Managing Re-emergent Malaria in South Africa

Malaria is a re-emerging disease in South Africa with a sustained upward trend in case incidence and deaths in the past two decades. Burgeoning travel by non-immune travelers into malaria areas, parasite carriers and infected mosquitoes into malaria-free areas, the variable incubation period and life-threatening nature of Plasmodium falciparum malaria make malaria one of the most important causes of febrile disease in South Africa. Every case of unexplained or unusual febrile disease presenting to a clinician in South Africa should therefore be investigated to exclude malaria and a careful travel history taken, as delays in diagnosing malaria and initiating effective therapy may prove fatal. Chloroquine resistance throughout sub-Saharan Africa precludes its use as a single prophylactic agent, but it must be emphasized that no chemoprophylactic agent is 100% effective and so careful advice on effective measures to prevent Anopheline mosquito bites should be provided to all travelers to malaria-endemic areas. The introduction of rapid card tests has enhanced field diagnosis of malaria. Single dose therapy with sulphadoxine-pyrimethamine (S-P) remains largely effective for treating uncomplicated malaria but careful monitoring is essential. If there are any features of organ dysfunction, treatment with quinine sulphate, preferably in hospital, is indicated. It is envisaged that combination therapy, possibly including an artemisinin derivative to retard the evolution of drug resistance, will characterize the future therapy of uncomplicated malaria.