Malaria

Organism-

Obligate intracellular parasite
Sexual reproduction in mosquitoes, asexual in humans
Only 4 species are infective to humans: P. falciparum, P. vivax, P. ovale  and P. malariae

Epidemiology

Only endemic in tropical areas of the developing world
Vector (Anopheline mosquito) present worldwide
In North America, transmission occurs after the influx of many infected persons (ex: refuges from endemic areas)
Transmission  can also occur by blood products, among IV drug users (IVDU) who shares needles and congenitally

Clinical syndromes

Initial infection is very non-specific, "flu-like"
P. falciparum infection in more fulminant than the other and is often resistant to chloroquine and is a medical emergency

Diagnosis

Blood smear

Comments on treatment

Prevention
screen, nets and DEET
Chloroquine sensitive (Haiti/Dominical Republic, Central America West and North of the Panama canal and parts of the Middle East): chloroquine phosphate
Chloroquine resistant: mefloquine, doxycycline, atovaquone
Treatment
P. vivax or P. ovale
chloroquine phosphate
chloroquine-resistant P. vivax: halofantrine
P. falciparum (chloroquine sensitive) or P. malaria: chloroquine phosphate
P. falciparum (chloroquine resistant): PO treatment
quinine + doxycycline
atovaquone + provaquine
P. falciparum (chloroquine resistant): IV treatment: quinidine