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Malaria parasites are transmitted by female ''[[Anopheles]]'' [[mosquito]]es. The parasites multiply within [[red blood cell]]s, causing symptoms that include symptoms of [[anemia]] (light headedness, [[shortness of breath]], [[tachycardia]] etc.), as well as other general symptoms such as [[fever]], [[chills]], [[nausea]], [[influenza|flu-like illness]], and in severe cases, [[coma]] and death. | Malaria parasites are transmitted by female ''[[Anopheles]]'' [[mosquito]]es. The parasites multiply within [[red blood cell]]s, causing symptoms that include symptoms of [[anemia]] (light headedness, [[shortness of breath]], [[tachycardia]] etc.), as well as other general symptoms such as [[fever]], [[chills]], [[nausea]], [[influenza|flu-like illness]], and in severe cases, [[coma]] and death. | ||
==History== | |||
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The malaria incubation period after an infective mosquito bite includes the time required for the parasites to progress through liver schizogony and produce symptoms by their propagation in the bloodstream. For primary attacks, this period is typically about 8 to 25 days but may be much longer depending on the immune status of the infected person, the strain as well as the species of Plasmodium, the dose of sporozoites, and the possible effects of partially effective chemoprophylaxis. Relapses from latent hypnozoites may develop months or years after mosquito bites. Late-onset or recrudescent P. falciparum malaria may also occur in individuals who have suppressed parasitemia of drug-resistant parasites with chemoprophylactic drugs367 (see Fig. 275-2). Febrile patients presenting within 7 days of entering an endemic area are unlikely to have malaria, unless there has been earlier exposure to infective mosquito bites. As a general rule, and because of the dangers of acute P. falciparum infection, all travelers who have visited a malaria-endemic area in the 3 months prior to onset of fever or other suggestive symptoms should be considered to have malaria until proven otherwise. Even in patients beyond this time frame, it is wise to consider P. falciparum malaria, as illustrated, for example, in the recent report of a symptomatic presentation in an 18-year-old patient with sickle cell disease 4 years after visiting an endemic area.248 Latent attacks from the reactivation of P. vivax or P. ovale hypnozoites usually occur within 3 years and are rare more than 5 years after expo- sure. Recrudescence of P. malariae symptoms in individuals with subclinical parasitemia has been reported decades after initial infection.170,368,369 | |||
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==Common Symptoms== | |||
* Fever | |||
* Headache | |||
* Weakness | |||
* Night sweats | |||
* Insomnia | |||
* [[Joint pain]] | |||
* [[Muscle pain]] | |||
==Less Common Symptoms== | |||
* Diarrhea | |||
* Abdominal cramps | |||
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The bloodstream parasites of P. falciparum infections are often asynchronous and may produce continuous fever. In other infections, fever may be cyclical, recurring every 48 or 72 hours, depending on the species and synchrony of the replicating parasites. Parasite subpopulations on different cycles in the blood- stream may produce complicated fever patterns. Patients with cyclical fevers may be relatively asymptomatic during afebrile periods. | |||
Particular elements from the history and physical examination, when considered together, may be suggestive of the diagnosis of malaria.372-374 Cyclical paroxysms of chills and rigors, fever, and drenching sweats are characteristic although not necessarily specific for malaria. A travel history that reveals risk of exposure months to years before in an endemic region is an alert for malaria and should always be sought in presentations of fever. Findings on physical exami- nation may include pallor and hepatosplenomegaly. Rarely, acute Plas- modium infections present with splenic rupture requiring surgery or conservative management.375,376 Findings such as jaundice, diminished consciousness, or convulsions indicate severe malaria (see later). Rash, lymphadenopathy, and signs of pulmonary consolidation are distinctly uncommon. | Particular elements from the history and physical examination, when considered together, may be suggestive of the diagnosis of malaria.372-374 Cyclical paroxysms of chills and rigors, fever, and drenching sweats are characteristic although not necessarily specific for malaria. A travel history that reveals risk of exposure months to years before in an endemic region is an alert for malaria and should always be sought in presentations of fever. Findings on physical exami- nation may include pallor and hepatosplenomegaly. Rarely, acute Plas- modium infections present with splenic rupture requiring surgery or conservative management.375,376 Findings such as jaundice, diminished consciousness, or convulsions indicate severe malaria (see later). Rash, lymphadenopathy, and signs of pulmonary consolidation are distinctly uncommon. | ||
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* Symptoms of malaria include [[fever]], [[shivering]], [[arthralgia]] (joint pain), [[vomiting]], [[anemia]] caused by [[hemolysis]], [[hemoglobinuria]], and [[convulsion]]s. | |||
* There may be the feeling of tingling in the skin, particularly with malaria caused by ''P. falciparum''. | |||
* The classical symptom of malaria is cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting four to six hours, occurring every two days in ''P. vivax'' and ''P. ovale'' infections, while every three for ''P. malariae''.<ref name=RBMarmenia>[http://www.malaria.am/eng/pathogenesis.php Malaria life cycle & pathogenesis]. Malaria in Armenia. Accessed October 31, 2006.</ref> | |||
* ''P. falciparum'' can have recurrent fever every 36-48 hours or a less pronounced and almost continuous fever. | |||
* For reasons that are poorly understood, but which may be related to high [[intracranial pressure]], children with malaria frequently exhibit [[abnormal posturing]], a sign indicating severe brain damage.<ref name="Idro ">{{cite journal | last =Idro | first =R | authorlink = | coauthors =Otieno G, White S, Kahindi A, Fegan G, Ogutu B, Mithwani S, Maitland K, Neville BG, Newton CR | title = Decorticate, decerebrate and opisthotonic posturing and seizures in Kenyan children with cerebral malaria| journal =Malaria Journal | volume =4 | issue =57 | pages = | publisher = | date = | url =http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16336645 | doi = | id =PMID 16336645 | accessdate =2007-01-21 }} </ref> | |||
* Malaria has been found to cause cognitive impairments, especially in children. It causes widespread [[anemia]] during a period of rapid brain development and also direct brain damage. This neurologic damage results from cerebral malaria to which children are more vulnerable.<ref>Boivin, M.J., "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12394524&dopt=Citation Effects of early cerebral malaria on cognitive ability in Senegalese children]," ''Journal of Developmental and Behavioral Pediatrics'' 23, no. 5 (October 2002): 353–64. Holding, P.A. and Snow, R.W., "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11425179&dopt=Citation Impact of Plasmodium falciparum malaria on performance and learning: review of the evidence]," ''American Journal of Tropical Medicine and Hygiene'' 64, suppl. nos. 1–2 (January–February 2001): 68–75.</ref> | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];
Overview
Malaria parasites are transmitted by female Anopheles mosquitoes. The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (light headedness, shortness of breath, tachycardia etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and in severe cases, coma and death.
History
Common Symptoms
- Fever
- Headache
- Weakness
- Night sweats
- Insomnia
- Joint pain
Less Common Symptoms
- Diarrhea
- Abdominal cramps
- Symptoms of malaria include fever, shivering, arthralgia (joint pain), vomiting, anemia caused by hemolysis, hemoglobinuria, and convulsions.
- There may be the feeling of tingling in the skin, particularly with malaria caused by P. falciparum.
- The classical symptom of malaria is cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting four to six hours, occurring every two days in P. vivax and P. ovale infections, while every three for P. malariae.[1]
- P. falciparum can have recurrent fever every 36-48 hours or a less pronounced and almost continuous fever.
- For reasons that are poorly understood, but which may be related to high intracranial pressure, children with malaria frequently exhibit abnormal posturing, a sign indicating severe brain damage.[2]
- Malaria has been found to cause cognitive impairments, especially in children. It causes widespread anemia during a period of rapid brain development and also direct brain damage. This neurologic damage results from cerebral malaria to which children are more vulnerable.[3]
References
- ↑ Malaria life cycle & pathogenesis. Malaria in Armenia. Accessed October 31, 2006.
- ↑ Idro, R. "Decorticate, decerebrate and opisthotonic posturing and seizures in Kenyan children with cerebral malaria". Malaria Journal. 4 (57). PMID 16336645. Retrieved 2007-01-21. Unknown parameter
|coauthors=ignored (help) - ↑ Boivin, M.J., "Effects of early cerebral malaria on cognitive ability in Senegalese children," Journal of Developmental and Behavioral Pediatrics 23, no. 5 (October 2002): 353–64. Holding, P.A. and Snow, R.W., "Impact of Plasmodium falciparum malaria on performance and learning: review of the evidence," American Journal of Tropical Medicine and Hygiene 64, suppl. nos. 1–2 (January–February 2001): 68–75.