Travelers' Malaria is a comprehensive yet practical reference for health professionals, scientists, and all others involved in the field of travel medicine. Its focus is on all types of travelers - tourists (an estimated 5 billion annually), migrants, occupational travelers, relief groups, etc. - because each have different needs and concerns with regards to the complex disease of malaria. Also discussed are the evolving techniques for the determination of antimalarial drugs. Experts from various academic, government, and international agencies, including the CDC and the Walter Reed Army Institute of Research, and opinion leaders worldwide, have contributed their expertise to this publication. This landmark publication is a thorough, up-to-date overview of all aspects of malaria and its effects. It offers a wealth of valuable information to all faced with the challenge of preventing and treating this multi-faceted disease.
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Book Description
Editorial Reviews
From The New England Journal of Medicine
What is malaria? The answer to this seemingly simple question is, in fact, quite complex, for it depends to a large extent on who is infected. It is particularly difficult for reference books to describe a "typical" patient with malaria, since plasmodium infection in a partially immune, long-term resident of a malaria-transmission zone is likely to be very different from acute malaria in a nonimmune traveler to the same area. Given these considerations, Travelers' Malaria provides an especially helpful resource for practitioners of travel medicine in areas where malaria is not endemic, such as the United States, Canada, and western Europe.
The book is a compendium of reviews that focus in detail on the prevention and treatment of malaria in nonimmune travelers and immigrants. Each chapter is an up-to-date monograph (with an abstract) and contains detailed references to published literature as well as to appropriate Web sites. The book is well edited, and the organization and writing style of the chapters are refreshingly uniform.
The contributing authors are civilian and military experts in travel medicine who practice in Europe, North America, South Africa, and the Middle East. Their knowledge provides very useful guidance for less experienced practitioners who have the task of advising or treating travelers exposed to malaria. Individual chapters detail the geographic distribution of malaria, the role of anopheles mosquito vectors, the value of protective measures against mosquito bites, and the pharmacologic features of the drugs used for the prevention and treatment of malarial infection. Space is given to the difficult problem of advising pregnant or immunocompromised travelers. There is also information (based on the experience of the Peace Corps) on how to advise those who are planning long-term travel in malaria-transmission zones.
There is a separate section devoted to the counseling of immigrants who are from countries where malaria is endemic and who are returning to their homelands. These travelers are at high risk for infection if they have not been exposed to malaria for some time and have lost their partial immunity to the disease. Often, because of language barriers and because they believe that their risk of malaria is minimal, these travelers do not take effective precautions and subsequently contract malaria. They may return with partially treated or recrudescent malaria. The book also contains an appendix that lists many of the trade names used for common antimalarial drugs in other countries; this list is a useful aid for documenting previous antimalarial therapy.
On a per case basis, malaria is more lethal in U.S. travelers than in persons who live in developing countries, in part because of the nonimmune status of U.S. travelers, which results in febrile illness in virtually 100 percent of their malaria infections. The case fatality rates are also high because of the delays that typically occur in establishing a diagnosis of malaria in the U.S. health care setting. Usually, malaria is first misdiagnosed as influenza; then, once the diagnosis of malaria is considered, blood-smear testing is performed, but limited laboratory experience reduces its sensitivity and specificity.
Thus, even after appropriate testing, the disease may be misdiagnosed and treated inappropriately. Delayed therapy results in a high incidence of life-threatening complications, including severe anemia, renal dysfunction, and cerebral malaria. To aid the diagnostic process, Travelers' Malaria provides guidance on the clinical features of malaria and their frequency in returning travelers and immigrants. It also covers the value of microscopical testing and antigen-detection assays in these patient populations. Details on the pharmaceutical and supportive care of nonimmune patients with symptomatic malaria are given, and common indications for intensive care and ancillary therapy, such as dialysis or exchange transfusion, are described.
Throughout the book, tables and figures summarize and illustrate the material presented in the text. A less handy feature is the grouping of the color figures in the center of the book. The publisher provides a CD-ROM version of the book with every printed copy, along with the software necessary for viewing it in its electronic (pdf) format. I found that the figures, particularly the photomicrographs of malarial blood smears, were easier to view on a computer screen than in the printed book. Installation of the software proved successful on several computers and took only a few minutes, even with a first-generation CD-ROM drive. Although the index in the printed book is good, use of the CD-ROM permits more efficient searches for key words or topics.
Travelers' Malaria is a comprehensive and well-focused book that fills a niche in the practice of travel medicine. It will serve as a worthwhile reference for specialists in the field as well as for any practitioner who may confront the complexities of caring for a traveler exposed to malaria.
Charles H. King, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
About the Author
Patricia Schlagenhauf-Lawlor PhD Insitute of Social and Preventative Medicine University of Zurich Zurich, Switzerland
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