Diagnosis and Treatment of Malaria

Diagnostic Approach

The presence of fever, chills, and headache in a patient living in an area with a high presence of mosquitoes is highly suggestive of malaria, with clinical symptoms being the best predictors of infection when laboratory facilities are not available 1, 2, 3
The thick blood smear and Giemsa staining should be the basis for the diagnosis of malaria 1, 2, 3
Fever or history of fever is the primary clinical indicator for performing malaria tests, with a positive likelihood ratio of 5.1 4

The Centers for Disease Control and Prevention recommends initiating chloroquine treatment immediately when a blood smear is taken, without waiting for laboratory results 3
For adults, the total dose of chloroquine is 1,500 mg (approximately 25 mg/kg of body weight) over a period of 3 days, administered as 600 mg, 600 mg, and 300 mg at 0, 24, and 48 hours, respectively 1, 2, 3
For children, the total dose of chloroquine is 25 mg/kg of body weight over a period of 3 days, administered as 10 mg/kg, 10 mg/kg, and 5 mg/kg at 0, 24, and 48 hours, respectively 1, 2, 3

Patients should receive education on personal protection against mosquitoes, including staying in well-screened areas 6, 7, 9, using mosquito nets, preferably impregnated with permethrin 2, 5, applying DEET-containing repellent to exposed skin 6, 7, 8, 9, wearing clothing that covers most of the body, especially between dusk and dawn 6, 7, 9, and spraying living and sleeping areas with pyrethroid-containing insecticide during the late afternoon and evening 6, 7
The transmission of malaria occurs mainly between dusk and dawn due to the nocturnal feeding habits of Anopheles mosquitoes 6, 7, 8, 9

Malaria can be effectively treated in the early stages of the disease, but delayed therapy can have severe or even fatal consequences 6, 7, 8, 9
Symptoms of malaria can develop as early as 8 days after initial exposure 6, 7, 8, 9
In areas with high endemicity of malaria throughout the year, all episodes of febrile illness can be assumed to be caused by Plasmodium falciparum 1, 2, 3