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The malaria parasite has caused untold grief throughout human history. The name originated from Italian mal aria (bad air), since the ancient Romans believed the disease was caused by the decay in marshes and swamps, and was carried by the malodorous "foul" air emanating from these areas.5 In the 1880s both the Plasmodium protozoa as well as its mosquito vector were identified.5 Today, 40% of world's population lives in areas where malaria is endemic. More than 500 million people suffer acute malaria infection, and one to three million die from the infection each year.5,41,129 Included among those at risk of becoming infected are 50 million travelers from industrialized countries who visit the developing countries each year. Despite using prophylactic medications (Table 58–1), 30,000 of these travelers will acquire malaria.97

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Table 58–1. Common Adult Doses of Antimalarials Used Worldwide
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The bark of the cinchona tree, the first effective remedy for malaria, was introduced to Europeans more than 350 years ago.114 The toxicity of its active ingredient, quinine, was noted from the inception of its use. Pharmaceutical advances occurred, funded largely by the military during World ...

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