Malaria
You’re walking along the road when suddenly you feel a slight pinch on the inside of your arm. OUCH! You swat at the mosquito who just had your blood for dinner. A slight bump forms, but you soon forget about it. A couple weeks later, you start to feel tired all the time and you are having frequent headaches. What’s going on? You tell your mom you are starting to feel very hot and she checks your temperature. Oh no! You have a fever of 102.3° F! A sudden chill goes down your spine as you remember your run-in with your mosquito friend. What if I’m infected with malaria? This dangerous disease has posed many questions that consist of; what the disease actually is, what are the symptoms, what are the types of treatments and how they are improving, if malaria is evolving and the new treatments, and is there any prevention and what is the new research.
Malaria, commonly known as Plasmodium Malariae, has been around as long as the fourth century B.C. in Greece. It is a fatal disease caused by the bite of an infected female mosquito or by contact with infected blood. Malaria is one of the world’s most infectious diseases, infecting whole populations at a time. There are around 225 million cases of malaria each year and around 780,000 people lose their life because of it. There are even mummies in Egypt that have actually been excavated and have shown signs of malaria. There are actually four one-celled parasites that can infect humans; plasmodium falciparum, plasmodium vivax, plasmodium ovale, and plasmodium malariae. Plasmodium falciparum is the only life-threatening form of this infection, namely it is the only human life-threatening form. The other three do cause infection in humans, but rarely do they cause deaths. Malaria can be found all over the world, such as Central and South America, India, sub-Saharan Africa, Southeast Asia, and the Middle East. Sub-Saharan Africa is where over ninety percent of all malaria cases are recorded. When bitten, a mosquito’s saliva mixes with the tiny, wormlike creatures of plasmodia. Only one plasmodia is all it takes for a human to be seriously ill. The period of time from when you are bitten to when you begin to feel symptoms is usually two-three weeks. This progression is when Plasmodium falciparum makes it’s move. The parasite moves through the body and moves towards the host’s liver. Inside the host’s liver cells, falciparum eat and multiply. As the parasite begins to grow, the cell becomes engulfed and digested. Michael Finkel, a journalist and scientist from National Geographic, explains that by one week, “Each falciparum that entered the body has now replicated itself 40,000 times.”(Finkel, 2007,12) and the cell explodes. At least 40,000 parasites are now loose in your bloodstream. Instead of a liver cell, falciparum now seek a red blood cell. After eating and multiplying, the cell erupts and more monsters are now reeking mayhem.
Now that you know what is going on inside your bloodstream, you are probably wondering what kind of symptoms you’re going to experience. Symptoms of malaria can range from being mild to being severe to even, in some cases, death. Now that your body has acknowledged your invaders, your immune system kicks in by trying to burn them away. First off is the shivering (warmth is created by muscle vibrations). Next comes your severe fever. Afterwards, you experience sweating so much that it drenches you. Other milder effects are muscle aches, tiredness, headaches, diarrhea, and vomiting. In some rare cases, you may undergo what is called “cyclical pattern”. This is when symptoms only last six-ten hours, disappear, and return every two-three days. Malaria is such a fast-acting disease that you could be healthy in the morning, but by night you could be on your death bed, waiting for the virus to consume your whole body. Dr. Sneh Khemka, from Bupa International recalls an instant when a young girl comes in to a hospital in Papua New Guinea stating, “…her mother had walked her the 14 miles needed to get to the local health clinic. During the course of that walk, the malaria had traveled to her brain…” (Khemka, 2) Sometimes falciparum will take over red blood cells to help themselves. Unfortunately, sometimes falciparum extend knobs on the end of the cells that keeps them from moving through the spleen. This lack of filtering damaged cells causes the brain to swell, which leads to cerebral malaria. Cerebral malaria is the most deadly case of malaria the world has seen. Patients who are treated and become cured of the disease are scarred in some way. Neurological damage can cause deficiencies. A case study during the late 1990’s, when the evolving malaria was discovered, proves this when Brewster writes, “Thirty five of the survivors of the cerebral malaria had residual neurological deficit, the most common manifestations of which were hemiplegic, cortical blindness, aphasia and ataxia.” (Brewster, 1990, 4).Severe symptoms of malaria include; kidney failure, mental confusion, coma, seizures, severe anemia, lung fluids, and, ultimately, death. People who are more susceptible to be infected with a severe case of malaria are young children and pregnant women. This is because they, generally, have a decreased immune system.
Don’t get scared, though. Malaria is actually curable, depending on the type of malaria you have been diagnosed with. Unfortunately, there is not yet a vaccine that prevents you from obtaining malaria. According to Declan Butler, he, among others, believes it will take a while before there will ever be a vaccine when he states, “But old hands of malaria research, such as Louis Miller of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, feel that it will take longer — perhaps two decades — to convert genomic information into effective vaccines.”(Butler, 2002, 37). In the past, chloroquine has been used as the sole treatment for malaria. This main treatment, chloroquine, works by injuring the parasite and fighting off the infection. Now, however, some regions have exchanged chloroquine for sulfadoxine/pyrimethamine. This change in medicines is because some parasites have actually become immune to the treatment. Other parasites, however, are still affected by the chloroquine treatment. While the parasites in sub-Saharan Africa are evolving, parasites in Haiti are still being effected by the chloroquine treatments. This is proven when scientist, Joseph Keating, conducts a study of malaria in Haiti and states, “…P. falciparum is still chloroquine sensitive in Haiti…” (Keating, 2008, 29). Scientists in the Southeasten Asia area have considered the use of an artemisinan derivative, which lowers the levels of malaria transmissions. After the artemisinan derivative, patients are given a quinine and halofantrine combination treatment. If left untreated, malaria can come back throughout the years. There are some life diseases that can cause humans to be resistant to malaria. Sickle cell disease, thalamassaeias, glucose-6-phosphate dehydrogenase, and Duffy antigens all give humans the resistance because they all impair the parasite’s growth and reproduction, and give some sort of protection.
The only problem you would have to worry about is whether you were bitten by a mosquito who has become resistant to chloroquine and to vector control insecticides. Since chloroquine is the world’s most often used treatment for malaria, some of the nasty parasites have grown an immunity to it. Malaria’s parasites are so genetically diverse that it allows them to overcome the most effective antimalarial drug treatments. The fact that malaria parasites reproduce so quickly adds to the increasing immunity. The drug-resistant trait is passed on to each new generation of parasites. Michael Finkel states that during the 1990’s, when malaria’s evolution was soon discovered, “…malaria afflicted a greater number of people, and was harder to cure, than ever.” (Finkel, 2007, 18). To reverse the immunity to chloroquine, scientists have tested different combinations of drugs with insecticides, one of which is zooprophylaxis. Zooprophylaxis is a concept that a mosquito will be attracted to a domestic animal(i.e. a dog, cow, pig, etc.) instead of a human. Since mosquitoes are naturally drawn to the smell of human blood, the zooprophylaxis/insecticide combination works by attempting to cause cow blood to be more enticing. Cows are primarily used as disease test subjects, when Kawaguchi states that “cattle can serve as a dead-end host.” (Kawaguchi, 2004, 35). A dead-end host simply means that when parasites are transmitted, the host cannot continue to help the parasites from completing their life cycles. Thus, ending the transmission of the disease. When searching for blood, a mosquito is more attracted to a host with a higher population density, meaning a bigger population. The main point in the zooprophylaxis experiment is that the cow population density rises with the new treatment and mosquitoes are, consequently, drawn towards the cattle. This results in a lessoning of malaria cases in the rural areas of the countries affected by malaria. For severe cases of malaria, patients are treated with quinine that is either intravenous, given in the vein, or intramuscular, given in the muscle.
You can easily prevent yourself from ever being infected with malaria. The use of insecticide covered nets has greatly effected the amount of cases of malaria. Again, the problem of the insecticide-resistant parasites remains, though. There are, however, nets without the use of insecticide that primarily have the job of simply keeping mosquitoes from making you their next snack. A reoccurring problem with nets are getting them to villages that are extremely remote. Especially to ones that are in dire need of protection. Spraying insecticides inside homes can immensely repel the mosquitoes that have not become immune. Emptying out water that is infested with mosquito eggs will help also. One other caution that can be performed is keeping a safe distance from marshy lands or any area of land near water. Mosquitoes are night-dwellers, feeding mainly from dusk until dawn. Knowing this, people should not go walking out at night in places that have a high malaria rating. Also, a simple knowledge of what malaria is can help prevent infections from occurring. Scientists everywhere are concerned with malaria and are constantly looking for new ways to rid the world of this terrible disease. Funding is a big part of malaria research. Every year donations are given to help scientists achieve new research, proven when Nantulva states, “with initial donations of more than US $2.5 million to the World Health Organization/Special Program for Research and Training in Tropical Disease Research (WHO/ TDR).”(Nantulva, 2007, 36).
Malaria is a significant problem in today’s world. Getting bitten by a mosquito with malaria could change your life forever and scar you. People tend to be confused as to the malaria disease, but questions such as what malaria is, what are the different types of symptoms, what are the treatments for malaria and how they are improving, and how can malaria be prevented and if there is any new research tend to be at the root of their confusion. Malaria is a constant problem in which it’s mysteries are still being researched.