Morbidity and mortality due to
malaria remains an important health problem for travelers visiting endemic zones. In this population, typical episodes of
chills and
fever followed by diaphoresis are not always observed; inaugural signs may limited to low-grade
fever accompanying digestive disorders. Early diagnosis is nevertheless essential to prevent progression to acute pernicious
malaria. Blood smears, quantitative butty coat (QBC) test or the Parasight test can give rapid diagnosis.
Chloroquine is the
drug of choice for Plasmodium vivax, P. ovale or P. Malariae
infection, but
chloroquine-resistant P. falciparum is widespread in tropical zones and resistant P. vivax has been reported in Indonesia. Currently,
halofantrine is the best treatment for P. falciparum
infection, although
cardiac toxicity may occur in patients with a long QT on the electrocardiogram.
Mefloquine can be alternative. The
sulfadoxine-pyrimethamine combination is also used in many tropical zones because of its low cost and availability, but many resistant strains of P. falciparum have been identified. Use of
quinine is also widespread in tropical zones. This basic
antimalarial is rapidly effective but is also rapidly eliminated, necessitating repeated oral doses.
Intramuscular injection may provoke
necrosis. The main indication for
quinine is acute pernicious P.
falciparum malaria, but the
drug is also used for simple episodes of
fever in many tropical zones. Symptomatic care including fluid replacement,
oxygen, transfusion,
diuretics, respiratory assistance and dialysis may also be required in some cases. Use of
corticosteroids or exsanguinotransfusion remains a question of debate. When administered rapidly,
fever should regress within a few days. Neurological sequellae are exceptional after acute pernicious
malaria in adults but may occur approximately 5% of children, emphasizing the importance of associating
chemoprophylaxis and protection against
insect bites. There has been much publicity concerning a
vaccine, but results to date have been disappointing.