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Each year over 200 million people contract malaria worldwide. While it’s a major public health problem in some parts of the world, it’s fair to say that most people born in the United States have never met a person sick with malaria. Americans, however, are traveling the world more than ever before, putting them face-to-face with malaria parasites. The good news is that, while malaria is a serious infection, it is very preventable. Understanding the disease and taking preventive measures while traveling can drastically decrease the chance of infection. Learn more in the sections that follow.
What is malaria?
Malaria is a serious and sometimes fatal parasitic infection of the liver and blood. Although malaria is one of the most common parasite infections among humans, it has been virtually eradicated in the United States. According to the Centers for Disease Control and Prevention (CDC), about 2,000 people in the United States contract malaria each year, and that group is mainly made up of immigrants and travelers.
Malaria is not spread from person to person. Instead, immature malaria parasites enter a person’s bloodstream when an infected mosquito bites a person to feed on blood. The malaria parasites spend the first part of their life cycle in a person’s liver cells, where they develop into more mature parasites in about one to two weeks. The mature parasites break out of the liver cells and infect red blood cells in the bloodstream. Malaria symptoms start when the parasites infect the blood cells and rapidly multiply. Sexual forms of the parasites can then be ingested by a mosquito where they can develop and be transmitted to another human to continue the life cycle. Depending on the species, some malaria parasites lie dormant in liver cells and can cause reinfection months or even years later.
Malaria is caused by a group of parasites called Plasmodium. There are five different species of Plasmodium, which include: P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi. Some species are more prevalent than others in certain parts of the world. The severity of malaria symptoms may also depend on the species. For instance, P. falciparum causes the most deadly form of malaria while P. vivax is the most widespread, causing severe infections.
Malaria is classified as either uncomplicated malaria or severe malaria. Both are primarily defined by the severity of symptoms and the number of parasites circulating in the blood (parasitemia). People who have never been infected with malaria are at the highest risk for severe infections.
While most people recover, malaria can result in serious and potentially lethal complications, such as cerebral malaria, anemia, kidney failure, severe anemia, circulatory failure, fluid in the lungs, and acute respiratory distress. Of the many serious complications, cerebral malaria accounts for four out of five malaria deaths. Cerebral malaria is most often associated with P. falciparum, which, unlike other Plasmodium species, causes red blood cells to “stick” to blood vessels. When blood vessels in the brain get blocked by infected blood cells, swelling in the brain can cause seizures, coma, and death.
Treatment consists entirely of antimalarial drugs and will depend on the parasite species, its drug resistance, and the condition of the patient. Because travel is the only risk factor for Americans, malaria is preventable through common-sense precautions and prophylactic antimalarial drugs.
How is malaria diagnosed?
In the United States, malaria is usually diagnosed from symptoms and patient history. It can then be confirmed with a microscopic examination of blood samples. While many patients are treated by general practitioners, an infectious disease specialist may be consulted.
The classic symptoms of malaria are:
- Fever
- Chills
- Headache
- Nausea
- Vomiting
- Diarrhea
- Muscle aches
- Fatigue
Fever is the defining symptom and may come and go in two- or three-day cycles.
Alarm symptoms indicating a severe infection or serious complications include:
- Jaundice
- Trouble breathing
- Abnormal bleeding
- Abnormally low blood sugar
- Anemia
- Dark urine
- Excessive vomiting
- Confusion
- Seizures
- Coma
A definitive diagnosis is made by analyzing blood samples under a microscope. This analysis helps identify the infecting species and determine the severity of the infection by counting the number of parasites. If a microscopic examination is not possible, rapid diagnostic testing (RDT) can identify a malaria infection.
Imaging is not necessary, but X-rays, CT scans, or an MRI may be used if the doctor sees signs of severe complications, such as fluid in the lungs.
Malaria treatment options
Malaria is treated with antimalarial drugs. Most healthcare professionals in the United States rarely encounter malaria infections, so they will usually follow treatment guidelines established by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).Except in severe and life-threatening infections, treatment of malaria does not begin until the infection has been definitively verified by microscopic examination of a blood smear. The drug regimen used will depend on the malaria species, the severity of the infection, the patient’s ability to tolerate side effects, and the region of the world where the infection was acquired. Malaria in some areas is resistant to the first-line antimalarial drugs, chloroquine and hydroxychloroquine.
Following CDC guidelines, patients who are infected with malaria for the first time will be admitted to a clinic or hospital for 24 hours of observation. For severe cases or high-risk patients, supportive care, fluid replacement, hospitalization, or intensive care may be required to prevent or treat complications.
Malaria is a preventable infection, so the best treatment is prevention. Mosquito bites are the only way to catch malaria, so travelers can avoid infection through simple common-sense measures when traveling to countries where malaria is transmitted:
- Wear long-sleeved shirts, long pants, and socks
- Use insect repellents on exposed skin
- Stay inside at night, dawn, and dusk when mosquitoes are active
Currently, there is no licensed vaccine against malaria. A physician or travel clinic can supply antimalarial drugs to take when traveling to endemic areas. Travelers will take daily doses of these drugs starting from a few days before they leave until two to four weeks after they return.
Malaria medications
Doctors follow well-established guidelines when prescribing antimalarial drugs. Combination drug therapy is used to target malaria parasites at all stages of their life cycle. The drug combination used will depend on the malaria species, the likelihood of drug resistance, and the patient’s physical status.
Antimalarial drugs
Antimalarial therapy typically takes two to three days. Patients with uncomplicated malaria will receive antimalarial pills, but some people with severe malaria may be started on intravenous antimalarial agents, such as artesunate. Microscopic analysis of blood samples is required to monitor the progress of the treatment.
For most infections, the treatment of choice will be a combination of chloroquine (or hydroxychloroquine) and primaquine, but other common first-line treatments are atovaquone-proguanil or artemisinin-based combination therapy (ACT).
Chloroquine is a powerful antimalarial agent that targets malaria parasites in the blood. Primaquine is a similar drug but kills latent malaria parasites in the liver.
Atovaquone-proguanil,also known as malarone, is used for P. falciparum infections that are resistant to chloroquine. This combination of drugs works to inhibit the growth of the parasites.
Artemisinins are highly effective against malaria parasites at all stages in their life cycle. Artemether-lumefantrine is the most commonly-used combination for chloroquine-resistant malaria.
Not all patients can take these drugs, so second-line therapies may include quinine sulfate, tafenoquine, mefloquine, pyrimethamine, and the antibiotics doxycycline, tetracycline, or clindamycin.
What is the best medication for malaria?
There is no “best” medication for malaria. Doctors treat malaria following well-established combination therapy protocols used throughout the world. The drugs prescribed will depend on the malaria species, drug resistance, and the patient’s physical status and tolerance for side effects.
| Best medications for malaria | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Chloroquine | Antimalarial | Oral | Initial dose of 1000 mg, followed by 500 mg six to eight hours later. Then, 500 mg daily for two days. | Headache, nausea, stomach cramps |
| Plaquenil (hydroxychloroquine) | Antimalarial | Oral | Initial dose of 800 mg, followed by 400 mg 6, 24, and 48 hours after the initial dose | Nausea, stomach pain, headache |
| Primaquine | Antimalarial | Oral | 52.6 mg or 26.3 mg once daily for 14 days | Nausea, stomach pain, loss of appetite |
| Malarone (atovaquone-proguanil) | Antimalarial | Oral | Four 250-100 mg tablets daily for three consecutive days | Headache, nausea, diarrhea |
| Coartem (artemether-lumefantrine) | Antimalarial | Oral | Initial dose of four 20-120 mg tablets. Then, four 20-120 mg tablets eight hours after the initial dose. Then, four 20-120 mg tablets twice daily for two consecutive days | Headache, loss of appetite, dizziness, nausea |
| Qualaquin (quinine sulfate) | Antimalarial | Oral | Two 324 mg capsules every eight hours for three or seven consecutive days | Headache, nausea, blurred vision |
| Artesunate | Antimalarial | Intravenous injection | 2.4 mg/kg body weight. Injections given at 0, 12, and 24 hours, and then once daily until treatment with oral antimalarial drugs can begin | Kidney failure, jaundice, anemia |
| Lariam (mefloquine) | Antimalarial | Oral | Five 250 mg tablets given as a single dose | Dizziness, headache, abdominal pain |
| Arakoda (tafenoquine) | Antimalarial | Oral | Two 150 mg tablets given as a single dose | Dizziness, headache, nausea |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of malaria medication?
All antimalarial drugs produce side effects that vary depending on the specific drug. This is not a complete list, so consult with a healthcare provider if you have any questions or concerns about possible side effects.
Quinoline drugs (quinine, chloroquine, primaquine, hydroxychloroquine, mefloquine, and tafenoquine) can cause common side effects such as headache, dizziness, vomiting, diarrhea, and abdominal pain.. Quinoline drugs can also cause a collection of symptoms known as cinchonism, which can result in deafness or blindness in severe cases. Psychiatric effects such as mood changes, sleep disturbances, and bizarre dreams are also reported. The most serious side effects are life-threatening blood problems, cardiac arrhythmias, and liver damage.
Like quinolines, artemisinins (artesunate, artemether, artemisinin, and artemisone) are also derived from a plant (wormwood). They, too, can cause adverse effects in the central nervous system and the liver. Side effects may include nausea, vomiting, dizziness, and hearing problems. Like quinolines, artemisinins can cause heart arrhythmias as well as liver damage. Because of this, many are not FDA-approved and only available to doctors through the CDC.
The most common side effects of atovaquone-proguanil are headache and digestive system problems (nausea, vomiting, diarrhea).
What is the best home remedy for malaria?
There is no safe alternative treatment other than antimalarial drugs. Although brief—usually two to three days—antimalarial drug therapy can produce difficult and sometimes serious side effects. It’s understandable that people will want to explore alternative treatments, but malaria is a serious and potentially fatal infection that can recur if not properly treated.
Natural treatments
Herbal treatments for malaria are well-documented and well-studied. A worldwide scientific initiative has been in place for over twenty years studying traditional malaria treatments. Nearly all antimalarial drugs, after all, are derivatives of substances found in plants. Scientific research has shown that some natural remedies are effective at reducing symptoms and a few have been shown to reduce parasites in the blood. Unfortunately, none of these plants are easily available in the United States. There is no scientific evidence that commonly-advised natural treatments for malaria, such as ginger, grapefruit, basil, cinnamon, garlic, or apple cider vinegar, substantially alleviate symptoms or reduce the number of parasites.
Take over-the-counter pain relievers
Fever and pain can be controlled with over-the-counter pain relievers such as acetaminophen, ibuprofen, naproxen, or aspirin. Malaria symptoms, however, are caused by the immune system’s reaction to parasites in the bloodstream. Antimalarial drugs quickly reduce parasites in the blood, so patients typically see a rapid resolution of symptoms in one or two days.
Frequently asked questions about malaria
Are malaria pills bad for you?
Are antimalarial drugs bad for you? Look at this way. Viruses, bacteria, and fungi are very different from human cells. In treating infections, drugs can target processes unique to those organisms without affecting human cells . . . much. Malaria parasites, however, are much like human cells. Many antimalarial drugs target processes in malaria parasites that are shared by human cells. That’s why side effects can be serious.
How many injections do you need for malaria?
Intravenous or intramuscular injections for malaria may be required for those with severe infections or pregnant women. Injections will be continued until symptoms improve and the number of parasites in the blood has declined to a certain level. Patients will then be transitioned to oral antimalarial drugs.
How much does a malaria vaccine cost?
There is currently no licensed malaria vaccine available. A travel clinic, however, may supply antimalarial tablets as a prophylactic treatment in some cases.
Which are the best anti-malaria tablets?
There is no “best” antimalarial drug. Doctors follow protocols established by the World Health Organization to treat malaria based on the species, possible drug resistance, the severity of the infection, and the patient’s physical status.
Which malaria drug causes nightmares?
Quinoline drugs (quinine, chloroquine, primaquine, hydroxychloroquine, mefloquine, and tafenoquine) can be neurotoxic. Among their side effects are neuropsychiatric disorders, such as insomnia, mood changes, and vivid dreams. All can cause nightmares. However, mefloquine has the highest incidence of neuropsychiatric disorders including nightmares, depression, and violence.
What is the best cure for malaria?
There is no “best cure” for malaria. The only way to effectively kill the parasites and permanently reduce the risk of recurrence are antimalarial drugs. Doctors will prescribe a drug combination based on the type of malaria, its drug resistance, and the physical status of the patient.
What plant can cure malaria?
The two most common classes of antimalarial drugs are plant-derived. Quinine, the fundamental basis of quinoline drugs, is extracted from the cinchona tree. Artemisinin, the basis of artemisinin derivatives, comes from wormwood.
Can garlic cure malaria?
Allicin, a compound found in garlic, is a sulfur drug that has been shown to inhibit bacterial growth, tumor cell growth, and malaria parasite growth. Allicin and other sulfur-containing substances in garlic have been widely studied, but no-one knows how much garlic must be eaten to have any effect on malaria infection.
Can drinking water cure malaria?
Tonic water contains quinine, an antimalarial drug extracted from the cinchona tree. In the 19th century, British colonists in India invented tonic water to prevent and treat malaria. Back then, however, tonic water contained a hefty dose of quinine and packed quite a punch. Today, tonic water contains only a small amount of quinine for flavor. To consume the equivalent of a therapeutic dose of quinine, you would need to drink more than a gallon and a half of tonic water. It will work, but wouldn’t a pill be easier?
Can I buy malaria tablets over the counter?
Antimalarial drugs are available by prescription only. When traveling to countries where malaria is prevalent, antimalarial drugs can be acquired from travel clinics.
Is ginger good for malaria?
Ginger is used as a home remedy to reduce swelling and fever. It may help reduce fever due to malaria. However, it does not treat the malarial infection itself. The only effective way to clear the parasites from the body, reduce the risk of complications, and prevent recurrence is through antimalarial drugs.
Is coconut water good for malaria?
Coconut water is a traditional remedy for malaria in many tropical countries. Its effects on malaria have been studied in animals, but not in people.