Albrecht Dürer, Malaria

Albrecht Dürer (1471 - 1521), the famous painter, graphic designer, mathematician and art theoretitian from Nuremberg, travelled in 1520/21 to the Netherlands, where he got malaria. Suffering years long finally the disease caused his death. In a letter he described his doctor pain in his milt, illustrated with the drawing where he points with his index finger and the yellow circle on the spot where the swollen milt is placed. Image from Wikipedia, common free.

Electric Mosquito Racket

This device can be very helpful catching mosquitoes. It's a practical and efficient mosquito racket. The insects get electrically toasted. This version has a supporting light in the handle. Inside is a rechargeable battery. Image by Asienreisender, 2013




Malaria Basics

Malaria is an infectious parasitic disease. It's naturally transfered by a female mosquito of the kind anopheles from man to man. Another way of transfer can be by blood transfusion or other injections (with used syringes) with parasite - containing blood. Smallest amounts of blood already allow a transfer. Pregnant mothers can in certain cases transfer malaria to their child, but it's not necessarily so.

No Mosquitoes! by Asienreisender

A poster warning before mosquitoes. Seen at a hospital in Chumpon, south Thailand. Image by Asienreisender, 2012

The development of the parasite happens exclusively inside anopheles mosquitoes and human bodies. There are three different kinds of malaria. Meaningful for travellers in Southeast Asia is malaria tropica, the most dangerous one. The others are malaria tertiana (which was widespread also in Europe, up to middle- and northern Europe until the first half of the 20th century) and malaria quartana.

Famous malaria patients of the European past were Albrecht Duerer, Oliver Cromwell and Friedrich Schiller. Malaria was finally extinct from Europe not before the 1960s due to the 'Global Malaria Eradiction Program' (see below).

The French explorer Henri Mouhot died 1861 near Luang Prabang in Laos due to malaria, and Alfred Russel Wallace concluded the mechanism of natural selection when he was shaken by malaria fevers in the Malay Archipelago.

A famous Asian malaria victim was Mohandas Gandhi (1869 - 1948), who suffered a severe attack in Aga Khan Palace in Pune in 1942, where he was held as a political prisoner.

All these three kinds of malaria are human-specific, means they don't infect animals (apart from very few exceptions at monkeys, some of them observed at macaques in Southeast Asia).

Anopheles mosquitoes are (together with aedes und culex mosquitoes) among the most widespread mosquito kinds. There are 360 different kinds of anopheles mosquitoes alone in the world, of whom 45 potentially carry malaria. Their habitats are not limited to the tropes and subtropes, but spread out until the borders of arctic regions.

Around 40% of the global human population lives in areas infested with malaria, of whom 300 - 500 million people are infected (according to the Robert Koch Institute, Berlin). More than 80% of them live in tropical Africa, 13.8% live in Asia.

In mountainous areas above 1.500m, near the equator from 2.500m on anopheles mosquitoes do not appear anymore. Malaria is pandemic in almost whole Southeast Asia. Indonesia and Burma / Myanmar have here by distance the most cases in percentage of the population. A growing resistance to antimalarials are a challenge in the Greater Mekong Sub-Region.

The exciter for malaria tropica is the parasite plasmodium falciparum, the most lethal one among the four plasmodium parasites. Estimated 1.8 million people died in 2004 worldwide, 1.2 million in 2010 due to malaria.

Let's assume that a biting mosquito is sucking blood. When the bitten human is malaria infected, the mosquito sucks with the blood the exciters which transfer within 8 to 16 days inside the mosquito into another phase and next to it's final stage. When it gets injected then into another humans blood circulation, reaching there the human liver, it's again breeding and spreading out into the vascular system. The perpetuation of the circle is then completed.

Read here more on the feeding habits of mosquitoes.



The easiest prevention would apparently be a vaccination. Unfortunately there is no vaccine for malaria yet developed. Some are under development, but it seems to be a challenging task. One vaccine is supposed to be licenced in 2015. Even then the question for it's efficacy remains open.

The best prevention is to avoid being bitten. Therefore a repellent is most effective. It's best to carry it alway wherever one goes. In some places are still mosquito coils in use, although far no more that often than a few years ago. The smog keeps the insects away, but contains also poisonous ingredients.

Mosquito by Asienreisender

A mosquito, caught with bare hands. Image by Asienreisender, 2011

All the chemical medicines for prophylaxis are not reliable but show or can show serious side-effects. Besides one has to care all the time to take the pills twice a day at the same time - not very attractive.

Covering the skin with long pants and sleeves helps - particularly the ankles are a mosquito target. When sitting in a restaurant the mosquitoes follow their ruthless activities in silence under the table while one is concentrated on whats going on above the table.

The anopheles mosquito is active at dusk and over the whole nighttime. A mosquito net is therefore a good mean of prevention. In some of the accommodations in Southeast Asia a mosquito net is included, but in most of the places it's not. Carrying one's own mosquito net is uncomfortable and the construction of it in a hotel or guesthouse is not easy. In some places it's simply impossible.

In environments with a lot of mosquitoes a mosquito net is very important. It's recommendable then to prepare it additionally with a repellent (a sprayer).

Forests and adjacent areas areas are most malaria infested. Staying in or near the jungle prevention in night-time is more important than elsewhere. In urban regions and bigger cities the anopheles mosquito is not home. Therefore the Asian tiger mosquito is adapted to urban habitates, and this kind of day-active mosquito carries another dangerous disease: the dengue fever.

Mosquitoes generally have problems with fans and air conditoners. I generally find rooms with aircons below a certain temperature mostly mosquito free.



Natural immunization against parasites is much more difficult for the human immune system than an immunization against bacterias or many viruses. That's because animally parasites have a complex and various genetic structure, some are familiar to the human cell system to provide an optimal adaption to the human host organism.

People who live in malaria infested areas can aquire a certain immunity , but it doesn't give them a total protection. In case of an infection the disease only proceeds easier, sometimes it's not even realized as malaria. A person who acquired such a semi-immunity will loose it again after staying over several years in a malaria-free country, because the maintainance of the immunity requires new infections from time to time.



The only method of malaria diagnosis is a blood analysis. A drop of blood is pressed out of the fingertip and spread out on an object slide that it covers some 10mm in diameter. Under application a certain preparate and a microscope the diagnosis can be made then. In case of an infection the parasites on the blood cells can be detected. There are several blood analyses possible, including also DNA tests.



The latent period of malaria tropica lasts 12 days in average (between 8 - 15 days). When applying a medical prophylaxis, the outbreak can be delayed (as already mentioned above, there is no reliable prophylaxis).

The parasites affect the red blood cells. If a certain amount of red blood cells is attaint, it leads to blood anemia. The brain, the lungs, kidneys, liver, other organs and the spiral can suffer malnutrition, alterations and damages. Despite these serious impacts there are no irreversible damages, at least in the most cases, even after suffering days in coma.

Plasmodium Falciparum under the Microscope

Plasmodium falciparum, the malaria parasite, under the microscope. The big, round 'bubbles' are red blood cells, while the small, dark spots are the parasites, sticking on the cells. Image from Wikipedia, common free.

Malaria tropica comes with periodic fever pushes, reaching more than 38.5 degree celsius body temperature. Ague at rising temperature, heavy sweating when the temperature is lowering are typical for malaria tropica, but it's not always appearing in this pattern. Very high temperatures up to 42 degree celsius together with neurological complications as disturbed consciousness and even coma can appear in heavy cases. It can come together with feverish dreams and hallucinations in a half-awake state. Spasms and stomach and digesting problems are typical as well.

Many other sympthoms can appear. Amog the possible organ sufferings and / or damages an edema in the lungs can happen (in about 10% of the cases).

Malaria tertiana has slightly different appearances; it can suddenly, without announcement reappear after months or years, because the parasites persist in parts of the bodies cell tissue. These reappearences can be triggered by other infections, stress, plane flights or climate changes.

While the reappearances for malaria tertiana will cease after about five years, malaria quartana can reappear even after decades, practically a live long.



All the yet available chemical medications have serious side-effects and are not fully reliable.

After the Second World War the invitation of chloroquin favoured the fight against malaria considerable. Though, from 1960 on more and more of the malaria parasites gained resistance against the medicine. More resistances against other chemicals caused a heavy backstroke in the fight against malaria. Resistances agains chloroquin are different in different regions. For Thailand and Vietnam there is a high 90% resistance reported.

Nevertheless, chloroquin (on which resochin, nivaquine, aralen and other medicines are based) is still among the most frequent medicines used for malaria prophylaxis and therapy. It's toxidity is relatively low, but the long-term use for prophylaxis is problematic.

Anopheles Mosquito, Sketch by Asienreisender 2013

Sketch of an Anopheles Mosquito.

The old classic in the fight against malaria, quinine, respectively medicines who base on it, are after a time of neglect again more and more in use. The followers of this website may remember, the botanist Franz Wilhelm Junghuhn was among the first working on the cultivation of quinine (Peruvian bark trees) in Southeast Asia in the 1860s, after it was brought from Peru to Java. Quinine is only used in therapy, not for prophylaxis.

Amodiaquin is comparable to chloroquin, but shows much heftier side-effects. Repeated reports about letal cases make it advisable to avoid it, particularly for prophylaxis.

Mefloquin, sold in form of lariam is a very strong medicine. It's applied in oral form. It has a bad recommendation because of it's strong (potential) side-effects on the central nervous system, as causing irritations, hallucinations, nighmares and more, up to schizophrenia. Therefore it's rather a good thing to keep it in reserve for the case that malaria appears, but not to use it for prophylaxis. There are more and more cases of mefloquin resistances reported from Thailand, due to an intensive use of the medicine there.

There is a number of more medicals; none of them is without at least the risk of strong side-effects.

The different resistances against the various medicines makes a therapy more difficult. It's particularly important to know where, in which region exactly the patient caught the disease, to be able to consider the local resistances.

For malaria tropica a stationary treatment (e.g. a hospital) is recommended, for a critical decline of the patients state can always happen. On the other hand are most of the hospitals in Southeast Asia themselves in a state that I personally would rather run away from them, even with a fever...

Besides, first of all they want to see cash. I remember the story of an elder Belgian fellow traveller, who told me that he went with a high temperature to an ambulance in Georgetown / Penang. They put him on a bed and he lost consciousness. In this state the staff anyhow let him fall down to the floor. When he went next to another hospital, the staff there first sent him out again to bring an appropriate amount of money. So he had to fight his way to the next ATM...

Later it turned out that he suffered dengue fever.


Global Eradiction of Malaria Program

In the early 1950s the World Health Organization (WHO) started the 'Global Eradiction of Malaria Program'. The massive use of DDT and the parallel treatment of malaria patients with chloroquin lead to a massive decrease of malaria worldwide. Malaria was fought out of Europe (until it came back into some southern regions decades later). Malaria was eliminated from Taiwan, great parts of the Caribics, parts of north Africa, completely from north Australia and great parts from the south Pacific. Great successes were done in Pakistan, Sri Lanka (Ceylon), great parts of Latin and central America. The cases in Southeast Asia were as well decreased considerably, but not that well. Particularly in Indonesia the results were weak. But the final goal to extinct malaria completely from the planet failed. It failed tue to the mentioned resistances who the plasmodias developed against DDT and chloroquine. In 1972 the WHO announced the programme publicly as failed.

It would have been possible to continue the program under application of other pesticides. But that wouldn't undertaken, because replacing DDT with other chemicals would have cost four to ten times more money.

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Published on July 28th, 2013