Malaria

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Malaria

MALARIA


Malaria is a deadly disease. This infectious disease is common in mostly tropical and subtropical areas. Certain types of mosquitoes spread it. You contract this disease after being bitten by a female Anopheles Mosquito.
This disease dates back to the Greek physician, Hippocrates. (Known as "The Father of Medicine") He identified Malaria as far back as 1600 B.C. It became common in the U.S. during the 19th century and the early part of the 20th century. (3)
A one-celled parasite, plasmodurim causes Malaria. There are over 170 species of plasmodium, but only four cause Malaria in humans. They are P. Falciparium, P. Vivax, P. Ovale and P. Malariae. (3,5)
When a mosquito bites you, it injects the sporozoites into that person’s bloodstream. These sporozoites migrate very quickly to your liver, and during the next couple of weeks they develop into a structure, housing thousands of cells called merozoites. In some cases the P.vivax and P.Ovale infection can remain inactive for an extended period of time. This often causes a relapse when the parasite’s lifecycle is re- activated. When the parasite life cycle matures the infected liver cells burst. ( Appendix I) This sends the merozoites into the bloodstream. The red blood cells reproduce further, and develop into trophozoites. Trophozoites are another form of plasmodium and gametocytes. These can be ingested by the next mosquito and renews the transmission cycle. When these infected blood cells burst, they once again start to invade even more red blood cells. As each wave of blood cells ruptures, which is every 48-72 hours, this is what causes you to experience chills, fever and sweating. (5,8,10)
The signs and symptoms, that you may have with malaria would include: chills, high fever, profuse sweating as body temperature falls and general feeling of unease and discomfort. Other signs and symptoms could include headache, nausea, vomiting and diarrhea. (6,7,12)
The amount of time between the mosquito bite and the appearance of these symptoms varies. It depends on the type of parasite involved. It can be as short as 8-12 days or as long as a year. (2,13)
Malaria is diagnosed by examining blood under a microscope. The parasite can be seen in the blood smears on the slide. In order to make a correct diagnosis, this procedure may need to be repeated over a 72-hour period. If a person has been in an area where malaria exists and becomes ill, they should request a blood test for Malaria. North American doctors often misdiagnose malaria as the flu virus. Many of the North American doctors are not used to seeing the disease. Treatment cannot be delayed or the prognosis could be fatal! (1)
The treatment for all strains of Malaria except for Falciparium is usually chloroquine (Aralen) by mouth for three days. There are some strains of falciparium that are resistant to chloroquine and are treated with a combination of quinine and tetracycline. In some countries, there is a quinine resistance developing and other treatments many include: Clindamycin(Cleocin), Mefloquin(Lariam), or Sulfadoxne/Pyrimethamine
(Fansidar). Most of these patients receive an antibiotic for seven days. If a patient becomes extremely ill, they may need intensive care and intravenous (IV) malaria treatment for the first three days. (1,5,8)
If you were unfortunate enough to acquire falciparium malaria in the Dominican Republic, Haiti, Central America, West of the Panama Canal, the Middle East or Egypt, this malaria can still be cured with chlorquine. If you acquired faliparium Malaria in Africa, South Africa, India and Southeast Asia, there is a resistance now to chloroquine. In Thailand and Cambodia, there are strains of falciparium malaria that have some resistance to almost ALL known drugs!!! (1,5,8,10)
A patient can become extremely ill when contracting falciparium malaria. They will need to be hospitalized and given anti-malaria drugs. Different combinations and doses will depend on the strain. Kidney dialysis, IV fluids, red blood cell transfusions and breathing assistance maybe necessary.
Most complications are associated with the most serious strain P.falciparium. Kidney failure and the rapture of the spleen, along with breathing problems, dehydration and liver failure are most common. But, if parasite filled blood cells block blood vessel to the brain (cerebral malaria) swelling of the brain or brain damage may occur. This is why treatment must be started immediately. If left untreated, the patient could be dead in just a few hours. (5)
Some less used alternative treatments include the Chinese herb Qiinghaosu. This herb has been used in China and Southeast Asia, and became available in Europe in 1994. It is not available in the U. S. or other parts of the world, due to fears of toxicity. There is also licensing issues. There is a Western herb called Wormwood (Artemesia annua) and if taken daily can be effective. Another drug called, Halofantrine is available abroad, but not marketed in the U.S. and not recommended by the Centers for Disease Control and Prevention. Still under method is known as Neem Leaf extract and it is also given to people to drink as tea, before going on a trip to a malaria infested area. (5,8,10)
Several scientists are still working on a malarial vaccine, but because the life cycle of the malarial parasite is very complex, this makes developing a vaccine difficult. Since a parasite has a numerous amount of more genetic material then a virus or bacterium, this is the reason why the vaccine is so difficult to develop. (5)
The malaria parasite goes through several separate stages, a vaccine that was developed was tested on people who had been exposed to malaria in South America and Africa, and it seems to have protected 60% of these people. But, it is not yet commercially available. (15)
Mosquito Control has been topic of the World Health Association
(WHO) for over 30 years. Any pesticide with DDT was most effective. However, the mosquitoes, and the parasite are now extremely resistant to these insecticides designed to kill them. (11)
Travelers to any high-risk area should use insect repellant containing DEET for any exposed skin. This repellant is highly toxic. Children using this repellant shouldn’t use a concentration higher then 35%. DEET should be washed completely after coming indoors. This repellant should be kept away from eyes, broken skin or children’s hands.
Some simple rules will help prevent infections:
1)     Remain indoors as much as possible in screen in areas
2)     Sleep inside a pyrethrin or permethrin repellant-soaked mosquito nets (Appendix II)
3)     Cover your entire body with clothing
4)     Take a anti-malaria drugs two days before leaving the U.S. and four weeks after re-entering the U.S.( chloroquineor mefloquine)]
The anti-malaria drugs that travelers take before and after their trip, still will not guarantee they will not contact malaria. Travelers who stay in hotels are at less risk then backpackers. There is even a risk at airports. Some people in the cities where malaria doesn’t usually exist may acquire the infection from a mosquitoes carried onto a jet. This is called airport or runway malaria. (5,8)
If malaria is treated in the early stages, it can be cured. But, for those people living in high-risk areas, some may never fully recover and reoccurrences are common between bouts of acute infection. (5)
Pregnant women should avoid traveling in malaria-endemic regions. If travel is unavoidable a doctor can prescribe an anti-malarial drug that’s appropriate for them, such as chloroquinme or mefloquine(during the second or third trimester) The drugs Malarone or doxycyline should not be taken because they could harm the fetus. Pregnant women are more likely to suffer from malaria than other women. It can cause anemia, miscarriage, premature birth or stillbirth. Babies born to mothers who have had malaria during pregnancy will probably be underweight and therefore more vulnerable to infection or death during their first year. Pregnant women should be treated immediately to prevent death! (12,15)
Many African and African-Americans carry the genetic trait for sickle-cell anemia. If a person gets the trait from both parents it usually causes a fatal blood disease. But, having one copy of the trait from one parent, seems to lower a person’s changes of getting malaria. Scientists discovered in 1953, there seem to be a connection between places where a high incidence of falciparium malaria and sickle cell traits were characteristic. Red blood cells, that are "sickled", have irregular crescent shapes rather than round shapes. They are rigid and block blood vessels causing anemia. If a red-blood cell is infected with a malaria parasite, the cell sickles more often dies, killing the parasite inside before it has time to reproduce. The body’s immune cells have a better chance of getting rid of the remaining disease- causing organisms before a full-blown case of malaria develops. If you have the sickle-cell trait and live or travel to a tropical location these sickled blood cells actually provide a defense against malaria.(4)
Malaria is a global infectious Killer. It is estimated that a many as 2.7 million people worldwide die each year. This is twice as many as people with AIDS. Malaria sickens at least a half billion! 90% of malaria deaths occur in Africa. Young children are especially vulnerable to the disease and kills an African child every 30 seconds. Many children who survive the infection suffer from learning impairments or brain damage. There is about 1,200 cases diagnoses in the U.S. each year. In most cases, these are of people that have been travelers. The most recent case in the U. S. was in September 2002. Two Virginia teenagers became ill. Researchers found malaria-carrying mosquitoes near their home. They did have the disease.(8,15)
Unfortunately the U.S. has shown little interest in the Malaria problem. Malaria is transferable in blood, yet it is not screened for in the American blood supply. The U.S. Anopheles Mosquito population has gone unmonitored for more that fifty years. Most Americans seem to think the disease as been eradicated or at least is confined to the tropics! (16) The real fact is that there are few places on earth that cannot sustain a malaria epidemic. (Appendix III)
There are four major reasons why Malaria hasn’t been able to eradicate.
1)     Anopheles Mosquitoes have built up a resistance to toxic sprays
2)     The malaria parasites became resistant to chloroquine and then to newer anti-malarial drugs as mefloquine
3)     Increased travel and international trade sent drug-resistant parasites all over the globe
4)     The fight become to expensive for poorer governments

Most scientists today have given up on getting rid of the disease. Most are concentrating on ways to control and reduce it! (3)

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