Malaria

Malaria is the preeminent infectious threat to the unwary tropical traveler.It is a mosquito-borne, protozoan infection of red blood cells that causes fever, headache, malaise, myalgias, prostration, vomiting, dehydration, and delirium-protean symptoms that mimic many infectious diseases.Untreated, malaria can cause severe anemia, thrombocytopenia, jaundice, hepatosplenomegaly, acidosis, kidney failure, noncardiogenic pulmonary edema, convulsions, coma, and death.75,Since antiquity, few diseases have caused such relentless human suffering.Nearly 40% of the world's 5.6 billion inhabitants-2.2 billion people in 100 countries-live in a broad tropical belt teeming with malaria (Fig. 1).Each year they suffer 300 to 500 million new cases of malaria and 1.5 to 3.5 million deaths, 90% occurring in rural, sub-Saharan Africa, overwhelmingly in children less than 5 years old.1h,134 Poverty, famine, war, social and ecologic upheaval, economic exploitation of the jungle, and vast, uncontrolled movements of nonimmune refugees into malarious areas have conspired to worsen its toll.'",136 Its legacy has been so lethal and enfeebling that it is easy to forget that malaria is both preventable and almost always curable, unless diagnosis and treatment are delayed.No one should ever die from malaria.With the global emergence of malaria parasites resistant to antimalarial drugs and Anopheles mosquitoes resistant to insecticides, both the prevalence and severity of malaria have dramatically increased, resurging in countries where it once had been eradicated or controlled.",y6 Vast geographical divides no longer serve to confine exotic tropical The color reproduction of Figure 4 in this article was made possible by a grant from