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Malaria

Fever - Fever in Thailand

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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).

  • Parasites
  • 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.Plasmodia

    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.

    chloroquine

    Malaria > 1 > 2 > 3 > 4

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