What Does Malaria Look Like on the Skin?

December 13, 2022December 13, 2022

Malaria is a disease caused by a protozoan parasite that invades the red blood cells through the bite of infected mosquitoes. The parasite is transmitted by mosquitoes in many subtropical and tropical regions that kill an estimated 660,000 people each year. What does malaria look like on the skin? Initially, it may appear as any other mosquito bite, but if it becomes an itchy rash resembling hives, or severely itchy skin lesions marked by the appearance of smooth, slightly elevated papules, it may be an early marker of malaria.

Malaria: Causes and Means of Transmission

Only female Anopheles mosquitoes can transmit the disease, and they must also have been infected through a previous blood meal taken from a malaria infected person. If a mosquito infected with the Plasmodium parasite bites you, malaria can occur. An infected mother can also pass the disease (congenital malaria) to her infant at birth. Malaria is a blood borne disease, so it may also be transmitted through blood transfusion, organ transplant or shared needles.

Risk Factors

The largest risk factor for developing malaria is to live in, or visits to tropical areas where the disease is a common occurrence. Many different sub-types of malaria parasites exist. However, the type that causes the most lethal complications is found most commonly in:

• Papua New Guinea, Solomon Islands, and Haiti
• African countries south of the Sahara Desert
• The Asian subcontinent

Symptoms of Malaria

What does malaria look like on the skin? Malaria has a wide array of symptoms, not just on the skin. After the infected mosquito bite occurs, it may take between 7-30 days of incubation before any symptoms are noticed.

Uncomplicated Malaria

The most common symptoms are usually:

• Nausea and vomiting
• Chills with fever
• Body aches and general weakness
• Jaundice (yellow coloring of the eyes and skin) because of the loss of red blood cells

A classic description of an attack of malaria would be a 6-to-12-hour period of fever and headaches alternating with cold and shivering, to a stage of sweating and general weakness, and because the symptoms are very non-specific, it is important to determine if you have other risk factors for malaria such as travel in areas where the disease is common.

Severe (Complicated) Malaria

Complicated malaria occurs when other body systems are affected, such as:

• Kidney failure
• Cardiovascular collapse
• Severe anemia due to destruction of red blood cells
• Cerebral malaria (confusion or abnormal behavior, seizures, unconsciousness)
• Low blood sugar in pregnant women after treatment with quinine

How Malaria Is Diagnosed

Your physician may suspect that you have malaria based on your symptoms and your travel history. During physical examination, your physician may find an enlarged spleen as the result of malaria infection.

To confirm the diagnosis, your physician will take blood samples that have been treated with special chemicals in a laboratory to be examined for the Plasmodium parasites. In addition, blood tests will also determine whether malaria has affected your blood chemistry, such as the levels of red blood cells and platelets, the clotting ability of your blood, along with liver and kidney functions.

Treatment for Malaria

Know that you know the answer to “What does malaria look like on the skin?” let’s look at possible treatment options. Malaria is a life-threatening condition, and treatment for the disease is typically provided in a hospital setting. With proactive treatment, the symptoms of malaria can be cured quickly, usually in about 2 weeks. Without treatment, malaria can return occasionally over a number of years, and repeated exposure may cause some people to become partially immune, developing only a milder case of the disease.

The length of treatment and types of drugs will vary, depending on:

• Your age
• The severity of your symptoms
• Which type of malaria parasite you have
• Whether you’re pregnant
• The most common antimalarial drugs include:
• Quinine sulfate (Qualaquin)
• Mefloquine
• Chloroquine (Aralen)
• Hydroxychloroquine (Plaquenil)
• Combination of atovaquone and proguanil (Malarone)

In some cases, the prescribed medication will not clear you from the infection. Some parasites that are resistant to drugs have been reported, and these parasites make many drugs ineffective. If this happens, your physician might need to use more than one medication or change medications in order to treat the condition.

Preventing Malaria

Medical experts are researching a vaccine against malaria, and the eventual vaccination is expected to be an important way to prevent malaria in the future. Other ways to prevent malaria is avoiding the mosquito using the following strategies:

• Wear clothing that covers most of your body, and apply insect repellent with permethrin to clothing.
• Apply an insect repellent that contains DEET or Picaridin to the exposed areas of your skin, except around your mouth and eyes.
• When possible, stay indoors, or in well-screened areas, especially in the evenings when the mosquitoes are most active.
• Use bed nets and mosquito nets when sleeping, and treat the nets with permethrin.

Medication

If you’re travelingg to areas where malaria is common, in addition to knowing “What does malaria look like on the skin? ” it’s also recommended that you use preventive medicine before, during and after your trip.The most commonly prescribed anti-malarial medications in the U.S. include:

• Chloroquine (Aralen): commonly prescribed anti-malarial drug in countries where there are no drug-resistant strains of malaria. This medication is taken once weekly, from 1-2 weeks prior to travel, until a month after you’ve returned.
• Mefloquine (Lariam): for travel to most regions and areas that have evidence of chloroquine-resistant malaria parasites, such as sub-Saharan Africa. This medication is taken once weekly, from 1-2 weeks before travell until a month after your return.
• Doxycycline (Vibramycin): for people who cannot take chloroquine or mefloquine. Doxycycline is taken once daily, from 2 days before traveling to a month after you’ve returned.
• Atovaquone and proguanil (Malarone): for the protection from chloroquine-resistant malaria. You take one tablet at the same time daily, beginning 1-2 days before traveling until a week after you return.
• Primaquine: is used upon your return if you’ve stayed for more than a few months in an area where you had heavy exposure to mosquitoes. Primaquine is taken daily for 2 weeks after you have left the area.

If you develop an illness with fever within a year of your return, seek immediate medical attention and tell a healthcare provider about your travel.

Cutaneous manifestations of malaria | BMJ Case Reports

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Cutaneous manifestations of malaria

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1. Ankur Chaudhary1,
2. Jasmine Sethi2,
3. Malik Parvez1 and
4. Vivek Kumar1

1. ¹Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2. ²Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

1. Correspondence to Dr Jasmine Sethi; jasmine227021{at}gmail. com

http://dx.doi.org/10.1136/bcr-2022-251257

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• Infections
• Skin
• Tropical medicine (infectious disease)

Description

Cutaneous findings, including skin necrosis, are a rare complication in patients with Plasmodium vivax malaria. Infected parasitised red cells can lead to complement activation, causing microvascular thrombosis and cutaneous complications. We present a woman in her third decade residing in a malaria-endemic area with no medical history who presented with fever associated with chills and rigors, abdominal pain, and decreased urine output for 7 days. She also gave a history of a painful, reddish black rash on the face for 4 days. Physical examination revealed tachycardia, with a pulse rate of 110 per minute, blood pressure of 150/90 mm Hg and necrotic black non-purpuric rash with perilesional erythema on the cheeks, tip of the nose and ear lobes (figure 1A,B). There was associated mild hepatosplenomegaly and pallor. The patient denied any history of joint pain, Raynaud phenomenon, photosensitivity, alopecia, over-the-counter drug use or exposure to extreme cold. There was no documented hypotension or vasopressor use. Laboratory evaluation revealed anaemia with haemoglobin of 78g/l, thrombocytopaenia with a platelet count of 76×10⁹/L, serum creatinine of 636 µmol/L, unconjugated hyperbilirubinaemia with total and direct serum bilirubin of 3.5 mg/dL and 0.9 mg/dL, aspartate transaminase of 76 U/L, and alanine transaminase of 65 U/L. P. vivax was detected in peripheral blood as well as by rapid malarial card test. The remaining work-up including coagulogram, scrub typhus serology, dengue serology, antinuclear antibody, complement levels, antineutrophil cytoplasmic antibody and anticardiolipin antibody were negative. She also had evidence of Coombs-negative haemolysis in the form of raised lactate dehydrogenase (1939 IU/L), elevated plasma haemoglobin level (22 mg/dL) and low haptoglobin. Schistocytes were not seen on peripheral blood smear. A skin biopsy done from the edge of the necrotic areas revealed evidence of fibrin thrombi in dermal capillaries with endothelial swelling suggestive of thrombotic microangiopathy with no features of vasculitis. Immunofluorescence was negative. The patient was initiated on intravenous artesunate and primaquine with topical fluticasone for the skin lesions. She underwent two sessions of haemodialysis and blood transfusion. On day 4 of hospital stay, the lesions started healing, urine output improved and the patient became afebrile. On day 10 of illness, the lesions healed completely without scarring and serum creatinine had decreased to 61 µmol/L (figure 1C,D).

Figure 1

(A, B) Image of the patient on admission showing black necrotic lesions on both cheeks, ear lobes and nose tip. (C, D) Image of the patient on day 10 showing complete resolution with minimal scarring.

Malaria remains a major cause of morbidity and mortality worldwide.1 Cutaneous lesions reported in malaria include angio-oedema, urticaria, peripheral symmetrical gangrene and petechiae.2–4 It is postulated that heavy parasite burden leads to complement activation, thereby causing endothelial injury, swelling and microvascular occlusion. In addition, inflammatory cytokines, disseminated intravascular coagulation and increased tissue factor expression lead to microvascular thrombosis. This pathophysiology is common for both P. vivax and P. falciparum malaria. Our patient’s acute kidney injury could also be attributed to severe endothelial injury and resultant renal thrombotic microangiopathy.5 Management of such patients with malaria and microvascular thrombosis is controversial. Parasite eradication with antimalarials and occasional use of anticoagulants have been suggested. To conclude, we report a rare association of necrotic facial skin lesions with complicated vivax malaria mimicking frostbite and cutaneous vasculitis. Our case suggests that infection with P. vivax may rarely result in systemic endothelial injury, thrombotic microangiopathy and skin necrosis.

Learning points

References

1. ↵
   1. Zaki SA,
   2. Shanbag P

   . Atypical manifestations of malaria. Res Rep Trop Med 2011;2:9–22.doi:10.2147/RRTM.S13431pmid:http://www.ncbi.nlm.nih.gov/pubmed/30881176

2. ↵
   1. Vaishnani JB

   . Cutaneous findings in five cases of malaria. Indian J Dermatol Venereol Leprol 2011;77:110.doi:10.4103/0378-6323.74985pmid:http://www.ncbi.nlm.nih.gov/pubmed/21220901

3. ↵
   1. Zaki SA,
   2. Shanbag P

   . Plasmodium vivax malaria presenting with skin rash-a case report. J Vector Borne Dis 2011;48:245–6.pmid:http://www. ncbi.nlm.nih.gov/pubmed/22297289

4. ↵
   1. Sharma A,
   2. Sharma V

   . Purpura fulminans: an unusual complication of malaria. Braz J Infect Dis 2013;17:712–3.doi:10.1016/j.bjid.2013.04.013pmid:http://www.ncbi.nlm.nih.gov/pubmed/24076110

5. ↵
   1. Sinha A,
   2. Singh G,
   3. Bhat AS, et al

   . Thrombotic microangiopathy and acute kidney injury following vivax malaria. Clin Exp Nephrol 2013;17:66–72.doi:10.1007/s10157-012-0656-9pmid:http://www.ncbi.nlm.nih.gov/pubmed/22752395

Footnotes

• Contributors AC: collected patient data and drafted the manuscript. AC, MP and VK: patient management. JS: patient management and drafted and revised the manuscript.

• Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

• Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

• Competing interests None declared.

• Provenance and peer review Not commissioned; externally peer reviewed.

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Clinical manifestations, treatment and diagnosis of malaria – clinic “Dobrobut”

Malaria on the lips of a person – clinic and treatment

Malaria is an infectious disease, a characteristic feature of which is a paroxysmal relapsing course. The fight against the symptoms of malaria should begin at the first manifestations. Otherwise, severe complications are not excluded, which include pulmonary edema, acute renal failure, severe anemia, malarial coma. The disease is widespread in southeast Asia, Africa and Oceania.

Ways of infection: transmissible, parenteral and transplacental. The causative agent of malaria is a protozoan parasite called Plasmodium. This is a seasonal disease of the autumn-summer period.

Malaria forms:

• three-day;
• four days;
• oval malaria;
• tropical infectious.

Each has its own characteristics and requires an individual approach to treatment.

Forms and development of signs of malaria

Three days. The incubation period is from two to eight months. The main manifestations are intermittent fever, enlargement of the liver and spleen, and anemia. In general, the prognosis is favorable. However, without proper treatment, malaria threatens with complications such as nephritis and malarial hepatitis.

Four-day malaria. The incubation period is three to five weeks. To the above symptoms, you can add a daily slight increase in temperature. The treatment of this form of the disease is largely identical to the treatment of three-day malaria. About how to treat three-day malaria, read on.

The tropical infectious form is usually severe. Without timely medical treatment, death can occur. The incubation period is up to 7 days. The disease is characterized by longer bouts of fever. Against the background of severe intoxication, the patient may experience convulsions, headache, insomnia, confusion. Perhaps the development of renal pathology and toxic hepatitis.

Malaria ovale. Symptoms are similar to the three-day form. The incubation period is 7-11 days. The main drug for the treatment of malaria are drugs based on quinine.

Periods of disease development:

• incubation;
• primary acute;
• secondary;
• relapse.

The sequence of occurrence of malaria in children

The disease in children is severe and specific. Characterized by atypical fever without chills and sweating. At the beginning of the disease, the temperature reaches its maximum, after which it stabilizes at subfebrile levels for several days. Against the background of intoxication, the child may develop convulsions, vomiting, cyanosis, diarrhea. In some cases, a hemorrhagic rash appears. Without timely treatment, there is a high probability of developing persistent anemia and hepatosplenomegaly. In more detail about the sequence of occurrence of malaria in childhood, the doctor will tell you at a personal appointment. You can sign up for a consultation on our website Dobrobut.com or by phone. The doctor will answer questions and tell you why there is still no vaccination against malaria in children.

Clinic of the disease

The incubation period, as a rule, does not manifest itself in any way. As signs of malaria develop, the patient may complain of increased sweating, increased heart rate, increased blood pressure, and a sharp change in feeling hot with chills. The tropical infectious form of the disease is characterized by partial cyanosis of the extremities and heavy breathing.

After the attack is over, the patient’s temperature may rise to 39-40 degrees. The skin becomes dry and red. In some cases, convulsions are possible, there is a violation of the mental state. It should be noted that each attack of the disease is accompanied by profuse sweating.

Lip malaria in humans

The disease can manifest itself on the lips for various reasons:

• weakened immunity;
• general exhaustion of the body;
• food poisoning;
• constant stress.

Clinical manifestations of malaria on the lips in humans: redness and itching in the area of ​​the nasolabial triangle, small blisters in the corners of the lips.

Diagnostic measures

Diagnosis of malaria disease includes a blood test, urinalysis, additionally serological methods – RIF, RFA, RNGA.

Microscopic examination of blood helps to determine the type, type and quantity of microbes. For this purpose, two types of smear are used – thin and thick.

In the general analysis of urine in a patient, hemoglobinuria and hematuria.

Treatment of malaria

The most effective is drug therapy in a hospital setting. The patient is prescribed hingamin, quinine, chloridine or chloroquine. In some cases, the use of sulfonamides and antibiotics is justified. As an additional treatment, detoxification therapy (rheopolyglucin, gemodez, saline), drugs that restore microcirculation, and decongestants are recommended. In severe cases, hormones, plasma and red blood cell transfusions are used.

Prevention of the disease

The main preventive measures are the identification of carriers of malarial plasmodium and already sick people, conducting epidemiological surveillance, extermination of mosquitoes and prophylactic administration of special preparations before traveling to a risk zone. In the latter case, we are talking about the specific prevention of malaria. It is recommended to take pills 2 weeks before departure and within 2 weeks after it. Only an infectious disease specialist can prescribe pills.

With early detection and qualified treatment, the prognosis is favorable. The complications of the doctor’s disease include pulmonary edema, acute nephritis, kidney failure, anemia, malarial coma.

In our medical center you can undergo a complete examination of the body. You can make an appointment with specialists directly on the website. During the consultation, the doctor will decipher the results of the examination and tell you about the ways of infection with tropical malaria. Recording around the clock

Malaria. What you need to know

Malaria is a serious and sometimes fatal disease. People who become infected with it tend to have severe symptoms, including chills, fever, and flu-like conditions. The causative agent of malaria is Plasmodium, which lives in the body of a certain type of mosquito that feeds on human blood.

Symptoms

Malaria is an illness whose symptoms include chills, fever, headaches and muscle pain.

Some patients experience nausea, vomiting, cough and diarrhea.

The state of fever recurs every one, two or three days – this is the most typical manifestation of malaria. Trembling and feeling cold are replaced by the so-called hot stage, which is characterized by high fever, convulsions, headaches and vomiting.

Complications are often signs of such a form of illness as tropical malaria.

Due to the destruction of red blood cells and liver cells, jaundice of the skin and whites of the eyes, as well as diarrhea and cough, may occur. In more rare cases, a rash appears on the body in the form of itchy reddish papules. Malaria is defined as such.

Severe forms, for example, if the causative agent of malaria is Plasmodium falciparum, accompanied by problems such as:

• bleeding;
• liver and kidney failure;
• shock and coma;
• damage to the central nervous system.

Without timely treatment, these symptoms often lead to death.

How is the infection transmitted?

Its sources are female malarial mosquitoes and infected humans (both sick and carrier).

This disease is not transmitted among people either by household or airborne droplets. Infection can occur only if the patient’s blood enters the body of a healthy person.

Diagnosis

If the above symptoms appear, especially after travel, it is recommended to be tested for the presence of malarial plasmodium.

Diagnosis of malaria primarily involves the classic and most commonly used test, the blood smear on a glass slide, which uses a stain indicator to indicate the presence of parasites inside the red blood cells.

Other tests that may help diagnose the disease: immunological tests; polymerase chain reaction.

Prevention of infection

If a person intends to travel to areas where malaria is common, he must first find out what drugs and in what dosages should be taken to prevent infection.

However, it is recommended to start taking these drugs two weeks before the intended trip, during the stay in the country and for a month after returning from the trip.

There is currently no vaccine available for malaria, but intensive research is ongoing and a vaccine is under development.

If possible, avoid visiting countries with a high percentage of infections, otherwise malaria prophylaxis is mandatory – this can save your health and save your life.

If you are a traveler, try to always be aware of where outbreaks are currently occurring.

The malaria vector can land on human skin at any time of the day, but most bites occur at night. Insects are also most active at dawn and dusk. Avoid being outdoors during these hours.

Prevention of infection is very important, given that there is no vaccine against malaria.

Wear appropriate clothing – trousers, long sleeve shirts, high closed shoes instead of open sandals, and a hat. Tuck your clothes into your trousers.