suitable for everyone, for example you can't take it if you are pregnant.

If your illness is mild, you will probably be able to take your medicines at home. However, you will need to go to hospital if you develop complications or need medication through an intravenous drip.

Treating severe malaria


Two treatments are available to treat severe P. falciparum malaria. The first type is quinine and quinidine and the second type is the artemisinin derivatives (artesunate, artemether and artemotil). Both of these are effective and the treatment you will be given will depend on what’s available. Chloroquine is no longer recommended for the treatment of severe malaria because of widespread resistance.

If you have severe vivax malaria, this is treated in the same way as severe falciparum malaria.

If you have severe malaria, you need to be monitored carefully and treated for any complications. The severity of malaria usually depends on the number of red blood cells infected with parasites.

Complementary medicines


There is no scientific proof that any herbal and homeopathic remedies can prevent or treat malaria and they aren't licensed for these uses. It may put you at risk if you rely on these remedies to prevent or treat malaria.

Special considerations

Special considerations

Acquired immunity


If you're born in a malarious area, you may develop immunity to the infection. But this only lasts for six to 12 months after you leave. After this, you will need to take antimalarial medicines if you return to a malarious area.

If you're pregnant


Complications of malaria are more likely if you are pregnant. Malaria in pregnancy is also associated with miscarriages or stillbirths.

If you have malaria and are pregnant, you will need to be treated with quinine. Evidence shows that quinine is safe in pregnancy, although it can increase the risk of low blood sugar and can cause labour. Your doctor will monitor you and your baby for any signs of complications. You may need to have your baby early if this is safest for you and your baby.

Sources

Sources

  • 10 facts about malaria. World Health Organization. www.who.int , accessed 12 April 2011
  • Lalloo DG, Shingadia D, Pasvol G, et al. UK malaria treatment guidelines. J Infect 2007; 54:111-21. doi:10.1016/j.jinf.2006.12.003
  • Malaria prophylaxis - background information. Clincial Knowledge Summaries. www.cks.nhs.uk, accessed 6 September 2009
  • Malaria Disease. Centres for Disease Control and Prevention. www.cdc.gov , accessed 7 September 2009
  • Guidelines for malaria prevention in travellers from the United Kingdom. Health Protection Agency (HPA), 2007. www.hpa.org.uk
  • National travel health network and centre. Travel health information sheets. Malaria. www.nathnac.org
  • Guidelines for the treatment of malaria -- 2nd edition. World Health Organization. 2010. www.who.int
  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. Oxford: Oxford University Press, 2005:507.
  • Whitty CJM, Lalloo D, Ustianowski A. Malaria: an update on treatment of adults in non-endemic countries. BMJ 2006; 333:241-45.
  • Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009:357-61
  • Statement on homeopathic remedies for malaria. Health Protection Agency (HPA). www.hpa.org.uk , accessed 9 September 2009
  • Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009:354
  • Exposure to blood or other bodily fluids. International Travel and Health. World Health Organization, 2009. www.who.int
  • Malaria: prevention in travellers. BMJ Clinical Evidence. www.clinicalevidence.com , accessed 16 September 2009
  • Beers MH, Fletcher AJ, Porter R, et al. The Merck manual of medical information. 2nd ed. New York: Pocket Books, 2003:1140-41
  • Who can't give blood. The National Blood Service. www.blood.co.uk

This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. This content was compiled by Bupa based on clinical information and practice current as at the stated date of publication. Content is likely to reflect clinical practice in a particular geographical region (as indicated by the sources cited) – accordingly, it may not reflect clinical practice in the reader’s country of habitation. This content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Photos and videos are only for illustrative purposes and do not reflect every presentation of a condition.

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