Malaria is a parasitic disease endemic in parts of the world where moisture and warmth permit the disease vector, mosquitoes of the genus Anopheles, to exist and multiply. The emergence of both drug-resistant strains of malarial parasites and insecticide-resistant strains of Anopheles has contributed significantly to the extensive reappearance of this infection. The annual global incidence of malaria is estimated to be approximately 200 million cases, and in tropical Africa alone, malaria is responsible for the yearly deaths of more than 1 million children younger than 14 years. Malaria ranks as a leading cause of mortality in the world today.

Most cases of malaria in the United States result from individuals who have contracted the disease before they entered this country. It is also possible to contract malaria during a blood transfusion if the transfused blood has been taken from a malaria-infected individual. Additionally, hypodermic needles previously contaminated by blood containing malarial parasites can be the source of an infection; this has occurred when needles are shared among drug addicts.

Effective treatment of malaria depends on early diagnosis. Since the patient's symptoms are often relatively nonspecific, it is crucial to examine stained blood smears for the presence of the parasite. Even this procedure may be inconclusive during the early stages of the infection, since the levels of parasitemia can be quite low. Thus, it is important to repeat the blood smear examination several times if malaria is suspected.

Once the presence of malarial parasites has been confirmed, it is vital to identify the particular plas-modial strain involved, since appropriate use of chemotherapy depends on the particular species responsible for the acute attack. Unfortunately, mixed infections, that is, simultaneous infections with more than one species of plasmodia, are often observed. If more than a single species is involved, treatment appropriate for the elimination of all strains must be instituted to avoid delayed attacks or misinterpretations.

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