Mikä ihmeen malaria?

Vaikka missäänpäin maailmaa malaria ei enää ole lasten yleisin kuolinsyy ja turistejakaan malariaan enää harvemmin menehtyy, vuodessa silti yli 200 miljoonaa ihmistä sairastuu malariaan, lähes puoli miljoonaa ihmistä menehtyy siihen vuosittain ja onhan tuo ihan tavalliselle matkajaallekin kettumainen sairaus. Ihan turhanpäiväisestä ja olankohautuksella ohitettavasta taudista ei siis ole kyse ja siksi malariasta tuleekin ihan oma postaussarja tänne Huoletonta matkaa-blogiin. Tässä ensimmäisessä osassa puhutaan siitä, mikä se malaria nyt ylipäätään on ja mistä sen tunnistaa. Myöhemmissä postauksissa tullaan käymään esimerkiksi läpi sitä, millaisia malarialääkkeitä on tarjolla, mietitään sitä, miksi malarialääkkeitä kannattaa syödä, miten muuten kun lääkkeillä malariaa voi ehkäistä ja mitä tehdä, jos kaikesta huolimatta malaria iskee.

Minkämoinen tauti se malaria sitten on?

Malarian takana on pienen pieni loisalkueläin, joka kulkeutuu ihmiseen hyttysen pistosta. Näitä loisia voi elää hyttysessä neljää erilaista ja näin ollen myös malariaa on neljää eri tyyppiä. Malariaa levittävät useat eri hyttystyypit ja malariaa esiintyy niin maaseudulla, haja-asutusalueilla kuin ajoittain myös kaupungeissa, koska osa malariahyttysistä pystyy lisääntymään myös pienissä talousvesissä. Malaria kuitenkin vaatii elääkseen melko lämpimän ilmaston, joten esimerkiksi Euroopassa malariaa enää harvemmin esiintyy, erittäin satunnaisia Etelä-Euroopan tartuntoja lukuunottamatta. Pääasiassa malaria tarttuu hämärän ja pimeän aikaan liikkuvista hyttyslajeista.

Kaikista vakavin malarian muoto, falciparum-malaria, esiintyy pääosin päiväntasaajan lähistöllä ja kaikista maanosista reilusti eniten Afrikassa. Ainoastaan vivax-tyyppistä malariaa esiintyy tropiikin ulkopuolella, viimeksi 1940-luvulla myös Suomessa. Muita kahta tyyppiä kutsutaan Ovale-tyypiksi ja Malariae-tyypiksi.

Malariatartunta ja oireet

Hyttysenpistosta sen vakavimman malariatyypin, eli falciparum-malarian oireiden alkuun menee vähintään viikko, mutta useimmiten parikin viikkoa. Noissa kolmessa muussa malariatyypissä itämisaika on vieläkin pidempi, jopa vuosi. Tästä syystä outojen oireiden ilmaantuessa pitkänkin ajan päästä reissusta, on lääkärille hyvä muistaa mainita oleskelusta malaria-alueella.

Usein alkaessaan malaria muistuttaa ihan  tavallista kuumepöpöä. Lihas- ja päänsärky on tyypillistä ja kuume on alkuun jatkuvaa tai epäsäännöllistä. Malarian edetessä kuume muuttuu kuitenkin yleensä nopeasti kellontarkasti nousevaksi kuumeeksi, joka kestää muutaman tunnin, laskee ja nousee taas yleensä joko joka toinen tai kolmas päivä. Yleensä kuumejaksojen välissä vointi on ihan hyvä. Oireet sammuvat vähitellen viikkojen kuluessa, mutta koska malarialoinen voi jäädä elämään maksaan piilevästi, voivat oireet uusia kuukausien ja vuosienkin jälkeen ja aiheuttaa harvoin myös elinvaurioita, joten myös tälläinen tavallaan itsestään helpottava vivatix-, ovale- tai malariae-tyyppinen malaria on syytä diagnosoida ja hoitaa.

Valitettavasti tuohon vakavimpaan falciparum-malariaan tuo kellontarkka kuumeilu ei kuitenkaan liity, vaan siinä kuume on tyypillisesti alusta asti epäsäännöllistä ja hyvänolonvaiheita ei ole lainkaan. Toisinkun muut malariatyypit, falciparum-malaria voi kehittyä hengenvaaralliseksi vain muutamassa päivässä. Tästä syystä malaria-alueella oleskellessa tai sieltä palattua kuumepöpön iskiessä on syytä hakeutua terveyskeskukseen testeihin, vaikka normaalisti ei vielä sairastumisen ensipäivinä sinne hakeutuisikaan. Malaria todetaan somernpäästä otettavasta verinäytteestä, joten isosta operaatiosta ei ole kyse.

Mitä malaria voi aiheuttaa?

Pahimmillaan varsinkin falciparum-tyyppinen malaria voi johtaa kuolemaan, mutta täytynee heti todeta, että varsinkin ihmisellä, jolla on pääsy laadukkaan hoidon pariin, se on äärettömän harvinaista. Suomalaisia on malariaan kuollut viime vuosikymmeninä vain kourallinen ja näissä kaikissa tapauksissa ydinongelma ei ole ollut malarian hoidossa, vaan siinä, että ihminen ei ole hakeutunut ajoissa hoitoon tai malariaa ei ole heti osattu epäillä ja hoitaa.

Vakavin malaria, falciparum-malaria, tukkii hoitamattomana pieniä verisuonia ja estää näin kudosten hapensaantia. Tämä johtaa nopeasti elinvaurioihin ja hoitamattomaan falciparum-malariaan kuolee joka viides sairastunut. Jos hoito kuitenkin aloitetaan ajoissa ja tehokkailla lääkkeillä, parantuvat lähes kaikki sairastuneet. Muut malariatyypit periaatteessa paranevat itsestään, mutta saattavat jäädä elämään maksaan ja aiheuttaa myöhemmin ongelmia, joten Suomessa myös nuo tartunnat hoidetaan ja varmistetaan, että kaikki loiset saadaan poistettua kehosta.

Tärkeää on muistaa, että sairastettu malaria ei suojaa uusilta malariatartunnoilta, vaan malariaan voi sairastua useita kertoja ja ovale- ja vivax-tyyppiset malariat voivat elää kehossa pitkäänkin hoidosta huolimatta.

Matkailijat ja malaria?

Malarian on sanottu olevan tropiikin seuduilla matkailevien reissaajien vakavin infektiouhka. Jos katsotaan Suomessa todettuja malariatapauksia, niistä yli 80% on saatu trooppisesta Afrikasta. Tästä kuitenkin puuttuvat itse kohdemaassa todetut ja hoidetut malariatapaukset. Noin 70% tartunnoista on ollut tuota edellä mainittua vakavinta malariatyyppiä, eli falciparum-malariaa, joten turhaan hoitoonhakeutumisen tärkeydestä ei puhuta.

Oleellista matkailijan on siis itse tietää se, että on matkaillut malaria-alueella ja muistaa pyytää malariatestejä, jos epämääräisiä oireita ilmestyy. Usein varsinkin pidemmälle edennyttä malariaa erehdytään luulemaan verenmyrkytykseksi, keuhkokuumeeksi, hepatiitiksi tai vaikkapa lavantaudiksi tai dengue-kuumeeksi. Malaria on kuitenkin erittäin helposti yhdellä verikokeella todettavissa ja kohtuullisen helposti hoidettavissa, kun sitä vaan osataan epäillä ja se todetaan tarpeeksi ajoissa!

 

Tässä kaikki malariasta tällä kertaa ja kuten todettu, myöhemmin keväällä palaillaan aiheeseen malarian levinnäisyyden, malarialääkitysten, muiden malarianehkäisykeinojen ja sen suhteen, miten tarkemmin toimia tilanteessa, jossa epäilee saaneensa malaria-tartunnan. Alla vielä muutama hyödyllinen suomenkielinen linkki. 

 

Hyödyllisiä linkkejä aiheeseen liittyen:

Duodecimin terveyskirjaston artikkeli malariasta

Duodecimin terveyskirjaston artikkeli malarian ehkäisystä

Matkailijan terveysopas: Malarian tartunta, taudinkuva ja diagnoosi

YTHS:n ohje malariasta

David Livingstone-seuran ohjeet matkailijoille


Oliko malaria teille jo ennestään tuttu sairaus? Kommentoikaa ihmeessä alle, tuliko tässä postauksessa uutta tietoa ja mitä vielä haluaisit tietää malariasta?

455 thoughts on “Mikä ihmeen malaria?

  1. Olisi hyödyllistä kuulla malarialääkityksestä ja etenkin estolääkityksestä myös lasten näkökulmasta. Minkä ikäisen kanssa esimerkiksi kannattaa alkaa edes suunnitella matkoja malaria-alueelle.
    Tosi kiinnostava näkökulma matkablogiin tämä koko blogisi!

  2. Komppaan kommentoijaa edellä, että kiva, että olet aloittanut näin spesifin matkablogin, johon sinulla on ammatillista osaamista! Aikoinaan kinasin nyt jo edesmenneen äidinäitini kanssa Suomessa esiintyneestä malariasta, kun luulin, että Suomessa ei olisi milloinkaan voinut esiintyä tällaista trooppista tautia. Mutta väärässähän minä olin ja mummo oikeassa, kun vähän enemmän asiaa silloin tutkittiin 🙂

    • Kiitos, ajattelin itsekkin, että tämä voisi olla mielekäs tapa yhdistää rakkautta reissuihin ja vähän myös sitä ammattillista osaamista! Ja täytyy myöntää, että tuli tuo itsellenikin aikanaan opiskellessa yllätyksenä, että Suomessakin on ollut malariaa ja että sitä edelleen satunnaisesti tavataan myös Euroopassa!

  3. Mahtava blogiaihe ja mielenkiintoinen postaus! Minä olen sairastanut malarian estolääkityksestä huolimatta. Edelleenkään minua ei huolita verenluovutukseen ainakaan täällä Espanjassa, vaikka sairastamisesta on jo yli 15 vuotta. Miten lie muualla? Ilmeisesti Suomessa se on jossain määrin mahdollista tietyn ajan jälkeen?

    • Kiitos! Toi on kyllä ikävää, jos se malaria iskee lääkityksestä huolimatta, mutta valitettavasti mahdollista kuten sunkin tapauksessa nähtiin. Onneksi kuitenkin usein oireet tulevat ainakin lievempinä ja hoito onnistuu helpommin jos on ollut estolääkitys päällä. Suomessa verta saa luovuttaa kolmen vuoden päästä malarian sairastamisesta ja silloinkin verestä tutkitaan malariavasta-aineet ja jos ne positiiviset niin valitettavasti siitä seuraa sitten pysyvä este verenluovutukselle, mutta jos vasta-aineita ei ole, tuon kolmen vuoden jälkeen saa luovuttaa ihan normaalisti.

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