Malaria is an infectious disease caused by any of four strains-P faIciparum, P malariae, P vivax, and P ovale of the Plasmodium protozoan, a single cell parasite. Once the parasites enter the body, they travel via the bloodstream to the liver, where they multiply rapidly. After an incubation of one to two weeks, thousands of parasites reenter the blood, where they destroy red cells. The parasites then invade and destroy red blood cells in regular cycles. Each wave of destruction produces a flare up of symptoms, which vary according to the specific Plasmodium strain. Attacks typically include inter mittent fever, chills, sweating, achiness, throbbing headache, and a generally ill feeling. Within a week, the typical pattern of the disease is established, which usually entails a short period of malaise or a headache followed by chills and a fever lasting up to several hours. Once the fever subsides, the patient will feel well until the onset of the next attack, which may come within 48 to 72 hours. If the infective organism is P falci parum, the typical pattern of attacks may be absent. Instead, there may be a sensation of chilliness followed by a gradually rising fever that can last from 20 to 36 hours, with an accompanying headache. After this, for a period of 36 to 72 hours the patient feels ill and has a low-grade fever. A life-threatening complication of infection with P falciparum is cerebral malaria. This is characterized by a fever, which may reach as high as 104°F , accompanied by severe headache, drowsiness, delirium, and confusion. When the agent is P malariae, the ill ness begins suddenly as a rule, with a paroxysm that recurs every 72 hours. Malaria is usually transmitted by a bite from an infected Anopheles mosquito, but it can also be contracted from a contaminated blood transfusion or by needle sharing among intravenous drug abusers. Malaria is rare in the industrialized countries, but is common in undeveloped tropical areas.

Diagnostic Studies And Procedures

Periodic attacks of chills and fever with no apparent cause alert a doctor to the possibility of malaria, especially if the person has traveled recently to an area where malaria is endemic. The physical examination will include palpating the spleen to determine if it is enlarged, one sign of the disease. To confirm the diagnosis, a blood sample will be examined for the parasite. More than one sample may be required, however, because the number of parasites present in the bloodstream varies according to the organisms’ life cycle. The strain of Plasmodium must also be identified to select the most effective treatment.

Medical Treatments

Malaria treatment is complicated by increasing Plasmodium resistance to the most common antimalaria drugs. This is especially true of P falciparum, the most dangerous form of malaria, which has developed resistance to chloro quine (Aralen) in much of the world. In these particular areas, a few days of quinine sulfate therapy followed by an oral antibiotic such as tetracycline or pyrimethamine/sulfadoxine (Fansidar) may be sufficient to treat a mild, uncomplicated case of P falciparum malaria. In more severe cases, hospitalization to give intravenous quinidine is necessary. Left untreated, P falciparum malaria has a 20 percent mortality rate. An uncomplicated case of P vivax, P malariae, or P ovale may be treated with several days of chloroquine. Because all antimalarial drugs can cause serious side effects, their use must be carefully monitored by a doctor. Call your physician immediately if you develop nausea and vomiting, blurred vision, or hearing loss, all signs of potentially serious drug side effects. laking the drugs with milk or food reduces intestinal upset.

Alternative Therapies

Herbal Medicine

Years ago, herbalists discovered that tea brewed from Peruvian bark, or cinchona trees, could cure malaria. Scientists later extracted quinine from cinchona bark. Today, this mainstay in the medical treatment of malaria is synthesized artificially, but resistance to these drugs is a growing problem. A Chinese herb called ging haosu appears to be a promising alternative, and pharmaceutical researchers are studying its potential as a new anti malaria drug.

Self Treatment

Prevention is the best self care for malaria. Before visiting an area where the disease is common, ask your doctor about taking an antimalaria drug as a preventive measure. hloroquine is often prescribed prophylactically where resistance is not a problem. Mefloquine (Lariam), another antimalaria drug, may be prescribed as an alternative. Be sure to take the full course of pills, even after returning home. When in a mosquito-infested area, protect yourself by using finemesh window screens and mosquito netting over your bed. Apply insect repellent before going out. Some doctors also recommend carrying a few pills of pyrimethamine/sulfadoxine to take, should a fever and other symptoms of malaria develop in a remote area where medical care is not readily available. If you contract malaria, drink large amounts of nonalcoholic liquids to replace fluids that are lost through sweating. During a prolonged period of very high fever, take a cool bath to lower the body’s temperature. Alternating hot and cold compresses on the forehead and the base of the skull can help ease headaches. Do not take aspirin or other nonprescription drugs, however, because they may interact with malaria medication.

Other Causes of Fever And Chills

Many infections, including Lyme disease and AIDS, can cause recurrent chills and fever. Recurrent fever is also a sign of some cancers, especially those that affect the blood and lymph sys ­ tems, such as Hodgkin’s disease, leukemia, and multiple myeloma.