Avoiding and Recognizing Malaria

Caused by parasites of the Plasmodium species, malaria can be a deadly disease due to the severe complications it can cause. Coming in multiple types, the most common forms are Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale. The specific type found recently in Texas and Florida was Plasmodium vivax or P. Vivax, which is considered less severe compared to the other variations. (2)

Primarily spread through infected mosquitos, each version of malaria can also be passed on through the sharing of needles, blood transfusion, and organ transplants. Each vector causes infection due to the Plasmodium parasites gaining entry into the human bloodstream. (3) 

While cases have been identified in Florida and Texas, the Center for Disease Control has stated the chances of catching malaria are still “extremely low.” (4) In the instances that it does occur in the states, those that have managed to catch it are typically traveling back from tropical regions of the world, more generally, from Africa, South Asia, and South America. Such cases are known as “airport” malaria, which is when an infected mosquito infects a person before they get on the flight or when the mosquito is transported to the States and bites someone locally. (5)

In the case that the disease is locally transmitted, it is due to the mosquito escaping the airport environment and finding an environment where it can reproduce. States like Texas and Florida have regions that are well suited for mosquitos, such as swamps and forests, where standing water is able to remain undisturbed long enough for mosquitoes to age to maturity. 

In the first month after catching the disease, those that are infected with malaria won’t feel anything as it needs time to develop. Once symptoms do appear after the incubation period, they often include recurrent episodes of fever, chills, sweating, headache, fatigue, muscle and joint pain, and sometimes nausea and vomiting. These symptoms can occur in cycles, with symptoms improving and then returning periodically. The characteristic pattern of P. vivax malaria involves relapses, where the infection reactivates from dormant forms (hypnozoites) in the liver, leading to recurrent episodes of malaria over an extended period of time.

While the frequency and severity of these relapses can vary among individuals, leaving malaria untreated will result in worse symptoms. Descriptively, fever spikes may occur every 48 hours, giving a characteristic pattern of recurring seizures. Along with fever, other symptoms may persist or intensify. (6) 

It's important to note that the type of malaria that has been recently appearing in Texas and Florida (P. vivax), is one form with potential for relapse if left untreated, unlike the other types of malaria. Hypnozoites, dormant forms of the parasite, can remain in the liver and reactivate later, causing recurrent malaria episodes. These relapses may occur weeks, months, or even years after the initial infection, leading to periods of recurring symptoms.

If a doctor suspects malaria in a patient before conducting any tests, they will typically take several steps to evaluate the situation. They will gather a detailed medical history, focusing on the patient's travel history to malaria-endemic areas and potential exposure to malaria. They will also perform a thorough physical examination, looking for signs and symptoms commonly associated with malaria. When the disease is suspected, the following tests can be performed:

• Microscopic examination of blood smears: This is considered the gold standard for malaria diagnosis. A small drop of blood is collected from the patient and spread on a microscope slide. The slide is then stained and examined under a microscope to identify and count the malaria parasites present in the red blood cells.
• Rapid diagnostic tests: RDTs are simple, portable tests that can provide quick results within minutes. These tests detect specific malaria antigens or proteins in the patient's blood. RDTs are useful in settings where microscopy may not be readily available or as a preliminary screening tool.
• Polymerase chain reaction: PCR is a highly sensitive molecular technique that can detect the presence of malaria parasites by amplifying their genetic material. PCR can differentiate between different species of Plasmodium and detect low-level infections. It is particularly useful for research, surveillance, and detecting drug-resistant strains of malaria.

Malaria is treated using antimalarial medications, which aim to eliminate the Plasmodium parasites causing the infection. The specific choice of medication and treatment regimen depends on factors such as the type of malaria parasite. In the case of Plasmodium vivax, the treatment regimen will include oral antimalarial prescriptions that generally are to be taken for two weeks, such as chloroquine and Atovaquone-proguanil. 

Chloroquine is effective against Plasmodium vivax because it targets the parasite's lifecycle within the red blood cells. It is a blood schizonticide, meaning it acts on the asexual stage of the parasite's life cycle when it replicates inside the red blood cells. It works by interfering with the parasite's ability to break down hemoglobin, preventing it from obtaining the nutrients it needs to survive and reproduce.

Atovaquone-proguanil, also known as Malarone, is effective against Plasmodium vivax due to its dual mechanism of action and broad-spectrum antimalarial activity. The combination of atovaquone and proguanil in this medication targets different stages of the parasite's life cycle, making it effective against both the liver-stage and blood-stage forms of Plasmodium vivax.

While there are other options that doctors can prescribe, these two medications have proven to be the most effective. Additionally, a doctor will also suggest fever management, plenty of fluids, and bed rest. More severe cases may require professional monitoring of the patient, but such instances are incredibly rare in the United States. 

Effective treatment can help clear the malaria infection, alleviate symptoms, and prevent complications. It is crucial to diagnose and treat malaria promptly to prevent the progression of the disease and potentially life-threatening complications associated with severe malaria.

Malaria can be prevented through a combination of interventions aimed at reducing the transmission of the malaria parasite. These measures include vector control strategies to target the mosquitoes that transmit the disease, as well as personal protective measures. Vector control involves using insecticide-treated bed nets, indoor residual spraying with insecticides, and environmental management to eliminate mosquito breeding sites.

Personal protective measures include wearing protective clothing, using insect repellents, and taking antimalarial medications when traveling to regions with a high malaria risk. Early diagnosis and prompt treatment of malaria cases also contribute to preventing the further spread of the disease. 

While still rare in the United States, educating yourself about malaria transmission will help you also combat many other diseases like it. As the main mode of transmission, managing and avoiding mosquitos in your personal environment is crucial, and learning how to do so is your best chance of staying healthy even when in an area where the disease is more common.