Malaria

General aspects:

• Travellers to all tropical countries are at some risk.

• Malaria is endemic in 102 countries; 4 2.3 billion people are at risk.

• The risk is very low in the major cities of Central and Southern America and South-East Asia but can be high in some African cities.

• Malaria is either benign (vax, ovale) or malignant (falciparum).

• Resistance to many drugs is increasing:

o The lethal Plasmodium falciparum is developing resistance to chloroquine and the antifolate malarials (Fansidar and Maloprim). 4 o Resistance is now reported to mefloquine.

o CRFM is common in South-East Asia, Papua New Guinea, northern South America and parts of Africa.

• Chloroquine is still effective against P. ovale and P. vivax (the most common forms).

• The long-awaited vaccine will make all the complex drug management much simpler. However, it still appears to be many years away despite considerable research.

• Patients who have had splenectomies are at grave risk from P. falciparum malaria.

• People die from malaria because of delayed diagnosis, delayed therapy, inappropriate therapy and parasite-host factors.

• Practitioners should follow updated recommended guidelines, e.g. NH&MRC, WHO.

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