[Malaria in Norway--diagnosis, treatment and prevention]

The paper describes and discusses procedures and problems related to diagnostics, therapy and prophylaxis of malaria in Norway. A high degree of suspicion in physicians evaluating febrile travellers is of the utmost importance. The clinical symptoms and findings are initially rather unspecific, with fever and fever related symptoms. A definite diagnosis is made by the demonstration of malaria parasites in thin and thick blood smears, which is best performed by an infectious disease physician. Before treatment is started, it is important to determine whether the patient is infected with Plasmodium falciparum or with one of the more benign malaria species. If this is difficult microscopically, a test that detects P. falciparum antigen in blood may be useful in some cases. The therapy of benign malaria is still chloroquine plus primaquine; most patients with malaria falciparum can be routinely treated with mefloquine. Cases of complicated falciparum malaria, usually due to delayed diagnosis and start of treatment, require extensive and sophisticated treatment, usually including parenteral treatment with quinine. Prophylaxis consists of prevention of mosquito bites and chemoprophylaxis; the importance of avoiding bites should never be underestimated. A more widespread use of mefloquine among travellers to Africa is the most important change in chemoprophylaxis in recent years. Finally the article discusses possible improvements in diagnostic procedure, therapy and chemoprophylaxis.