Malaria: Information for Providers
Malaria is caused by infection from Plasmodium parasites and is transmitted through the bite of an infected Anopheles mosquito. Rarely, cases can be transmitted through blood transfusion, organ transplantation, shared needles or syringes, or congenitally (transplacental or during birth).
Prompt diagnosis and treatment are critical. Delayed treatment can increase the risk of severe complications, death, and, in rare circumstances, local mosquito-borne transmission. Malaria should be considered in any patient with fever who has traveled to or lived in a malaria-endemic area within the past 12 months.
Symptoms of malaria may include fever, chills, sweats, headache, myalgia, nausea, vomiting, and diarrhea. Plasmodium falciparum infection is associated with the greatest risk of severe disease and death.
Malaria must be reported within 24 hours of diagnosis. Reporting instructions can be found at Reporting Diseases and Conditions.
Prevention
Advise travelers to malaria-endemic areas on appropriate malaria prevention measures. There are various malaria chemoprophylaxis regimens that can be prescribed based on travel destination, duration, and patient factors. This in combination with avoiding mosquito bites significantly reduce malaria risk.
Treatment
Treatment depends on disease severity, the infecting Plasmodium species, parasite drug susceptibility in the area where the infection was acquired, and prior use of antimalarial medications.
- Artemisinin-based combination Therapy (ACT) is preferred for uncomplicated Plasmodium falciparum infections. Artemether-lumefantrine (Coartem) is the preferred oral regimen for most patients.
- Alternative regimens may include atovaquone-proguanil (Malarone), or quinine sulfate plus doxycycline or tetracycline or clindamycin.
- Chloroquine may only be used when the infection is known to have been acquired in an area with chloroquine-sensitive parasites.
- Intravenous (IV) artesunate is the first-line treatment for severe malaria, a medical emergency.
- IV artesunate rapidly reduces parasite burden and should be administered without delay.
- Once the patient has clinically improved and can tolerate oral medications, treatment should be completed with an appropriate oral antimalarial regimen.
- Artesunate for Injection™ is FDA-approved and commercially available through major drug distributors. For more information on obtaining IV artesunate and selecting follow-up oral therapy, consult CDC Clinical Guidance.
For country-specific information on malaria species distribution and antimalarial drug resistance, consult the CDC Yellow Book.
Consultation for Patient Care and Laboratory Diagnosis
For urgent consultation regarding malaria diagnosis or treatment, call the CDC Malaria Hotline at 770-488-7788 or 855-856-4713 (toll free), Monday through Friday, 9 a.m. to 5 p.m.
For after hours, weekends, and federal holidays, call 770-488-7100 and ask to speak with the malaria clinician on call.
For assistance with laboratory diagnosis of malaria, visit CDC DPDx.
Additional Resources
- CDC: Clinical Guidance for Malaria Diagnosis & Treatment in the U.S.
- Massachusetts General Hospital: Heading Home Healthy