$Unique_ID{BRK03961} $Pretitle{} $Title{Malaria} $Subject{Malaria Acute Malaria Ague Chronic Malaria Jungle Fever Swamp Fever Paludism Autochthonous Malaria Imported Malaria Induced Malaria Relapsing Malaria Therapeutic Malaria Cerebral Malaria Plasmodium Falciparum Malaria (Falciparum Fever, Malignant Tertian Fever, Malignant Tertian Malaria, Algid Malaria, Gastric Algid Malaria, Dysenteric Algid Malaria, Bilious Remittent Malaria, Cerebral Malaria, Malaria Comatosa, Aesthetivoautumnal Fever, Pernicious Malaria, Remittent Malaria ) Plasmodium Malariae Malaria (Quartan Malaria, Quartan Fever) Plasmodium Ovale Malaria (Ovale Tertian Malaria) Plasmodium Vivax Malaria (Tertian Malaria, Benign Tertian Malaria, Tertian or Vivax Fever) Quotidian Malaria (Quotidian Fever, Double Tertian Malaria) Intermittent Malaria (Tertian or Quartan Malaria) Nonan Malaria (Occurrences every nine days) Blackwater Fever (Hemorrhagic Malaria) Babesiosis Toxoplasmosis} $Volume{} $Log{} Copyright (C) 1988, 1990, 1992 National Organization for Rare Disorders, Inc. 434: Malaria ** IMPORTANT ** It is possible the main title of the article (Malaria) is not the name you expected. Please check the SYNONYMS listing on the next page to find alternate names, disorder subdivisions, and related disorders covered by this article. Synonyms Acute Malaria Ague Chronic Malaria Jungle Fever Swamp Fever Paludism Autochthonous Malaria Imported Malaria Induced Malaria Relapsing Malaria Therapeutic Malaria Cerebral Malaria DISORDER SUBDIVISIONS Plasmodium Falciparum Malaria (Falciparum Fever, Malignant Tertian Fever, Malignant Tertian Malaria, Algid Malaria, Gastric Algid Malaria, Dysenteric Algid Malaria, Bilious Remittent Malaria, Cerebral Malaria, Malaria Comatosa, Aesthetivoautumnal Fever, Pernicious Malaria, Remittent Malaria ) Plasmodium Malariae Malaria (Quartan Malaria, Quartan Fever) Plasmodium Ovale Malaria (Ovale Tertian Malaria) Plasmodium Vivax Malaria (Tertian Malaria, Benign Tertian Malaria, Tertian or Vivax Fever) Quotidian Malaria (Quotidian Fever, Double Tertian Malaria) Intermittent Malaria (Tertian or Quartan Malaria) Nonan Malaria (Occurrences every nine days) Blackwater Fever (Hemorrhagic Malaria) Information on the following diseases can be found in the Related Disorders section of this report: Babesiosis Toxoplasmosis General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources section of this report. Malaria is a communicable parasitic disorder spread through the bite of the Anopheles mosquito. Major symptoms may vary depending on which species of parasite causes the infection and the stage of development of the parasite. Chills and fever commonly occur, although not every case follows the same pattern. Each recurrence becomes milder. Although the disorder was once thought to be under control throughout the world, Malaria is a wide spread infection especially in the tropics where certain types of mosquitos are becoming resistant to pesticides. The annual number of cases reported in the United States has increased in recent years. Symptoms Symptoms of Malaria vary depending on which of the four parasite species is the cause. Severity of symptoms may differ as the parasite goes through three different stages of development in humans. It is possible to contract more than one kind of Malaria at a time. Symptoms may begin a week after exposure to the mosquito or it may show up months later, even with preventive treatment. An incubation period ranging from nine to forty days is usually followed by a feeling of listlessness, loss of appetite, headaches, muscle aches, low fever, and other flu-like symptoms. Then onset of rigidity or spasms usually lasting twenty to thirty minutes may occur. Following this, teeth rattling chills and fever (possibly reaching 107 degrees F.) may last from three to eight hours. Profuse sweating and a feeling of exhaustion mark the end of the feverish stage. Cold sores may appear on the lips or nose, skin may be pale, slightly bluish, or dry and flushed in appearance. An increased heart rate may be associated with heavy breathing. The spleen may become enlarged. Bloody diarrhea rarely may occur. If the brain is involved, headaches or depression may develop. Anemia, marked weight loss, mild yellowish discoloration of the skin (jaundice), swelling of the ankles, digestive difficulties, and muscle weakness can occur. Until drugs are administered, symptoms such as diarrhea, vomiting or nausea may recur. Between episodes of these symptoms, patients may feel well except for tiredness. Without treatment, symptoms often redevelop months or even years later. Although subsequent attacks are often milder due to built-up immunity, the infection can last from one to twenty years. With treatment, patients usually recover and live a normal life span. Cerebral Malaria is a form of Malaria which occurs when the immune system produces a certain protein called "Tumor Necrosis Factor" (TNF) or "cachectin." This complication develops in less than one percent of cases and is often fatal in third world countries. Causes Malaria is most commonly transmitted through the bite of the female Anopheles mosquito which is infected by a malaria parasite (Plasmodium). Plasmodium Falciparum, Plasmodium Ovale, Plasmodium Malariae and Plasmodium Vivax are the four species of the parasite which can affect humans. Additionally, transfusion of blood from an infected donor, or sharing contaminated needles may transmit the infection from one person to another. In very rare cases, the disorder has been transmitted from an infected mother to a fetus. Affected Population According to the Centers for Disease Control (CDC) in Atlanta, GA, Malaria is uncommon in the United States where less than 1,100 cases are diagnosed each year, usually having been contracted abroad. The World Health Organization (WHO) estimates Malaria to be one of the world's major health problems, with at least 100 million new cases reported annually, resulting in more than 1 million deaths. Cerebral complications account for more than half of all Malaria deaths even though this condition develops in less than one percent of cases. Related Disorders Symptoms of the following disorders can be similar to those of Malaria. Comparisons may be useful for a differential diagnosis: Babesiosis is a communicable parasitic infection of animals which on rare occasions may occur in humans. The parasites are transmitted by tick bites and cause premature destruction of red blood cells (hemolytic anemia). Babesiosis may be fatal in people who have had their spleens removed. In other individuals, the disorder usually resolves spontaneously. Initial symptoms may include abdominal pain, headache, chills and fever, lack of appetite, vomiting, and diarrhea. Most cases in the United States seem to have been contracted on islands off the coast of New York and Massachusetts. (For more information on this disorder, choose "Babesiosis" as your search term in the Rare Disease Database). Toxoplasmosis is an infectious disorder that is caused by a parasite (Toxoplasma Gondii). This infection is found worldwide and may be either acquired or transmitted to a fetus from an infected mother. When the disorder is acquired, cases may either resemble mononucleosis or involve lesions of the lungs, liver, heart, skin, muscle, brain, and spinal cord membranes. Lesions are often accompanied by inflammation and in some cases, hepatitis. Acute cases are often characterized by rash, high fever, chills, and prostration. The prognosis for the acquired forms of Toxoplasmosis (of moderate severity) is usually good with treatment and complications are uncommon. However, without treatment this disorder may persist for many months. It is rarely fatal in adults. (For more information on this disorder, choose "Toxoplasmosis" as your search term in the Rare Disease Database). Therapies: Standard Prevention is the most effective means of controlling Malaria. Americans traveling to third world countries where the disease is rampant are advised to begin Chloroquine drug therapy at least two weeks before traveling to areas at risk. These areas include Africa, areas of South and Central America, the Indian subcontinent, Southeast Asia, and areas of Oceania (Papua, New Guinea or Irian Java, the Solomon Islands and Vanuatu). This drug should continue to be taken during travel and for six weeks thereafter. The drug not only helps prevent malaria, but can suppress and eliminate the disease in those who have already been infected by the parasite. Where parasites are known to be resistant to Chloroquine such as Africa, parts of Southeast Asia, and some South Pacific Islands, the drug Fansidar may be used, although some people may have severe reactions to it. This drug must be discontinued if itching, rash, sore throat, or lesions in the mouth or genital areas appear. Quinine or tetracycline drugs can be substituted. The drug Primaquine may be effective if parasites persist in the liver after other drug treatments have been used. Rural areas carry a higher risk for Malaria than cities. Travelers should remain in well screened areas, especially at night when mosquitos usually feed. Clothes should cover most of the body and mosquito netting should be used around the bed. A good insect repellent such as DEET should be used on any exposed area of the skin, and living and sleeping areas should be sprayed with a flying-insect spray containing pyrethrum. Health information for travelers is available from the Centers for Disease Control (CDC) in Atlanta, GA at (404) 329-2572 or from state and local health departments. The publication, "Health Information for International Travel" is available from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402, or (202) 783-3238. The orphan drug Larium has received FDA approval as standard therapy in the prevention and treatment of mild to moderate Malaria. It is manufactured by Hoffman LaRoche, 340 Kingsland St., Nutley, NJ 07110. Therapies: Investigational Experimental treatment for a potentially fatal form of Malaria known as Cerebral Malaria involves blocking the reaction of the immune system protein which causes it. Research on special agents to block this reactive protein known as "tumor necrosis factor" (TNF) or "cachectin" are being studied to determine safety and effectiveness. During the past ten years the number of cases of Malaria in the United States caused by the Plasmodium Falciparum parasite increased tenfold, mostly due to Americans traveling to areas of endemic malaria such as Africa and Thailand. This type of Malaria has typically been treated with intravenous quinine dihydrochloride available only from the Centers for Disease Control (CDC). In an effort to avoid delays in treatment of malaria patients, a new treatment of continuous fusion of intravenous quinidine gluconate has been developed. Preliminary reports indicate that this treatment appears effective. More research is needed to determine the long term safety and effectiveness of this treatment. The drug mefloquine is being investigated as a possible treatment for Malaria associated with the Plasmodium Falciparum parasite. The Food and Drug Administration (FDA) has awarded a research grant to A.G. Mephra, Switzerland, for studies on mefloquine HCT (Mephaquin) as a treatment/vaccination for chloroquine-resistant falciparum malaria. In a few cases, the drug Amodiaquine was investigated for therapeutic value, but was found to be less effective than the drug Chloroquine. These drugs are still under study to analyze side effects and effectiveness. More research is needed before they can be recommended for use in all but the most severe cases of Malaria. For information on additional therapies that have been designated as Orphan Drugs in the last few months, please return to the main menu of NORD Services and access the Orphan Drug Database. Smith-Kline Beecham Pharmaceutical, P.O. Box 1510, King of Prussia, PA, 19406, is sponsoring a new orphan drug, Halofantrine, for the treatment of Malaria caused by strains of P. Falciparum and P. Vivax. This disease entry is based upon medical information available through January 1992. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Malaria, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Allergy and Infections Diseases (NIAID) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control (CDC) 1600 Clifton Road, NE Atlanta, GA 30333 (404) 639-3534 World Health Organization 525 23rd Street Northwest Washington, DC 20037 (202) 861-3200 (202) 861-3305 (Library) References TRAVELERS' ADVISORY: MALARIA STILL THREATENS MUCH OF THE GLOBE: Evelyn Zamula; FDA Consumer (May 1987). Pp. 8-13. AN ULTRASTRUCTURAL STUDY OF THE EFFECTS OF MEFLOQUINE ON MALARIA PARASITES: G.H. Jacobs, et al.; Am J Trop Med Hyg (January 1987, issue 36(1)). Pp. 9-14. AMODIAQUINE LESS EFFECTIVE THAN CHLOROQUINE IN THE TREATMENT OF FALCIPARUM MALARIA IN THE PHILIPPINES: G. Watt, et al.; Am J Trop Med Hyg (January 1987, issue 36(1)). Pp. 3-8.