Malaria

Malaria Overview

Anyone can get malaria, but it is not endemic in the United States. Most cases occur in people who live in countries with widespread malaria. These countries are also called malaria-endemic regions. People from or living in countries with no malaria can become infected when they travel to countries with malaria. Plasmodium falciparum is the parasite species causing malaria that can be severe and life-threatening. It is very common in many countries in Africa south of the Sahara Desert.

Military servicemembers may be exposed to malaria during deployment or travel to areas where the disease is prevalent, including Africa, Asia, the Middle East, Central and South America, and Oceania. Veterans who served in the Southwest Asia theater of operations during the Gulf War (starting August 2, 1990) or in Afghanistan on or after September 19, 2001, are presumed to have a service-connected connection to malaria if they meet certain criteria regarding diagnosis and disability.

Malaria Risk Factors

Not taking antimalarial medication when traveling to endemic countries
Not regularly using insect repellants and mosquito netting
Not wearing protective clothing

Causes:

Malaria is a disease caused by a parasite. Anopheles mosquitoes are the type of mosquito that transmit malaria from one person to another. Not all Anopheles mosquitoes have malaria, but if they bite a person with malaria, they can become infectious. Once they bite another person, this continues the cycle of spreading malaria from mosquito to people.

How it spreads:

Most people get malaria when bitten by an infective mosquito carrying the malaria parasite. Only female Anopheles mosquitoes can spread malaria from one person to another. Malaria is not contagious. People can’t spread malaria to other people like a cold or the flu, through casual contact, close physical contact, or even sexual contact.

In rare occasions, malaria can spread through:

Blood transfusions,
Organ transplant,
Sharing needles or syringes contaminated with malaria-infected blood, or
Congenitally, meaning from a mother to her unborn infant before or during delivery.

At-Risk Populations

Veterans may have contracted malaria while deployed to certain parts of Asia, Africa, Central and South America, and other malaria-endemic regions.
People who have little or no recent exposure to malaria parasites.
Includes young children and pregnant women, or travelers coming from areas with no malaria. People heavily exposed to the bites of mosquitoes infected with falciparum.
People living in rural areas who lack access to health care.

Malaria Signs and Symptoms

Malaria symptoms range from very mild illness to severe disease and even death. The incubation period between the infection and development of malaria symptoms generally varies from 7 to 30 days. One strain has an incubation period of 8 to 10 months. With infection from some malaria species, relapses can occur months to years later.

Early symptoms may include:

Fever and flu-like illness
Chills
Headache, muscle aches, and tiredness
Nausea, vomiting, and diarrhea may also occur

Severe symptoms can include:

Kidney failure
Seizure
Mental confusion
Coma

Malaria Treatment

In general, the drugs taken to prevent malaria are the same drugs used to treat the disease. Starting treatment immediately is the best way to treat malaria and prevent serious and life-threatening issues. Patients in the U.S. are typically hospitalized for treatment. The types of drugs and length of treatment depend on several factors.

Factors affecting drug choice:

Type of malaria parasite
Geographic location of infection
Severity of symptoms
Age
Pregnant or not

Most common antimalarial drugs include:

Chloroquine phosphate.Chloroquine is the preferred treatment for any parasite that is sensitive to the drug. But in many parts of the world, parasites are resistant to chloroquine, and the drug is no longer an effective treatment. Also, prolonged use has been linked to psychosis, depersonalization, anxiety, and visual hallucinations.
Artemisinin-based combination therapies (ACTs).Artemisinin-based combination therapy (ACT) is a combination of two or more drugs that work against the malaria parasite in different ways. This is usually the preferred treatment for chloroquine-resistant malaria. Examples include artemether-lumefantrine (Coartem) and artesunate-mefloquine.
Mefloquine (Lariam®): Used widely for years for malaria prevention, but its long-term health effects are a concern for millions of servicemembers and veterans who took it. Some veterans who took mefloquine have experienced neuropsychiatric problems, including anxiety, depression, paranoia, agitation, personality changes, poor memory, and even suicidal ideation.

Other common antimalarial drugs include:

Atovaquone-proguanil (Malarone)
Quinine sulfate (Qualaquin) with doxycycline (Oracea, Vibramycin, others)
Primaquine phosphate

Malaria Long-Term Complications

If not treated right away, the infection can become serious, and malaria symptoms may become more severe. It may cause:

Anemia (low red blood cells)
Jaundice (yellow coloring of the skin and eyes)
Mental confusion, personality disorders, mood changes, memory problems, attention deficits, and behavioral issues
Psychiatric symptoms from mefloquine can occur early in treatment and continue for months or even years after the drug discontinued
Loss of balance, dizziness, or tinnitus from mefloquine may become permanent
Kidney failure
Seizures, coma, death

Cerebral Malaria — severe complication of malaria where parasite-filled blood cells block small blood vessels in the brain, leading to swelling and damage. This can cause seizures, coma, and long-term neuropsychiatric effects. Long-term behavioral problems and impairments in performance and learning have been noted in individuals who experienced cerebral malaria.

Other Resources And Support

https://www.cdc.gov/malaria/

https://www.publichealth.va.gov/exposures/infectious-diseases/malaria.asp