Malaria

Written by Dr Charlie Easmon, specialist adviser in travel medicine

Blackwater-fever
In malignant malaria a large number of the red blood corpuscles are destroyed. Haemoglobin (the red pigment) from the blood corpuscles is excreted in the urine, which therefore is dark and almost the colour of cola.

Late complications
If someone with a benign form of malaria is untreated, anaemia and an enlarged spleen may develop after days or weeks.

Ability to resist malaria attacks
Immunity to malaria develops very slowly and is quickly lost. Children living in endemic regions (where the disease occurs naturally all year round) develop their own protection against the disease over four to five years if they survive. On average one child dies every 30 seconds from malaria in these countries.

Britons neither have nor develop immunity unless they have been exposed to malaria with no protection.

It is important to remember that nationals from malarious areas who return home for holidays need the same malaria protection as ordinary travellers, because immunity develops slowly and is rapidly lost.

What can you do yourself?
There is no risk of catching malaria in the UK, but if you visit tropical and subtropical countries it is important to investigate the chances of catching malaria.

Because the situation can change rapidly, you should talk to a doctor or pharmacist before planning your trip, both as regards to products for malaria prevention and also for expert advice on avoiding other dangers and diseases.

Prevention of malaria is important. If you travel to a region where malaria is prevalent, you should take preventive medication against the parasite and take whatever steps you can to avoid being bitten.

How is the disease diagnosed?
The symptoms of malaria are similar to those of many other feverish diseases and infections, which can upset the stomach. Therefore you should always tell your doctor if you have been abroad, especially if you have been to the tropics in the last 12 months.

The actual diagnosis is made by detecting the parasite in the blood. This is done using a special product mixed with one to two drops of the patient's blood and spreading it on a microscope slide. This is then stained and examined carefully under a microscope.

The examination may have to be repeated if the fever has only just begun and/or preventive medication is to some extent keeping the numbers of the malaria parasite low.

Treatment
The treatment of malaria normally calls for admission to hospital, because it may be malignant malaria, which can have a fatal outcome in only a few days.

In addition, there is an increasing level of resistance of the malaria parasite, particularly P. falciparum, to several of the known antimalarial products.

Outpatient treatment, or worse still, self-treatment of malaria, is something only to be undertaken when no qualified medical help is available, ie if you develop malaria in a remote area.

The same antimalarial agents may be used to treat malaria as to prevent it, but if you have caught malaria in spite of using the correct preventive medication, a different product should be used to combat the possibility of resistant parasites.

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