CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0396/03961.txt

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$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 [phone] 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 [phone].

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
     [phone]

     NIH/National Institute of Allergy and Infections Diseases (NIAID)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control (CDC)
     1600 Clifton Road, NE
     Atlanta, GA  30333
     [phone]

     World Health Organization
     525 23rd Street Northwest
     Washington, DC  20037
     [phone]
     [phone] (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.