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Malaria quartana: Causes, Symptoms and Treatment

Malaria quartana is a form of malaria caused by Plasmodium malariae, characterized by fever recurring every 72 hours. It is usually mild but can become chronic.

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Things worth knowing about "Malaria quartana"

Malaria quartana is a form of malaria caused by Plasmodium malariae, characterized by fever recurring every 72 hours. It is usually mild but can become chronic.

What is Malaria quartana?

Malaria quartana is a form of malaria caused by the parasite Plasmodium malariae. The name derives from the Latin word for “four” and refers to the characteristic fever that recurs every 72 hours (i.e., on the fourth day). Compared to other forms of malaria, such as malaria tropica caused by Plasmodium falciparum, malaria quartana is generally less severe. However, it can become chronic, with the parasite persisting in the body for years or even decades.

Causes and Transmission

Malaria quartana is transmitted exclusively through the bite of infected female Anopheles mosquitoes carrying Plasmodium malariae. After the bite, the parasites first travel to the liver, where they multiply before invading red blood cells. Rarely, transmission can also occur through blood transfusions or shared needles.

Geographic distribution: Sub-Saharan Africa, South and Southeast Asia, Central and South America, and parts of Oceania
Main route of transmission: Bite of the female Anopheles mosquito
Rare routes: Blood transfusion, needlestick injury, mother-to-child transmission during pregnancy or childbirth

Symptoms

The hallmark symptom of malaria quartana is quartan fever: fever attacks recurring every 72 hours, typically following a characteristic sequence of chills, high fever, and sweating. Additional symptoms may include:

Shaking chills and profuse sweating
Headache and muscle pain
Nausea and vomiting
Enlarged spleen (splenomegaly)
Anemia due to destruction of red blood cells
In rare chronic cases: quartan nephrotic syndrome (kidney damage caused by immune complex deposition)

Diagnosis

The diagnosis of malaria quartana is established by directly detecting the parasite in the blood. The following methods are used:

Blood smear (thick blood film): Microscopic examination of a stained preparation to identify Plasmodium malariae
Rapid diagnostic tests (RDTs): Antigen detection from capillary blood
PCR (polymerase chain reaction): Highly sensitive method for accurate species identification, especially at low parasite densities
Serology: Detection of antibodies, primarily used for epidemiological studies

Treatment

Malaria quartana is treated with antimalarial medications. Since Plasmodium malariae does not form hypnozoites (dormant liver stages), no additional treatment to prevent liver-stage relapses is required.

Chloroquine: First-line treatment, as Plasmodium malariae remains largely susceptible to chloroquine in most regions
In cases of chloroquine resistance or intolerance: alternatives such as artemisinin-based combination therapies (ACT)
Supportive care: antipyretics (e.g., paracetamol), adequate fluid intake

Prevention

Travelers to endemic areas should take the following precautions:

Apply insect repellents to exposed skin
Wear long-sleeved clothing, especially at dusk and during the night
Sleep under insecticide-treated bed nets
Take antimalarial chemoprophylaxis as recommended by a physician

References

World Health Organization (WHO): World Malaria Report 2023. Geneva: WHO Press, 2023.
Centers for Disease Control and Prevention (CDC): Malaria - Biology. Available at: www.cdc.gov/malaria, accessed 2024.
Bousema T, Drakeley C: Epidemiology and infectivity of Plasmodium falciparum and Plasmodium vivax gametocytes in relation to malaria control and elimination. Clin Microbiol Rev. 2011;24(2):377-410.

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