CDC: Unexplained Fever? Malaria Might Be Suspected Even Without Travel History

Do not dismiss the possibility of malaria simply because you haven’t traveled anywhere. Recent cases of locally acquired malaria in the United States have shown that international travel is not always a necessary factor in contracting the disease, especially if individuals experience unexplained fever and new anemia. The Centers for Disease Control and Prevention (CDC) have issued an update through their Health Alert Network, emphasizing the importance of considering malaria as a potential diagnosis in such cases.

Dr. Obinna Nnedu, an infectious diseases specialist and medical director at Ochsner Health in New Orleans, Louisiana, notes that while malaria is commonly associated with travel abroad, there have been rare instances of locally acquired mosquito-transmitted malaria. Anopheles mosquitoes, which carry the malaria parasite, breed in still containers and puddles of water outdoors, and they are most active in the evenings and at night. It is crucial to be aware of these factors when assessing the risk of malaria transmission.

There are four main species of the Plasmodium parasite that primarily cause malaria in humans: P. falciparum, P. vivax, P. malariae, and P. ovale. The CDC’s health alert specifically focuses on P. falciparum, which is the most severe form of the disease and can lead to rapid and severe illness if not promptly diagnosed and treated.

Previous reports have highlighted cases of locally acquired malaria in Florida and Texas, unrelated to the recent case in Maryland. These cases were caused by P. vivax, which typically causes a milder form of the disease. The CDC’s national malaria system plays a vital role in identifying and connecting patients to appropriate treatment.

The risk of malaria in the United States is currently very low. The last reported cases of local transmission occurred in mid-July in Florida and in June in Texas, and all patients are recovering after receiving treatment. Prior to 2023, the last cases of local transmission happened in 2003 in Florida.

Malaria is caused by a parasite transmitted through the bite of infected female Anopheles mosquitoes. While these mosquitoes are found throughout many parts of the United States, most cases of malaria occur in international travelers, particularly those visiting sub-Saharan Africa or South Asia. The disease can also be transmitted during pregnancy, through blood transfusion, organ transplantation, or unsafe needle sharing.

The symptoms of malaria typically include fevers, body aches, headaches, and shortness of breath. In some cases of infection with P. falciparum and P. vivax, a fever might occur in a cyclical pattern every other day. Microscopy, which involves examining a blood smear under a microscope, is the gold standard for diagnosing malaria. Rapid diagnostic tests are also available and equally effective.

Prevention of malaria includes measures such as emptying standing water containers outside of homes, using mosquito nets for windows and doors, and applying mosquito repellent containing 20% DEET when outdoors. It’s important to apply mosquito repellent after sunscreen and to be aware that sweating can decrease its effectiveness. Taking precautions to prevent mosquito bites is the best way to protect against malaria and other diseases spread by mosquitoes, according to the CDC.

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