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Malaria: how is it caught and how is it cured?

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Malaria: how is it caught and how is it cured?

The malaria it is an infectious disease caused by such a parasite plasmodiumwhich is transmitted to humans through mosquito bites Anopheles. The latter in turn became infected by “sucking” blood from an already infected person. There are several types of parasites that cause malaria in humans:

Plasmodium falciparum. It is widespread especially in Africa and is responsible for the most serious and lethal form.
Plasmodium vivax. It is mainly present in Asia and South America and can remain “dormant” in the liver for up to three years, even without causing any disturbance.
Plasmodium ovale. It is widespread in West Africa and, like the previous one, can remain silent in the liver without triggering obvious symptoms.
Plasmodium malariae. It is a rare parasite, which generates a form of malaria called “quartana” and is found mainly in Africa.
Plasmodium knowlesi. Present in some areas of south-east Asia, it is quite rare.

The malaria situation in Italy

On November 17, 1970, the World Health Organization officially declared that Italy had freed itself from malaria. This disease, therefore, disappeared from our country fifty years ago. The cases of disease that occur are mainly linked to tourists returning from areas where the disease is still present. According to the Health portal of the Istituto Superiore di Sanità, the disease is present in:

Large areas of Africa and Asia Central and South America Haiti and the Dominican Republic Some areas of the Middle East Some Pacific islands

The malaria situation in the world

According to World Malaria Report 2023 of the World Health Organization, in 2022, malaria infections in the world experienced a sharp surge: the cases recorded were 249 million, 5 million more than in 2021 and almost 17 million more than in 2019. Above all, the spotlight is on climate changes, which could not only create environments favorable to the transmission of the infection but also trigger migrations of individuals without immune defenses towards endemic areas. This happened, for example, in Pakistan: Due to extreme climate events, malaria cases increased 5 times in 2022 compared to 2021.

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However, there is also good news coming from the rest of the world. The first Vaccine approved to fight malaria (read more below) ha reduced deaths among African children by 13% e it reduced cases of severe malaria by 22% in children who received three doses of the vaccine. The data emerge from the pilot study, which lasted almost 4 years, conducted following the launch of the RTS,S (or Mosquirix) vaccine and which involved Ghana, Kenya and Malawi.

Furthermore a note from the OMS reports that, at the beginning of 2024, Cape Verde has become the third malaria-free African countryafter Mauritius (in 1973) and Algeria (in 2019).

How is it transmitted?

The parasites are transmitted to humans through mosquito bites Anopheles femaleswhich become infected by biting a person already ill with malaria and then transmit the parasite plasmodium biting other people. Malaria infection can also occur as a result of infected blood transfusionbut this is an extremely rare occurrence.

In Italy, in fact, there are laws that exclude from donating blood people who have stayed in risk areas and/or who have undergone anti-malarial chemoprophylaxis. In any case, the infection cannot be transmitted directly from person to person.

What is the incubation period of the parasite?

The incubation period of malaria, i.e. the time elapsed between the bite of the infected mosquito and the appearance of the first clinical symptoms, varies based on the type of parasite. For the Plasmodium falciparum is 7-14 days, for Plasmodium vivax and the Plasmodium ovale is 8-14 days, for Plasmodium malariae is 7-30 days.

What are the symptoms of malaria?

The symptom that should arouse suspicion, especially in people who have recently returned from countries where malaria is present, is feverwhich often reaches and exceeds 40 degrees and is associated with strong temperatures chills, intense sweating, vomit, diarrhea, heachache e widespread pain. If these symptoms appear upon returning from a trip to countries at risk of malaria, you should consult your family doctor as soon as possible: if he deems it necessary, he can prescribe a blood test to verify the presence or absence of the parasite in the blood.

How is it treated?

If detected early, malaria can be completely eradicated. Some antimalarial drugs used to prevent the infection are the same as those used to treat it. However, when you take an antimalarial to avoid contracting the disease, it should not be used to treat an attack. So, in case you contract the infection, you must inform your doctor about the medications you are taking for pharmacological prophylaxis.

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In any case, the choice of a drug for the treatment of malaria depends on the infecting parasite, the severity of the symptoms, the age of the patient and the state of health (it is necessary to evaluate, for example, whether a pregnancy is underway). Your doctor can prescribe an antimalarial medicine or a combination of several medicinesused in the form of tablets or capsules.

“Emergency” treatment

In the event that a person were to travel to an endemic country and stay here for a long time, the doctor might suggest bringing some medicines with them for possible emergency treatment. This could happen especially if there is little or no access to medical care in that place. The most used combinations, in these cases, are:

atoviquone con proguanil,
artemetere con lumefantrina,
chinine and doxycycline,
quinine and clindamycin.

Malaria and pregnancy

The subjects who are most affected by the effects of malaria are, in addition to the elderly and children, women pregnant women. It is no coincidence that the World Health Organization recommends that the latter avoid travel to risk areas because the infection could lead to serious complications. If this is not possible, the pregnant woman must consult her doctor to understand which antimalarial she can take (in fact, not all of them can be taken during pregnancy).

How to prevent malaria

Antimalarial drugs are used to both prevent and treat malaria. Before embarking on a trip to risk areas, you should always find out from the regional specialist centers on the behavior to adopt before leaving and during your stay. The risk of contracting the infection is reduced by using a combination of behavioral prevention measures e di pharmacological prevention measures.

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Behavioral measures. Avoid, if possible, being outdoors during the hours in which Anopheles mosquitoes are active (after sunset onwards) and wear light colored clothes with long sleeves and pants that cover most of the body. It is always a good idea to apply on exposed skin DEET-based insect repellents. You should stay in environments equipped with air conditioners or, in the absence of these, of mosquito nets on the windows. In the absence of mosquito nets and air conditioning systems in the residential structure, spray insecticides based on pyrethrum or its derivatives in the living rooms and bedrooms, or use insecticide diffusers (operating on electricity or batteries, with plates or liquids) that contain pyrethrum derivatives (remember to ventilate the rooms well before staying there).
Pharmacological prophylaxis. Behavioral prophylactic measures can be combined with pharmacological prophylaxis which further reduces the risk of infection. To date, however, there is no antimalarial drug that prevents contagion in 100% of cases. The drugs most used for prophylaxis areatovaquone-proguanilethe doxycyclinethe meflochin e clorochina-proguanile.

Malaria vaccine

The green light for the malaria vaccine arrived at the end of 2021, Mosquirix, the first capable of preventing the disease. The studies conducted showed that this vaccine, which is not only the first created for malaria but also for a parasitic disease in general, had an effectiveness of approximately 50% against severe malaria in the first year. To find out more, read our in-depth analysis.

What are the complications?

As has been said, if diagnosed early, malaria can be completely eliminated. If not treated promptly, however, it can lead to serious complications: l’anemia gravethat is, when red blood cells do not transport enough oxygen into the tissues, the cerebral malariawhich causes permanent brain damage, kidney and liver failure, shock, dehydration, pulmonary edema, swelling and spleen injury.

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