Confirming the Disease Name
Malaria — the medically accurate disease name. The pathogen that mainly circulates domestically is Plasmodium vivax (vivax malaria), while globally, Plasmodium falciparum (falciparum malaria) causes severe and potentially fatal disease.
1) Disease Description (Causes and Symptoms)
- Cause: Caused by infection of the host (humans) with malaria parasites (Plasmodium spp.). Mosquitoes (genus Anopheles) are the vectors. Domestic transmission is mainly due to Plasmodium vivax.
- Pathophysiology: Immediately after infection, the parasites multiply in the liver (stage; asymptomatic intrahepatic stage) and are released into the bloodstream, where they invade red blood cells. Red blood cell destruction and immune responses cause fever, anemia, splenomegaly, and other symptoms. P. vivax and P. ovale can relapse because of dormant forms in the liver (hypnozoites).
- Main symptoms: Chills, high fever (possibly 39–41°C), sweating, headache, muscle pain, loss of appetite, and fatigue. P. vivax may characteristically cause periodic fever (every other day—the “tertian” pattern). P. falciparum may cause irregular or persistent fever and carries a risk of severe complications (encephalopathy, shock, acute kidney failure, etc.).
2) Treatment Methods
- Begin treatment immediately after diagnosis (treatment varies according to the species and severity).
- Oral treatment (uncomplicated malaria):
- P. vivax: In areas where it is susceptible, chloroquine (or another antimalarial selected when there is local resistance) plus primaquine (or tafenoquine) to eliminate dormant liver forms is recommended for “radical cure.” G6PD testing is essential before administering primaquine or tafenoquine.
- P. falciparum: Taking regional resistance into account, artemisinin-based combination therapy (ACT; e.g., artemether-lumefantrine) is generally used.
- Severe malaria:
- Hospitalization and intensive care are required. Intravenous treatment such as IV artesunate (or IV quinidine/quinine in areas where these may be used), vital-sign monitoring, and management of complications (hypoglycemia, kidney failure, pulmonary edema, encephalopathy, etc.) are needed.
- Other:
- Treatment of fever, fluid replacement, anemia, and infectious complications.
- Pregnancy: Some medications (e.g., primaquine and tafenoquine) are contraindicated during pregnancy. During pregnancy, consult a specialist regarding medication selection.
- Prevention (travelers):
- Chemoprophylaxis according to resistance information for the travel destination (e.g., atovaquone–proguanil, doxycycline, mefloquine, or chloroquine in susceptible areas) is recommended. Tafenoquine can be used for prophylaxis and radical cure, but G6PD testing is required.
- Avoid mosquito bites (window screens, insect repellent, avoiding nighttime activity, using a bed mosquito net, etc.).
Precautions:
- Primaquine and tafenoquine pose a risk of hemolysis in people with G6PD deficiency → G6PD testing is essential before administration.
- P. falciparum can be fatal if treatment is delayed, so immediate medical evaluation is necessary when fever occurs after travel.
- Treatment selection depends on the parasite species, the patient’s condition, and regional drug resistance → treatment prescribed by a specialist is recommended.
Prognosis:
- With appropriate diagnosis and treatment, P. vivax generally has a good prognosis (although relapse is possible). With delayed treatment, the risk of severe disease and death from P. falciparum increases.
3) Outpatient Visit Checkpoints (Preparation, Information to Confirm, and Example Questions)
Items/information to bring:
- Recent travel history (country, region, dates of entry and departure, and length of stay) — including when and where you may have been bitten
- The date fever began, its pattern (every other day, persistent, etc.), and a record of symptom progression
- Medications currently being taken (including antibiotics and antimalarial prophylaxis)
- Existing conditions (especially pregnancy status, liver or kidney disease, anemia, and whether you have G6PD deficiency)
- Previous malaria diagnosis and treatment history, including medications used
- Copies of recent test results (blood tests, urine tests, etc.), if available
- History of allergies (including drug allergies)
Information that is helpful to provide during the outpatient visit (what the doctor may ask):
- When you were bitten by mosquitoes (distinguishing domestic from overseas exposure), and whether you were mainly active at night
- The fever pattern (when it comes and goes) and whether chills are present
- Whether you took prophylactic medication and whether you took it as directed
Simple example questions (for patients to check themselves):
- Bring photos taken during fever episodes or a record of your temperature
- Whether you have recently received a blood transfusion (also check the possibility of transfusion-related infection)
4) General Example Questions to Ask the Doctor
- “What species of malaria parasite do I have, and what is the standard treatment for it?”
- “What are the main side effects of the treatment medications, and when should I return to the hospital?”
- “What additional medication, such as primaquine, should I take to prevent relapse?”
- “If I am pregnant (or breastfeeding), how will the treatment plan change?”
- “What is the prognosis, and when should follow-up tests (blood smear/PCR) be performed?”
5) Disease-Specific Example Questions
- “Do I need to take primaquine (or tafenoquine) to prevent relapse of an infection with dormant liver forms (P. vivax/P. ovale)? When should I have a G6PD test?”
- “Resistance of P. falciparum has been reported in the area I visited (country name). Which preventive medication do you recommend before travel?”
References (Summary):
- Malaria is a protozoan infection transmitted by mosquitoes, and its clinical course and treatment differ by species. In Korea, P. vivax is the main circulating species (with re-emergence and areas of domestic transmission). Diagnosis is possible through peripheral blood smear, rapid antigen testing, and PCR. Treatment varies according to the species, resistance, and the patient’s condition, so follow the instructions of a specialist.