I chose this topic because this website is being read all over the world. Malaria, not a big problem in the United States or Canada, is a worldwide problem that we should all know about. Caring for what happens elsewhere is a win for us in and of itself. But it’s especially important if we wish to travel abroad. The world is getting smaller and smaller! I hope you enjoy my brief discussion on malaria.
The disclaimers are the same. Don’t use this to practice medicine on yourself. Don’t practice medicine on yourself in general. Trust your physicians. Obviously challenge them when you feel you need more care on something. For example, you’ll be an expert on malaria! Enjoy.
Discussion of Malaria
Malaria is extremely common in many places of the world, especially Third World areas. There’s a very famous story by a physician who was doing a sabbatical in Africa. He was assigned to a small town. On his first day, people started lining up for care. They knew the physician for the month for the town, albeit a new one for them, had finally arrived for the week. The first person he saw said in the native language, which he was just learning, that they had “fever.“ So, he worked it up aggressively, and finally figured out is malaria; he treated it. He won them over. The next patient came in. They said the same thing. After this happened a couple of dozen times, it finally dawned on him that the local word for fever was what they were calling malaria. They were telling him what he had. So he finally got over the hump of figuring this out.
Funny story. Of course, he eventually stopped massive fever work ups on one after another after another patient of every size and shape. And he simply started treating from the need to see hundreds of people in a day for the same thing. Malaria.
So, the history the patient will present with from malaria is fever. On exam, the physician will note hepatosplenic organomegaly, the enlargement of the liver and the spleen. The liver which is under the ribs on the right will hang below the rib cage, larger than it usually is. The spleen may even be palpable by pushing up deep into the left upper quadrant under the ribs. Don’t try to do this stuff on your own! This is just why the physician needs to examine your belly when you have malaria. Lab work will show liver transaminases as elevated. These are called liver function tests. But they are not really an indication of liver function. Rather, they are an indication of liver inflammation and likely dysfunction ahead. Nonetheless, this is what physicians have come to call them. The other thing ordered from the blood as an important laboratory it’s called a thick blood smear. It reveals the malarial parasite. Also obtained is something called a thin blood smear. The thin blood smear reveals more specifically falciparum. It’s extremely common that this organism is chloraquinne resistant. So the therapy of choice now is quinine and doxycycline. Travelers are routinely given doxycycline to start before their travel to avoid getting it. It is usually continued after their travel at least a week.
Malaria folks. Helps to remember that it’s everywhere even though we don’t have it. It’s nice to learn about what others in the world experience every day. Happy travels. Happy learning even if you don’t plan to travel.
