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Malaria symptoms, causes, and treatment – Malaria

Malaria is an infectious disease caused by the Plasmodium parasite. In the following article, we’ll review all the essentials of this topic.

Worldwide, malaria is responsible for more than 400,000 deaths each year. In rough numbers, there are around 230 million cases annually. Both males and females can be affected by it equally. However, it can be more deadly to pregnant women and babies. In terms of age, young children between 6 months and 3 years old have a higher chance of dying. Also, travelers with no immunity have a higher mortality risk, no matter their age. 

The following article will discuss all the essentials of malaria—everything from its symptoms, complications, diagnosis, and treatment. In the words of a doctor, all of this will simplify this complex disease for your understanding. So, keep reading, and you will find yourself with all the basic knowledge about this disease. 

What is malaria? 

Malaria is a parasitic disease caused by the Plasmodium protozoa. This microscopic parasite can infect humans through the bite of an infected Anopheles mosquito.

File:Anopheles mosquito engorged with human blood.jpg
Anopheles mosquito engorged with human blood

Five species of Plasmodium can infect humans. These are P falciparumP vivaxP ovaleP malariae, and P knowlesi. They are different in shape, which makes it easy to identify them.

Plasmodium identification is important since some of them can be fatal or resistant to classic treatment. Also, each species of Plasmodium can be more common in a specific region. The period between getting the infection to the onset of symptoms (incubation period) also depends on the Plasmodium species. This disease can be deadly; however, both illness and death from it can be prevented. 

malaria, parasites, undergo, asexual, multiplication, erythrocytes, erythrocytic, schizogony
Malaria Plasmodium

How do you get it?

Humans get malaria when they suffer the bite of an infected Anopheles mosquito. When the mosquito bites a person infected with this disease, they suck blood with the Plasmodium parasite. Then, the parasite reproduces inside the body of the mosquito. It takes about a week for the parasite to appear in the saliva of the mosquito. When this happens, parasites are injected into the blood of another person getting bitten. 

Since the parasite then infects the red blood cells, malaria can also be transmitted through blood transfusions. Organ transplant or the use of needles contaminated with blood are also ways of transmission. An infected pregnant woman can transmit the disease to her baby during pregnancy or at the moment of childbirth. Importantly, the disease can’t be transmitted from person to person and can’t be sexually transmitted. 

What’s the incubation period?

The incubation period is the time from the moment of the infection to the moment of showing symptoms. Most of the time, the incubation period can last from 10 days to 4 weeks. This is due to the way the parasite behaves in your body. There is one interesting fact about this disease, which is the relapse. Some species of Plasmodium can remain dormant in the liver for a long time. After this, they can reactivate and start invading the blood cells again. When this happens, the person becomes sick again. 

Which organ is the most affected by malaria?

In terms of organs, we could say the liver is the most affected one. Once you get the mosquito bite, the Plasmodium parasite gets into your blood in the form of sporozoites. Then, they travel to the liver, where they infect the liver cells. There, they reproduce and mature to become schizonts. After this, the liver cell bursts and releases the parasite in the form of merozoites. Once in your bloodstream, the merozoites are the ones that infect your red blood cells. 

As you can see, having malaria directly affects your liver. Since the parasite uses liver cells to reproduce itself, more and more liver cells die while you have the infection. Also, your blood cells get really affected as well. The main reason behind malaria being such a problem is the destruction of red blood cells

What are the symptoms?

As we mentioned before, malaria symptoms can appear anywhere from 10 to 4 weeks after getting infected. Some of the most common symptoms include the following.

There are sudden fever, chills, and sweats: typically, the patient starts having shaking chills, and then the high fever appears. When your body temperature goes back to normal, you’ll experience excessive sweating. This happens because of the destruction of the red blood cells due to the parasite. Also, the periodicity of these episodes can be from 48 hours to 72 hours. This is variable and often depends on the Plasmodium species causing the infection. P. falciparum, P. vivax, and P. ovale will usually have spikes of fever every 48 hours. For P. malariae, it is usually a space of 72 hours between fever spikes. In early infection, these fever patterns are not apparent since the parasite is destroying blood cells simultaneously. 

Other common symptoms of malaria infection include: 

  • Coughing
  • Headache
  • Fatigue or malaise
  • Shaking chills
  • Pain in your joints, also known as arthralgia
  • Pain in your muscles, also known as myalgia

There are other, less common malaria symptoms, including: 

  • Diarrhea
  • Yellow coloration of the skin, known as jaundice
  • Nausea and vomiting
  • Loss of appetite

Does it affect the eyes? 

It is not common, but yes. This disease can, in fact, affect the eyes. This happens more often in the severe form of the disease. Since it destroys red blood cells, this can affect blood vessels in both the brain and the eyes. Severe malaria is damage to these blood vessels, destroying them and causing the tissue to die. Also, hemorrhages in the retina (inner eye portion) are very common ophthalmic consequences of the disease. This damage can impair your vision, depending on the extent. 

Is coughing a symptom of malaria? 

It is not one of the typical symptoms, but it can exist. Remember, malaria can present itself with respiratory damage. In this case, cough, difficulty breathing, and expectoration can be symptoms of the disease. When it presents itself this way, it is hard to establish a diagnosis. This can delay the right treatment and results in a more severe, uncontrolled infection. 

What are the complications of malaria? 

Most of the complications are caused by P. falciparum. When the disease presents itself with one or more complications, it can be considered severe malaria. One of the more common and deadly complications of the disease is cerebral malaria. In fact, it is the most common cause of death from malaria since around 20% of patients die from it. The definition of cerebral malaria includes coma, altered mental status, or seizures, with P. falciparum in the patient’s blood. 

Other complications of it include: 

  • Seizures: Secondary either to low blood sugar or cerebral malaria.
  • Renal failure: Around 30% with P. falciparum infection will experience acute renal failure. 
  • Low blood sugar or profound hypoglycemia
  • Hemoglobinuria: The passage of dark, wine-colored urine. This is due to the loss of hemoglobin through the urine due to red blood cell destruction. 
  • Pulmonary edema: Your lungs fill with liquid, making it hard for you to breathe. 
  • Hemolysis: The destruction of red blood cells causes severe anemia and jaundice. 

What is the prognosis or outlook of malaria?

Malaria can be a deadly disease. However, if treated right and on time, the prognosis is usually excellent. For uncomplicated malaria, patients will experience marked improvement only 48 hours after initiating treatment. Also, they can be fever-free after 96 hours of treatment.

In the case of infection due to P. falciparum, the prognosis is usually bad, with a high mortality rate if left untreated. Falciparum malaria is the most dangerous form of the disease.

What is the mortality rate of malaria? 

As we mentioned before, malaria can be a life-threatening disease. Worldwide, malaria is the cause of more than 400,000 deaths every year. Of these deaths, children under 5 years old are the most affected group, with 67% of all malaria deaths worldwide.

Moreover, there is a high rate of malaria cases in Africa. In fact, there is a high disproportion between malaria cases since around 94% of all the cases occur in Africa. This results in 80 to 90% of all malaria deaths occur in this continent, especially in the region of sub-Saharan Africa.

Doctors think that higher mortality in this region happens not only because they have a higher malaria incidence. It has been shown that P. falciparum has a higher appearance rate in this region too. 

Who is at risk of malaria? 

According to the WHO, around half of the world’s population is at risk of developing malaria. As we mentioned, a big part of malaria cases and deaths occur in sub-Saharan Africa. Also, Asia, Latin America, the Middle East, and some parts of Europe are affected too.

Virtually anyone can get malaria, especially if they live or travel to endemic areas (areas with many malaria cases). In these regions, the malaria risk is higher. However, certain groups have a higher risk than other people, like: 

  • Young children in malaria transmission areas
  • Pregnant women: As malaria can cause miscarriages and maternal death
  • People with AIDS/HIV
  • International travelers

What are ways to prevent malaria? 

The most important thing to remember is that malaria transmission depends almost always on Anopheles mosquitoes. So, the key to malaria prevention is to avoid getting bitten by mosquitoes. You should avoid visiting endemic areas for malaria. If you do or happen to live in one, you should avoid places where mosquitoes can bite you. Stay on the inside, and wear long sleeves and pants when on the outside. 

Another way to prevent malaria is through seasonal malaria chemoprevention or chemoprophylaxis. It consists of getting antimalarial tablets if you are traveling to endemic areas in order to prevent the infection. Chemoprevention is available in many forms, but the drug depends on the destination of the traveler. 

In terms of vaccines, there is still no malaria vaccine fully tested and approved. However, some candidates are going through clinical trials. 

How is it diagnosed? 

If you suspect you are suffering from malaria, you should see your doctor. To diagnose malaria, doctors will begin by asking you about your medical history.

You must mention any travels you’ve had recently. Your doctor will put special emphasis on the symptoms you have had. Then, they will perform a physical examination. Most of the time, malaria presents itself with no relevant clinical findings. However, your doctor can palpate your abdomen to check if your spleen increased its size.

The doctor may indicate some laboratory tests in order to confirm the diagnosis. For malaria, your doctor may ask for a Complete Blood Count to see if you have anemia or low platelets. Also, they will ask for liver function studies, which result in altered in around half the patients with malaria. However, the most important study to diagnose malaria is through blood smears.

In a blood smear, doctors will take a sample of your blood. Then, they will put it in a slide, and then they’ll smear it. Once they do this, they’ll put the slide under the microscope. This way, the plasmodium parasite can be easily identified while infecting red blood cells. Blood smears are also used to determine if the patient is responding well to antimalarial medication. 

blood smear, micrograph, plasmodium falciparum, parasite, microgametocyte
Plasmodium falciparum in a blood smear

What is the treatment for malaria?

Most of the time, patients with malaria infection can receive outpatient treatment. Especially if the case is a non- P. falciparum malaria. However, the treatment is different depending on the species of malaria parasite the patient has. This is why it is so important to identify them. Among the most common antimalarial drugs, we find:

  • Quinine – Quinidine
  • Artemether-Lumefantrine 
  • Chloroquine
  • Primaquine
  • Atovaquone-proguanil

Keep in mind that these antimalarial tablets need to be prescribed by a doctor. And anyway, you should see a doctor if you suspect you have malaria. Also, P. falciparum can develop drug resistance, making it a stronger enemy than other Plasmodium species. This is also the reason why P. falciparum is responsible for severe malaria cases.

In cases with high parasitemia (more than 5% of red blood cells infected), the treatment should be in the hospital. This, in order to prevent complications and to administer treatment through an IV. 

Is paracetamol good for malaria? 

There are mixed opinions about the use of paracetamol in malaria. Some malaria research studies state that paracetamol is not useful in controlling the fever caused by malaria. This happens because the fever results from an inflammatory reaction, a consequence of the destruction of red blood cells.

Because of the mechanism that causes the fever, paracetamol is not effective in stopping nor preventing a fever. Therefore, paracetamol is not helpful in non-severe malaria.

On the other side, some studies suggest that, even if it doesn’t stop the fever, paracetamol has other benefits. It has been shown that, in severe malaria, paracetamol can help protect the kidneys. Remember, severe malaria can result in renal failure. So, the use of paracetamol instead of other fever-medication can help prevent this type of complication. 

Does malaria ever go away?

Yes, with adequate treatment, malaria can go away for good. However, the problem with malaria is the relapse. This happens because some species of the parasite leave dormant forms in the liver: the hypnozoites.

These forms can become active later, even after receiving treatment for the first infection. In order to eliminate these dormant forms, the patient needs special treatment. Also, this treatment should be followed right after receiving treatment for the first attack.

Does malaria cause long-term damage? 

If malaria gets treated correctly, there is no risk of long-term damage after complete malaria elimination. However, in the event of severe malaria or cerebral malaria, there can be sequels and damage. Of course, this depends on the extent of the damage during the infection and how much it lasted.

Another long-term effect of malaria can relapse. As we mentioned before, some species of malaria leave inactive reproductive forms, like P. vivax. These forms can reactivate even months or years after the primary infection. 

Do you have symptoms of this infection?

This tool is a Malaria Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the infection. Therefore, the tool would tell anybody who uses it the likelihood of their symptoms because of malaria. Using the tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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