n 2020, approximately 241 million cases of malaria occurred in 85 countries with endemic malaria. Travelers to these regions are at risk for infection. 1 The number of people with malaria who arrive in the US has increased each year since 1972, from approximately 614 cases in 1972 to an 2161 cases in 2017. 2 Patients with malaria typically present to frontline US health care workers, who need to diagnose and manage this infection. This Review summarizes current evidence regarding the prevention, diagnosis, and treatment of malaria. MethodsWe searched the PubMed and Cochrane Library databases for English-language randomized clinical trials, meta-analyses, systematic reviews, and observational studies of the epidemiology, diagnosis, and treatment of malaria, published from January 2016 to March 2022. References were searched manually for additional relevant publications, including World Health Organization IMPORTANCE Malaria is caused by protozoa parasites of the genus Plasmodium and is diagnosed in approximately 2000 people in the US each year who have returned from visiting regions with endemic malaria. The mortality rate from malaria is approximately 0.3% in the US and 0.26% worldwide. OBSERVATIONS In the US, most malaria is diagnosed in people who traveled to an endemic region. More than 80% of people diagnosed with malaria in the US acquired the infection in Africa. Of the approximately 2000 people diagnosed with malaria in the US in 2017, an estimated 82.4% were adults and about 78.6% were Black or African American. Among US residents diagnosed with malaria, 71.7% had not taken malaria chemoprophylaxis during travel. In 2017 in the US, P falciparum was the species diagnosed in approximately 79% of patients, whereas P vivax was diagnosed in an estimated 11.2% of patients. In 2017 in the US, severe malaria, defined as vital organ involvement including shock, pulmonary edema, significant bleeding, seizures, impaired consciousness, and laboratory abnormalities such as kidney impairment, acidosis, anemia, or high parasitemia, occurred in approximately 14% of patients, and an estimated 0.3% of those receiving a diagnosis of malaria in the US died. P falciparum has developed resistance to chloroquine in most regions of the world, including Africa. First-line therapy for P falciparum malaria in the US is combination therapy that includes artemisinin. If P falciparum was acquired in a known chloroquine-sensitive region such as Haiti, chloroquine remains an alternative option. When artemisinin-based combination therapies are not available, atovaquone-proguanil or quinine plus clindamycin is used for chloroquine-resistant malaria. P vivax, P ovale, P malariae, and P knowlesi are typically chloroquine sensitive, and treatment with either artemisinin-based combination therapy or chloroquine for regions with chloroquine-susceptible infections for uncomplicated malaria is recommended. For severe malaria, intravenous artesunate is first-line therapy. Treatment of mild malaria due to a chloroquine-resistant parasite consists ...
Purpose of reviewThis is a review of Plasmodium vivax epidemiology, pathogenesis, disease presentation, treatment and innovations in control and elimination. Here, we examine the recent literature and summarize new advances and ongoing challenges in the management of P. vivax. Recent findingsP. vivax has a complex life cycle in the human host which impacts disease severity and treatment regimens. There is increasing data for the presence of cryptic reservoirs in the spleen and bone marrow which may contribute to chronic vivax infections and possibly disease severity. Methods to map the geospatial epidemiology of P. vivax chloroquine resistance are advancing, and they will inform local treatment guidelines. P. vivax treatment requires an 8-aminoquinoline to eradicate the dormant liver stage. Evidence suggests that higher doses of 8-aminoquinolines may be needed for radical cure of tropical frequentrelapsing strains. Summary P. vivax is a significant global health problem. There have been recent developments in understanding the complexity of P. vivax biology and optimization of antimalarial therapy. Studies toward the development of best practices for P. vivax control and elimination programs are ongoing. Keywords 8-aminoquinoline, cryptic infection, glucose-6-phosphate dehydrogenase deficiency, P. vivax drug resistance, P. vivax prevention, P. vivax treatment, Plasmodium vivax, Plasmodium vivax circumsporozoite protein (PvCSP) vaccine development, radical cure P. vivax was estimated to cause 4.5 million (2%) of the 241 million cases of malaria in 2020 [2]. P. vivax is prevalent in the Middle East, Asia, the Western Pacific and Central and South America as well as in parts of Africa [1]. P. vivax accounted for 68.3% of malaria cases in the Americas, 36.3% of cases in Southeast Asia, 30.1% of cases in the Western Pacific, 18.1% of cases in the Eastern Mediterranean and 0.3% of cases in Africa in 2020 [2].P. vivax, like other Plasmodium species, is acquired from the bite of an infected female Anopheles mosquito. Sporozoites enter the bloodstream
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