| ICD-9-CM: |
| 084.0 - | Malaria, Falciparum; Malaria by Plasmodium Falciparum, Subtertian |
| 084.1 - | Malaria, Vivax (Benign Tertian); Malaria by Plasmodium Vivax |
| 084.2 - | Malaria, Quartan; Malaria by Malariae; Malariae Malaria |
| 084.3 - | Malaria, Ovale; Malaria by Plasmodium Ovale |
| 084.4 - | Malaria, Other; Monkey Malaria |
| 084.5 - | Malaria, Mixed; Malaria by More than One Parasite |
| 084.6 - | Malaria, Unspecified; Malaria NOS |
| 084.7 - | Malaria, Induced; Therapeutically Induced Malaria |
| 084.8 - | Malaria; Blackwater Fever; Hemoglobinuric Fever (Bilious), Hemoglobinuric Malaria, Malarial Hemoglobinuria |
| 084.9 - | Malaria, Other Pernicious Complications of Malaria; Algid Malaria; Cerebral Malaria |
Malaria is an infection caused by one of several species of minute protozoan parasites of the genus Plasmodium. The disease is transmitted through the Anopheles mosquito. If the mosquito bites an individual already infected by the parasite, the insect too becomes infected, thus perpetuating the life cycle of the parasite.
The parasite grows inside the mosquito and is transmitted when that mosquito bites a human and injects material from her salivary glands, which contain malarial parasites called sporozoites. (Only female mosquitoes bite.) Once injected into the blood by the mosquito, the parasite circulates before settling in the liver, where the parasite multiplies. After about 12 days, the liver cell ruptures, releasing the parasite (in the form of merozoites) into the bloodstream to infect other red blood cells, simultaneously releasing substances that cause the symptoms of malaria.
The four species of Plasmodium that can cause malaria are P. vivax, P. ovale, P. falciparum, and P. malariae. Each species causes slightly differing symptoms. It is possible to be infected by more than one Plasmodium species at the same time.
The most serious type of malaria is P. falciparum malaria. It can quickly become fatal as the parasites multiply rapidly, causing significant red blood cell destruction (hemolysis) among cells at all levels of maturity. The other types of malaria are less serious and cause a low grade of malaria that can last for years.
Individuals who have traveled to an area where malaria is common and suspect malaria should see a physician immediately and be sure to mention their travel history. Although not directly contagious from individual to individual, malaria can be transmitted from mother to fetus during pregnancy. Malaria can also be passed through contaminated needles and blood transfusions, although this is now rare in the US.
Residents in areas where malaria is endemic (Central and South America, Africa, Asia) develop some immunity to the disease.Incidence and Prevalence: The incidence of malaria is increasing. In 2010 there were 1,691 cases of malaria diagnosed in the US. Each year, approximately 10,000 to 30,000 of 25 to 30 million US and European travelers to tropical areas acquire malaria (Perez-Jorge). Internationally, in 2010 the estimated number of cases of malaria was 219 million, and the estimated number of deaths was 660,000. More than 91% of these deaths occur in Africa (CDC). Besides Africa, the disease remains a leading cause of death in rural areas of Asia, South America, and Central America. |
Source: Medical Disability Advisor
| Travelers to countries of Asia, Africa, and Central and South America where malaria is present are at higher risk of developing the disease. Malaria has also occurred in the US from bites of mosquitoes that have been transported by airplane from endemic areas. |
Source: Medical Disability Advisor
History: The incubation period varies from 7 to 30 days after being bitten by an infected mosquito, but it may be years for some Plasmodium species. Individuals may report flu-like symptoms, including periodic (every 48 or 72 hours, contingent on Plasmodium species) fever, chills, sweating, tiredness (malaise), headache, nausea, vomiting, muscle and joint aches (myalgias and arthralgias), cough, and diarrhea. Infections with P. falciparum may cause cerebral malaria, resulting in mental confusion, convulsions, and coma. Cyclical symptoms reflect the life cycle of the parasite. Physical exam: The exam can reveal an enlarged spleen (splenomegaly) or liver (hepatomegaly). Jaundice may also be present. Severe malaria from P. falciparum may cause jaundice, renal failure, hypoglycemia, severe anemia, high fever (hyperpyrexia), and coma. Tests: A blood smear will be taken for microscopic observation. Because the number of parasites in the blood varies depending on the life cycle stage of the parasite, blood samples are best collected when the individual's temperature is rising and may need to be taken at 6- and 12-hour intervals in order to identify the Plasmodium. In severe cases of malaria caused by P. falciparum, blood tests may indicate abnormal liver function, hemolytic jaundice, low platelet count (thrombocytopenia), and marked anemia. Serology tests can also be done to determine the causal species of Plasmodium. |
Source: Medical Disability Advisor
Antimalarial drugs taken prior to and during a visit to an endemic area can reduce the risk of an individual contracting malaria. The most common antimalarial drug is chloroquine. However, many strains of malaria have become resistant to chloroquine. Alternative drugs are chosen based on the age of the individual, the type of malaria diagnosed, the severity of the disease, where the individual was infected, and hence the likely sensitivity of the parasite. Alternative antimalarial drugs include atovaquone-proguanil, artemether-lumefantrine, and mefloquine. Ideally, those with severe malaria (for example, cerebral malaria) should be treated in a hospital intensive care unit (ICU).
Visitors to areas where malaria is endemic should take every precaution to avoid mosquito bites. Because mosquitoes generally start feeding at dusk, wearing fully protective clothing and using high-DEET mosquito repellent at those times is particularly critical. Covering beds with netting is another essential precaution. |
Source: Medical Disability Advisor
| The outcome depends on the type of malaria contracted. Uncomplicated malaria usually subsides with proper treatment. Without treatment, P. vivax and P. ovale infections can continue to cause relapses for up to 5 years. Infections with P. malariae can last longer. |
Source: Medical Disability Advisor
| Complications associated with P. falciparum include severe anemia, pulmonary edema, jaundice, acute or chronic renal failure, decreased blood sugar (hypoglycemia), and irregular heartbeats (arrhythmia). P. falciparum malaria can also block small vessels, depriving some tissues of oxygen. In the absence of treatment, cerebral malaria due to P. falciparum may cause death within 24 hours. P. vivax and P. ovale can become dormant in the liver, causing relapses several months to years after the initial infection. Chronic infection can result in immunological disorders. |
Source: Medical Disability Advisor
| After recovery, the individual may experience extended periods of weakness that may restrict the ability to perform strenuous work and will require additional breaks. Risk: Malaria is not transmitted directly from one individual to another. Use of mosquito repellents and fully protective clothing is indicated to prevent recurrence. Capacity: During active, cyclical outbreaks of infection, individuals may require temporary reassignment to less strenuous job duties until flu-like symptoms subside. There would not be any expected capacity impact on an individual undergoing long-term treatment. Tolerance: Once the individual has recovered from an uncomplicated malaria infection, there is no expected impact on tolerance unless relapses occur. Employer sponsored education and protective measures would be needed for individuals working in high-risk endemic areas. Accommodations: Employers willing to accommodate activities as needed can have employees return to work earlier. |
Source: Medical Disability Advisor
| 30 to 120 days (variation reflecting type of malaria). |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual recently traveled to tropical or subtropical areas and been bitten by mosquitoes?
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Has individual recently received a blood transfusion?
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Has individual used contaminated needles?
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Does individual report flu-like symptoms, including periodic fever and chills, sweating, headache, nausea, vomiting, muscle aches, and diarrhea?
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Does individual report mental confusion and convulsions?
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Do the symptoms cycle every 48 to 72 hours?
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Were blood samples examined microscopically for the presence of parasites?
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Has a diagnosis of malaria been confirmed?
Regarding treatment:
- Was the strain of Plasmodium that caused the malaria susceptible to chloroquine?
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If not, what alternative drug(s) were chosen based on the age of individual, type of malaria diagnosed, severity of the disease, where individual was infected, and hence the likely sensitivity of the parasite?
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Did individual require hospitalization?
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Has individual responded to drug therapy? If not, what other treatment options are available?
Regarding prognosis:
- What strain of Plasmodium caused the malaria?
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Was treatment administered for 2 to 4 weeks? Was individual compliant with medication regimen?
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Is this an initial episode of malaria, or could this be a relapse?
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What other treatment options are available for this strain of Plasmodium?
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Have complications occurred such as immunological disorders?
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If P. falciparum caused malaria, has individual developed anemia, pulmonary edema, jaundice, renal failure, decreased blood sugar (hypoglycemia), irregular heartbeats (arrhythmia), or mental confusion, convulsions, and coma? If so, how will these be treated, and what is the expected outcome with treatment?
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Source: Medical Disability Advisor
| Cited "Malaria." CDC. 18 Aug. 2014. Centers for Disease Control and Prevention. 17 Sep. 2014 <http://www.cdc.gov/malaria/>.Perez-Jorge, Emilio P. "Malaria." eMedicine. Ed. Michael Stuart Bronze. 14 Mar. 2014. Medscape. 17 Sep. 2014 <http://emedicine.medscape.com/article/221134-overview#showall>. |
Source: Medical Disability Advisor
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