Malaria is a disease that conjures up all sorts of images, and none are pretty. This illness used to be common in most of the temperate places on earth. Once, our home town of Blythewood, South Carolina was a summer retreat from the malaria infested parts of the capital city, Columbia. Malaria was originally named for the symptoms that were thought to be caused by the bad air of the marshes surrounding Rome so the antebellum did as the Romans did and moved in the summer. Malaria is now confined to specific areas in the world and the height of malaria season in Africa is almost upon us.
Malaria is frightfully still common. There are 200-300 million cases per year of which 2-3 million die annually. This means you really can be the other guy and contract malaria with its very real mortality rate. We realize that these numbers sound abstract and may be difficult to relate to. A recent visit to Africa impressed us about malaria far more than any medical school lecture.
While on a two week safari to Zimbabwe in May/June 2003 with Out of Africa Adventurous Safaris we were amazed to find out that virtually all the PH’s, trackers and camp staff had had Malaria at least once. Gratefully an African winter hunt, prophylaxis and mosquito repellant worked for our group. We did see a few mosquitos’s but planning and prevention was worth the proverbial pound of cure. Our group of hunters from Blythewood took 3 Sables >41”, 2 Livingston Elands >40”, 3 Waterbucks touching the magic 30”, several huge bossed Buffalo, a magnificent black maned Lion, and other fantastic trophies.
The dreaded disease is transmitted by the Anopheline mosquito. When this critter draws its blood meal from you it leaves behind a parasite called Plasmodium. There are four varieties of this parasite: Falciparum, Vivax, Ovale and Malariae. While all are nasty, some are clearly nastier than others. The parasite has a remarkably complex life cycle. We can provide you with the details on our website, but for the purposes of this discussion we will provide a brief outline. Basically the Plasmodium parasite enters your red blood cells after the mosquito infects you. It then greatly multiplies in your red blood cells until these cells literally break open and release numerous new parasites that repeat this cycle. Other organs can be infected and there can be dormancy, but again for brevity this gives a clear enough picture.
The first symptoms resembling a virus illness appear after 5 to 15 days depending on which type of malaria you have contracted. These symptoms consist of headache, fatigue, muscle aches and mild abdominal discomfort. Classic malarial symptoms of pain, high fever and chills begin to occur every 48 to 72 hours depending again on which type of malaria you have. These rigors and paroxysms are the result of the parasite exploding your red blood cells and surging in your blood stream until they settle in uninfected red blood cells and repeat the cycle. Without treatment severe complications can occur because of small blood vessel damage that results in destruction of lung, brain and kidney tissue. Ultimately this can lead to death especially with the Plasmodium falciparum.
Plasmodium falciparum is the most virulent of this parasite family with highest complications because of its high rate of reproduction. Plasmodium vivax and ovale are less dangerous with malariae bringing up the rear simply because its rate of reproduction is the slowest of the four types. With these bad boys less dangerous is still quite dangerous. The ovale and vivax varieties can leave dormant parasites in your liver which can take up to 6 to 12 months for them to reactivate and cause you relapsing malaria. That means you can get the symptoms of malaria up to one year after your trip when you thought all was safe. Isn’t prevention sounding better all the time?
The diagnosis is easy if malaria is suspected because a simple stain of your blood smear will confirm the diagnosis to your doctor. It is also possible to have two types of malaria at the same time and that actually occurs 5% of the time. As with most parasitic infections, you will build little immunity regardless of how many times you get exposed. While there are no vaccines, multibillionaire Bill Gates has set his sights and fortune on that noble cause. His foundation has already spent 100 million on the effort. In the mean time, simple steps toward prevention need to be the focus.
Preventing malaria can be broken into three distinct approaches. Mosquito control via the judicious use of insecticides and drainage of breeding sites works but are not adequately employed in most countries that we hunt in. Simply using an insect repellent containing DEET can be a life saver. You shouldn’t worry about the smell spooking game; you already play the wind when you hunt. More natural smelling products such as No Stinkin’ Bugs from Robinson Outdoors, Inc. may make you more comfortable with this tactic. The third option is to take prophylactic medications. You’ll note that we do not suggest quinine. Yes the native “fever tree” (pictured with Paul and Out of Africa PH Johan Van Der Merwe) has retained some usefulness still, but it is inadequate these days.
Chloroquine is also less useful then it once was because of the emergence of resistant strains of the parasite(s). The dose is 500mg one time per week starting one week prior to travel and continuing for four weeks after your return. It is pregnancy safe and the side effects are minimal. They include headache, dysphoria and itching in folks with darker skin. Larium (mefloquine) is used in areas that have chloroquine resistant malaria which includes most of Africa, South America and Southeast Asia. The preventative dose is 250mg one time per week starting one week prior to travel and continuing for four weeks after your return. It is also pregnancy safe but does carry the potential side effects of nausea, dizziness, psychiatric symptoms and disturbed sleep. Doxycycline at 100mg per day is an alternative to Larium but is not pregnancy safe, should not be used in children and causes skin sensitivity to the sun.
Malarial resistance and endemic geographic patterns are constantly in flux. Instead of providing you with data that is likely to be less than accurate down the road, we urge you to look at the CDC website (www.cdc.gov/travel) or make a phone call to their travel hotline; FYI TRIP at 1 877-394-8747 prior to your hunt. The CDC provides the latest and most accurate information on whether and what medications are needed in the area and season you plan to travel to.
In conclusion, planning and prevention are the order of the day. It is not the other guy who always gets sick. Malaria is the real deal and must be treated that way. Copy this article and file it away for future reference. BE SAFE and ENJOY THE OUTDOORS.