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Synonyms

There are many names for the fever of malaria, reflecting its geography and clinical presentation: some are in general and widespread use, others are well known only in small regions. They cannot all be listed here, but amongst the geographic names are the Cameroon, Corsican, West African, Panamanian, Roman, jungle, marsh, miasmic, coastal, and tropical fevers. The clinical approach is shown by congestive, remittent, intermittent bilious, remittent gastric, algid, typhoid-malarial, tertian, quartan, quotidian, and acute-pernicious fevers. The names due to complications include blackwater fever, malarial nephrosis, hemoglobinuric, falciparum malaria, bilious hematuric fever, and melanuric fever; there are many others and the multitude of names is a reminder of the numerous ways in which malaria can affect the patient and how widespread it still is.

Sp: Aire infecto. Fiebre palúdica. Fr: Malaria. Paludisme. Fievre paludeenne. Ger: Wechselfieber. Sumpffieber.

Definition

Malaria is the general name for a disease caused by any species of the genus Plasmodium (WHO). In man, the four most frequent are P. falciparum, P. vivax, P. malariae, and P. ovale. Of these four, P. falciparum and P. vivax are the most common, but mixed infections can occur. There are very rare infections by other Plasmodia, some of which may cause severe illness.

Laboratory Diagnosis

The diagnosis is made by examination of a thick film of blood, preferably stained with Giemsa. A thin blood film preserves the parasite and red blood cells more clearly. Recognition of the species is important (consult clinical or laboratory texts for complete details). The rapid diagnosis of P. falciparum can be made with a dip-stick test which is very sensitive and has good specificity. There are many other helpful laboratory findings, including DNA probes.

Fig. 46.1. Geographic distribution of malaria.

Etiology

Malaria is widespread throughout the tropics (Fig. 46.1) and is passed from person to person by female anopheline mosquitoes. It can also be transmitted by infected blood, e.g., during blood transfusion. Transmission has also occurred during organ transplantation. Intrauterine transmission is rare, but can happen when there is a heavy malarial parasite concentration in the maternal blood.

Infection alone does not always indicate active malaria: repeated infection can result in tolerance to the parasite, and the hemoglobinopathies (especially sickle cell and ß-thalassemia) offer some protection.

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Copyright: Palmer and Reeder