Fever
- Fever in Thailand
A fever occurs when your temperature rises above
its normal range. What's normal for you may be a
little higher or lower than the average temperature
of 37 C. That's why it's hard to say just what a
fever is. But a "significant" fever is usually
defined as an oral or ear temperature of 38 C or a
rectal temperature of 39 C. If you're an adult, a
fever may be uncomfortable, but it usually isn't
dangerous unless it rises above 39 C. For very
young children and infants, however, even slightly
elevated temperatures may indicate a serious
infection. In newborns, a subnormal temperature -
rather than a fever - may be a sign of serious
illness.
The Prevention and
Treatment of Malaria
Avoidance of Bites
Mosquitoes cause much
inconvenience because of local reactions to the bites themselves and
from the infections they transmit. Mosquito bites spread other diseases
such as yellow fever, dengue fever and Japanese B encephalitis.
Mosquitoes
bite at any time of day but the
anopheles bites in the night with most activity at dawn and dusk. If you
are out at night wear long-sleeved clothing and long trousers.
Mosquitoes may bite
through thin clothing, so spray an insecticide or repellent on them.
Insect repellents should also be used on exposed skin.
Spraying insecticides
in the room, burning pyrethroid coils and heating
insecticide impregnated tablets all help to control mosquitoes. If you
are sleeping in an unscreened room a mosquito net (which should be
impregnated with insecticide) is a sensible precaution. If sleeping out
of doors it is essential. Portable, lightweight nets are available.
NOTE: Things like Garlic, Vitamin B and ultrasound devices do not
prevent mosquito bites.
Taking Anti-Malaria
Tablets
It should be noted
that no prophylactic regimen is 100% effective and advice on malaria
prophylaxis changes frequently. There are currently five prophylactic
regimens used (A,B,C,D & E), due to the differing resistance that exists
by the malaria parasites to the various drugs used. (See the above map
of Malaria Endemic Areas).
The tablets you require depend
on the country to which you are traveling. Start taking the tablets
before travel take them absolutely regularly during your stay,
preferably with or after a meal and continue to take them after you have
returned. This is extremely important to cover the incubation period of
the disease.
Prompt Treatment
If you develop a
fever between one week after first exposure and up to two years
after your return, you should seek medical attention and inform the
doctor that you have been in a malarious area.
Anyone with suspected malaria should be treated under medical
supervision as soon as possible. If malaria is diagnosed then treatment
is a matter of urgency. Treatment should not normally be carried out by
unqualified persons.
The drug treatment of malaria depends on the type and severity of
the attack. Typically, Quinine Sulphate tablets are used and the normal
adult dosage is 600mg every twelve hours which can also be given by
intravenous infusion if the illness is severe.
Remember: Prevention is better than cure and over two million
people die from malaria every year. It is a very serious illness!
Side Effects of
Anti-Malarials
Like all medicines,
anti-malarials can sometimes cause side-effects:
Proguanil (Paludrine) can cause
Nausea and simple mouth ulcers.
Chloroquine (Nivaquine or
Avloclor) can cause
Nausea, temporary blurred vision and rashes.
Patients with a history of
psychiatric disturbances (including
Depression) should not take mefloquine as it may precipitate these conditions. It is now advised
that mefloquine be started two and a half weeks before travel.
Doxycycline does carry some risk
of photosensitisation i.e. can make you prone to sunburn.
Malarone is a relatively new
treatment and is virtually free of side effects.
No other tablets are required
with mefloquine or doxycycline or Malarone.
Drug Resistance
It is the plasmodia that cause
malaria that develop resistance to anti-malarial drugs not the
mosquitoes that transmit the disease.
Resistance to antimalarial drugs is proving to be a challenging problem
in malaria control in most parts of the world. Since the early 60s the
sensitivity of the parasites to chloroquine, the best and most widely
used drug for treating malaria, has been on the decline.
Drug resistance is the ability of a parasite species to survive and
multiply despite the administration of a drug in doses equal to or
higher than those usually recommended but within the limit of tolerance.
Newer antimalarials have been developed in an effort to tackle this
problem, but all these drugs are either expensive or have undesirable
side effects. Moreover after a variable length of time, the parasites,
especially the falciparum species, have started showing resistance to
these new drugs.
Drug resistance is most commonly seen in P. falciparum. Only sporadic
cases of resistance have been reported in P. vivax malaria. Resistance
to chloroquine is most prevalent, while resistance to most other
antimalarials has also been reported.
The discovery of chloroquine
revolutionalised the treatment of malaria, pushing quinine to the
sidelines. However, resistance to chloroquine began from 2 epi-centres –
Columbia (South America) and Thailand (South East Asia) in the early
1960s. Since then, resistance has been spreading world wide.
Recently, cases of mefloquine resistance have been reported from areas
of Thailand bordering with Burma and Cambodia (see map right).
Structurally mefloquine is similar to quinine and hence cross resistance
is common. It is therefore recommended that travelers avoid mefloquine
when traveling to Thailand since it is easy to induce resistance for
mefloquine due to its prolonged half life.
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