Yesterday November 7, 2024 to Verona a was found case of malaria initially believed to be “indigenous case” (i.e. caused by the bite of an infected mosquito present in the national territory) but now classified as “imported case”. The Prevention Directorate of the Veneto Region in collaboration with the competent Health Authority and with the Istituto Zooprophylattico Sperimentale delle Venezie activated the procedures envisaged for the management of these cases, and in the hours following hospitalization it was possible to verify that the patient had actually took a trip to an area where malaria is endemic.
The concern for the identification of an indigenous case was high, considering that Malaria has been eradicated in Italy since 1970 (more than 50 years ago) and a resurgence of the disease would have presented health authorities with new scenarios of spread and contagion. Malaria is not transmitted by direct contact between humans, but requires the intervention of mosquitoes like that Anopheles. It is endemic in Africa, India, South America, the Middle East, Korea and Mexico, among other countries. It causes destruction of red blood cells, anemia, very high fevers and if left untreated leads to death.
What is malaria and how is it transmitted
There malaria it is a disease caused by such a protozoan Plasmodium; four different species of this pathogen can infect humans, but the most widespread is the Plasmodium falciparumwhich, among other things, unlike other species, in addition to infecting the host’s red blood cells, has the ability to cause obstructions to the capillaries and ischemic forms. Malaria is endemic in Africa, India, South and Southeast Asia, Korea, Mexico, Central America, Haiti, the Dominican Republic, South America, the Middle East and Central Asia; it was once endemic in Italy too.
Malaria is not transmitted by direct contact between humans, but requires the intervention of mosquitoes like that Anophelesvectors of this disease to humans and other mammals. If a female mosquito Anopheles bites a person suffering from malaria ingests reproductive cells of the malaria plasmodium together with the blood which begin to multiply in the body of the mosquito and move into its salivary glands. When the insect bites another human being, it also inoculates a certain number of plasmodium cells at a certain stage of development. These reach the host’s liver, complete the development cycle and pour into the bloodstream within a short time 1-3 weeksthus invading and destroying red blood cells.
About 70 species of the genre Anopheles in the world are capable of transmitting malaria plasmodium and well 6 species they are dominant vectors of Plasmodium in Europe. In the twentieth century, the spread of malaria in the world was significantly reduced thanks to control programs promoted by the WHO and in Italy, where historically the disease plagued many marshy areas, such as the Pontine marshes in Lazio, it was eradicated in 1970.
Currently, the species of mosquitoes vectoring malaria and the cases of contagion are constantly kept under control at the European level because the increase in international movements and travel and the favorable climatic conditions, with increasingly prolonged hot-humid periods, could lead to a re-emergence in Europe cases even where malaria had been eradicated. Moreover, indigenous episodes have already been reported since the end of the 1990s in Germany, the Netherlands, Spain, France, Greece and Turkey. Furthermore, even where it is not endemic, malaria continues to be a rather serious imported disease that must be identified and treated as quickly as possible. For this reason, in Italy, the Ministry of Health and the Istituto Superiore di Sanità maintain an active surveillance system continuous on malaria in Italy and each Region has the obligation to immediately notify new cases. The most frequent cases of the disease to date are those contracted by travelers returning from risk countries.
What happens if you get malaria: the symptoms
Symptoms of malaria generally appear later 7-15 days from the bite of the mosquito, although differences are noted based on the species of plasmodium injected. There destruction of red blood cells infected and the inflammatory reaction of the organism cause high fever, nausea, headache, diarrhea, but in its course malaria causes recurrent fever attacks and above all anemia. Furthermore, the accumulation of now destroyed red blood cells ends up obstructing the capillaries of the brain or “overloading” organs such as the kidneys, liver and spleen. Untreated cases may present renal failure, pulmonary edema, coma and lead to death.
How malaria is treated and what are the prophylactic measures
Malaria is treated with particular drugs called antimalarialswhich act on the reproductive cycle of plasmodium. A widely used drug is la chloroquinebut in cases of Plasmodium resistance, artemisinin, mefloquine or quinine can be used.
Travelers heading to countries in the world where the disease is endemic should be informed about the risks of contracting the disease and transmitting it indirectly to others and about the usefulness of implementing prophylactic measures. The development of a malaria vaccine it is really very recent and is dedicated to children; in particular, in 2021 the WHO started the use of this new vaccine among children in particularly at-risk areas of Africa. Travelers are currently recommended to adopt both behavioral measures such as the use of mosquito nets, skin and environmental repellents and pharmacological measures with the use of drugs that do not completely eliminate the risk, but considerably reduce it.
