areasthaninruralareasandmayevenbenegligibleinacity(exception:cer-
taincitiesintropicalAfricaandIndia).Thefollowingprotectivemeasuresare
recommended:
— Alwayswearclothingintheduskandatnight(longsleeves,longtrou-
sers)thatpreventsmosquitobitesasfaraspossible.Sprayclothingwitha
fast-actinginsecticide(pyrethrines).
— Applyaninsectrepellenttouncoveredskin(sprayorspreadbyhand)
(productswith 20 %diethyl-m-toluamideareprotectiveforthreeto
fivehours).
— Screenoffroomstokeepmosquitoesout(closedoorsandwindows,fit
fine-meshedscreensondoorsandwindows).
— Spraymosquitorestingplacesinroomwithinsecticide.Useinsecticide
dispenserwithrenewableinsecticidepelletorpyrethroidsmokecoils.
— Screenoffbedswithmosquitonets(veryimportanttoprotectinfantsand
smallchildren!).
— Impregnatingbednetswithaninsecticide(pyrethroids:permethrin,del-
tamethrin)increasestheireffectiveness.
&Chemoprophylaxis and emergency treatment. Chemoprophylaxis
comprisesregularintakeofantimalarialdrugsbefore,during,andforade-
finedperiodafterastayinamalariousarea.Dependingonthetargetadis-
tinctionbetweensuppressiveandcausalprophylaxiscanbemade:suppres-
sivedrugspreventclinicalsymptomsbyaffectingtheasexualstagesinthe
erythrocytes,whereascausaldrugsactagainstthetissueschizontsofP.fal-
ciparumintheliver,thuspreventingtheerythrocyticcycle.Mostofthe
agentscurrentlyinusehaveasuppressiveeffect(Table9. 6 ).Forshortstays
inlow-riskareas,itmayundercertaincircumstancesmakesensetorefrain
fromchemoprophylaxisandtakealonganemergencystand-bydrug.Self-
treatmentcanbeinitiatedinresponsetomalarioussymptomsifaphysician
cannotbereachedwithin 12 hours.Takingalongastand-bydrugisalsoworth
consideringifthereisahighriskofinfectionwithP.falciparum(especially
multiresistantstrains)anditisunclearwhethertheplannedchemoprophy-
laxiswillprovidesufficientprotection.Alwaysrememberthefollowing
principles:
— Thereisatpresentnochemoprophylacticregimenthatcanguarantee
100 %efficacy.Therefore,aphysicianmustbeconsultedimmediatelyif
feveroccursduringorafterthechemoprophylacticregimen.
— Specificantimalarialsrecommendedbyspecialistsmustbeusedforche-
moprophylaxisandemergencytreatment.Thesesubstancesmaycause
sideeffects.
— Specificadvisementoftravelersadaptedtotheirindividualsituation
(generalhealthstatus,pregnancy,age,smallchildren,allergies,etc.)
andthespecificsituationattheirdestinationisveryimportant.536 9 Protozoa9
Kayser, Medical Microbiology © 2005 Thieme