Malaria, a disease with staggering mortality worldwide, is increasingly encountered in US emergency departments. Given both the unfamiliarity of US physicians with the disease and its nonspecific manifestations, the potential for misdiagnosis increases the risk of morbidity and mortality associated with malaria diagnosed in US emergency departments. Maintaining a high index of suspicion and eliciting a travel or blood transfusion history in any patient who presents with fever and nonspecific symptoms is central to making the diagnosis. Spreading resistance to standard antimalarial therapy and the recognition of the mortality associated with Plasmodium falciparum infection has led to the development of better guidelines for therapy, including intravenous quinidine gluconate therapy and exchange transfusion. This article outlines these and other issues crucial to the diagnosis and management of malaria in the emergency department.
MALARIA, as an insidious and nefarious disease, has managed to wield its lethal power by developing resistance to both pesticides and antimalarial therapies. Malaria currently accounts for 75% to 90% of pediatric deaths in sub-Saharan Africa, with mortality worldwide ranging from 1.0 to 2.75 million deaths per year and cases totaling 300 to 500 million each year. 1-3
It is surmised that insecticide resistance, war and civil disturbances, population increase, and environmental changes are the underpinnings of the malaria resurgence. Both the sharp increase in plasmodium resistance to existing antimalarials and the dearth of research dedicated to the development of new antimalarials signal the potential for an uncontrolled malarial epidemic. The elimination of endemic malaria from North America (last reported case in the United States in 1940s) and Europe and the failure of a worldwide malaria eradication program led to waning interest in this disease, with a great decline in the manufacture of modern antimalarial therapy; out of the 1223 drugs developed from 1975 to 1996 only 3 were antimalarial agents. 4
Given the globalization of the travel industry, with increasing US citizen/resident travel to malaria endemic countries and immigration of people from malaria endemic regions to the United States, malaria is now a disease that is encountered with some frequency in Emergency Departments across the North America. 2