Malaria is a very serious infection which you can catch from a bite from an infected mosquito. The most common symptoms are high temperature (fever) and a flu-like illness. The symptoms of malaria can occur even up to a year after travelling in an area in which malaria is present. Prompt treatment for malaria is essential, as without treatment it can be fatal. This leaflet gives general information about malaria and its treatment.
What is malaria?
Malaria is a serious infection. It is common in tropical countries such as parts of Africa, Asia and South America. It is caused by a parasite called plasmodium. A parasite is an organism that lives on an animal and feeds from it. The parasite is passed to humans from a mosquito bite.
There are four main types of plasmodium that cause malaria. These are called Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae. Recently, another type has been discovered called Plasmodium knowlesi. Plasmodium falciparum is usually the most serious of the four.
Most infections occur in travellers returning to the UK (rather than visitors coming to the UK). The risk of getting malaria is greatest if you do not take your anti-malarial medication or do not take it properly. People who take last-minute holidays and also those visiting friends or relatives abroad have been shown to be the least likely to take their anti-malarial medication.
It was estimated that worldwide there were 214 million cases of clinical malaria in 2014 with nearly half of the world's population at risk of acquiring the infection. In 2014,1,586 people in the UK developed malaria which had been caught whilst abroad and three people died from the infection. Malaria can kill people very quickly if it is not diagnosed promptly.
Note: if you feel unwell and have recently visited an area in which there is malaria, you should seek prompt medical advice, even if you have taken your anti-malarial medication correctly.
How is malaria transmitted?
The plasmodium parasite is usually transmitted by a particular species of mosquito, which is the anopheles mosquito. If a female anopheles mosquito bites a person who is infected with malaria, the mosquito can then carry the plasmodium parasite and spread it to others when it bites and feeds from other people's blood.
When the plasmodium parasite enters your blood, it travels to your liver and then re-enters the bloodstream where it can invade your red blood cells. Eventually, these infected red blood cells burst which leads to them releasing even more of the tiny parasites into your blood. These infected red blood cells tend to burst every 48-72 hours. Each time they burst, you will usually experience an episode of chills, high temperature (fever) and sweating.
What are the symptoms of malaria?
There are two general types of malaria: benign and malignant. Benign malaria is milder and relatively easy to treat. Malignant malaria can be very severe and can sometimes be fatal.
Symptoms of malaria usually occur between one to four weeks after the initial mosquito bite. However, in some cases, depending on the type of plasmodium you are infected with, it can take up to a year before any symptoms start to show. This means that you should suspect malaria in anyone with a feverish illness who has travelled to a malaria area within the previous year, especially in the previous three months.
The most common symptom of benign malaria is a very high temperature (fever). However, the absence of fever in an ill person does not exclude the diagnosis of malaria.
Other symptoms of benign malaria may include:
- Headaches, muscle pains, tummy (abdominal) pains, cough, feeling more tired than usual and feeling generally unwell.
- Children are more tired and can have runny stools (diarrhoea) and/or sickness (vomiting).
- If you have taken anti-malarial medication then you may have different symptoms (for example, backache) if you have malaria.
- The fever in most people has no specific pattern and may present 1-2 days after the symptoms start. If the malarial infection becomes established, then malarial symptoms can come in cycles, occurring every 2-3 days (see above).
Malignant malaria is caused by Plasmodium falciparum. Malignant malaria usually begins with similar symptoms to benign malaria. However, it will often lead to your developing further complications, such as breathing problems, liver failure and shock. Malignant malaria can also affect the brain and central nervous system, which can even lead to death.
Note: if you are pregnant then you are at particular risk of severe malaria and should, ideally, not go to malaria risk areas. This is because your immune system can be weaker during your pregnancy. If you are pregnant and have malaria, you may pass the infection on to your baby.
How is malaria diagnosed?
If you think you may have malaria then you need to seek medical advice without delay. If you have travelled to an area in which there is malaria in the previous year then you may be at risk of this disease, even if you took anti-malarial medication when you were abroad.
Your doctor will perform a blood test. The blood sample will be sent to the laboratory and will be examined for the presence of the malaria parasite. The type of malaria causing the infection will also be determined. If the first blood test is negative but your doctor suspects you have malaria then you may be asked to have another blood test taken a couple of days later.
How is malaria treated?
If malaria is promptly diagnosed and treated, most people make a full recovery. Malaria is normally treated using anti-malarial medicines. Quinine, chloroquine and artesunate are some of the different types of medicines available.
The type of medicine prescribed and the duration of treatment can vary from person to person. It depends on various factors such as:
- The type of malaria that you have.
- If you have taken any anti-malarial medication when you were travelling.
- The severity of your symptoms.
If your symptoms are mild then you will be treated at home. However, if you have Plasmodium falciparum malaria then it is very likely you will be treated and monitored in hospital.
Some people are given more than one type of medication or an alternative medication if they develop side-effects to a medication. Resistance to anti-malarial medicines has spread rapidly over the past few decades, especially resistance to Plasmodium falciparum. This means that newer medicines or a combination of medicines may be given.
If the first anti-malarial medicine that you are prescribed fails to improve your symptoms, you may have to try a variety of other medicines as part of your treatment. You may find that your treatment for malaria leaves you feeling very weak and tired for several weeks afterwards.
Travellers going to remote places far from medical facilities sometimes take emergency medication with them. This can be used to treat suspected malaria until proper medical care is available.
How can malaria be prevented?
There is an 'ABCD' of malaria prevention. This is:
- Awareness of risk of malaria.
- Bite prevention.
- Chemoprophylaxis (taking anti-malarial medication regularly and exactly as prescribed).
- Prompt Diagnosis and treatment.
Further help & information
Dr Louise Newson
Dr Laurence Knott
Dr Adrian Bonsall