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Malaria Tertiana: Causes, Symptoms and Treatment

Malaria tertiana is a form of malaria caused by Plasmodium vivax or Plasmodium ovale, characterized by fever episodes recurring every 48 hours.

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Things worth knowing about "Malaria tertiana"

Malaria tertiana is a form of malaria caused by Plasmodium vivax or Plasmodium ovale, characterized by fever episodes recurring every 48 hours.

What is Malaria tertiana?

Malaria tertiana is a form of malaria caused by the parasites Plasmodium vivax or Plasmodium ovale. The name derives from the Latin tertiana (the third), referring to the characteristic fever episodes that recur every 48 hours – that is, on every third day. Compared to the more dangerous malaria tropica, malaria tertiana generally follows a milder course; however, it can persist for months or even years due to relapses caused by dormant liver stages of the parasite.

Causes and Transmission

The disease is transmitted through the bite of infected female Anopheles mosquitoes, which introduce Plasmodium parasites into the human bloodstream. After the bite, the parasites first travel to the liver, where they multiply. A distinguishing feature of P. vivax and P. ovale is their ability to form so-called hypnozoites – dormant liver stages that can be reactivated months or even years after the initial infection, causing disease relapses. Malaria tertiana occurs primarily in tropical and subtropical regions of Africa, Asia, Central and South America, and parts of Oceania.

Symptoms

Symptoms typically begin 12 to 17 days after the infective mosquito bite, although delayed onset is possible. The classic presentation is a fever paroxysm with three distinct phases:

Cold stage: Intense chills and shivering
Hot stage: High fever (up to 40°C or more), headache, and muscle pain
Sweating stage: Profuse sweating with rapid defervescence, followed by a feeling of relative well-being

Additional possible symptoms include:

General fatigue and weakness
Nausea and vomiting
Enlargement of the spleen (splenomegaly) and liver (hepatomegaly)
Pallor due to anemia caused by destruction of red blood cells

Diagnosis

Diagnosis of malaria tertiana is established through the following methods:

Thick blood film and blood smear: Microscopic examination of blood to directly visualize parasites – the gold standard of malaria diagnostics
Rapid Diagnostic Tests (RDT): Antigen-based rapid tests, particularly useful in resource-limited settings
PCR (Polymerase Chain Reaction): Highly sensitive molecular method for species identification
Blood count and laboratory parameters: Detection of anemia, elevated inflammatory markers, and changes in liver function values

Treatment

Treatment of malaria tertiana involves two essential steps to address both the blood stage and the liver stage (hypnozoites):

Treatment of the Blood Stage

Chloroquine remains the drug of choice for the acute blood stage in non-resistant strains. In cases of chloroquine-resistant P. vivax (particularly in South America and Oceania), alternative regimens such as artemisinin-based combination therapies (ACT) are used.

Treatment of the Liver Stage (Anti-Relapse Therapy)

To eliminate hypnozoites and prevent relapses, primaquine is administered. This medication must be taken under medical supervision, as it can cause severe hemolysis in individuals with G6PD deficiency (glucose-6-phosphate dehydrogenase deficiency). A G6PD test is therefore recommended before initiating treatment. Tafenoquine is a newer alternative that can be given as a single dose.

Prevention

The following measures are recommended to prevent malaria infection in endemic areas:

Use of insect repellents on skin and clothing
Wearing long-sleeved shirts and long trousers, especially at dusk and during nighttime hours
Sleeping under an insecticide-treated bed net
Chemoprophylaxis (e.g., with atovaquone/proguanil or doxycycline) following medical advice before travel
Seeking medical attention promptly in case of fever after returning from an endemic region

References

World Health Organization (WHO): World Malaria Report 2023. Geneva: WHO Press, 2023. Available at: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023
Centers for Disease Control and Prevention (CDC): Malaria – Disease. Atlanta: CDC, 2023. Available at: https://www.cdc.gov/malaria/about/disease.html
White NJ et al.: Malaria. In: Lancet. 2014;383(9918):723–735. DOI: 10.1016/S0140-6736(13)60024-0

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