Malaria:

Malaria is the “influenza” of Africa, and Beira is a hotspot. I imagine it has something to do with the fact that city is built on a sandbar, on the edge of a vast swamp. Malaria kills several million people yearly, primarily children in sub-saharan africa. Prior to coming to Mozambique, I´d diagnosed a grand total of one case of malaria (a patient who had just flown from the Dominican Republic to Kodiak, and got off the plane with typical symptoms). I´ve been hesitant to write about the disease until I had more experience, but since we are seeing 5 or 6 cases a day, and I´ve been here 7 weeks, I think I´m getting there. I am getting to the point where I think I can diagnose a case from across the room.

It is an impressive disease, especially in kids. A typical story is the sudden onset of severe headache, muscle and joint aches, recurrent fevers with shaking rigors. But it can masquerade like many other illnesses, sometimes causing a cough, and other times vomiting and diarrhea. Cerebral malaria looks like meningitis, and is just as deadly in kids. I´ve also seen patients with what looked like hepatitis, and also glomerulonephritis with anasarca (kidney disease with total body edema) due to malaria. I´ve felt more enlarged spleens and livers (from malaria) in the past 7 weeks, than in the previous 20 years of medical practice.

People with malaria are listless, eyes dull, suffering. Like victims of dementors in Harry Potter, they look like they´ve had all the joy sucked out of them. Though the picture often seems pretty typical, we try to do a rapid blood test to check for the presence of the plasmodium falciparum parasite before treating: we did a study, and found that only 20% of the patients from the clinic overall, that looked like they had malaria, actually tested positive for it. (I am going to brag, and tell you that I get it right over 50% of the time). The tests are not perfect: there is an Austrian ex-pat here who came down with typical symptoms, but two sequential tests were negative. He developed what looked like hepatitis, decided to go home (to Austria), where he ended up in the ICU, gravely ill for two weeks. A subsequent test for malaria was positive. (He´s getting better, and coming back soon).

Just as victims of the dementors respond to chocolate, there is still a prompt and effective treatment for malaria. Co-Artem is a combination of two medications (to prevent resistence from developing) that brings rapid relief, usually within a day or two, although some effects linger for weeks.

A historical tidbit: before antibiotics, it was found that patients with syphilis could be treated by intentionally infecting them with malaria. The resulting fever would kill the spirochete that causes syphilis, and the malaria could then be treated with quinine. (Just thought you´d like to know).
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