Socio-Economic and Environmental Conditions Contributing to Malaria

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QUESTION

what socio-economic and environmental conditions contribute to the disease?

ANSWER

Malaria transmission requires the presence of Anopheles mosquitoes; as such, conditions which favor the growth and persistence of these mosquitoes will also be hotspots for malaria transmission, provided the climate is also sufficiently warm for the development of the parasite within the mosquito.

Rural areas without sophisticated water and sanitation systems often utilize streams or ponds for everyday water needs; if these produce stagnant patches of water, they can be an ideal location for the development of mosquito larvae. Similarly, if rural farmers dig canals or ditches to irrigate their fields, these can become breeding areas. Urban areas tend to have less standing water, apart from cisterns, so in many cases transmission is less prevalent in urbanized locations. As a further socio-economic factor, preventing mosquitoes from entering the house and biting people is  key way to prevent infection. Rich people in malarial areas may be more able to have fully screened houses, possibly even with air-conditioning, which will prevent mosquitoes from establishing in the house. They may also be more likely to have access to a long-lasting insecticide treated bednet, which further reduces mosquito bites, and also access to accurate diagnostic screening and treatment, if they do happen to get infected.

All of these factors contribute to making malaria burden highest in some of the world’s poorest areas, with the highest levels of mortality in sub-Saharan Africa.

Relapsing Malaria

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QUESTION

I’m constantly on malaria drugs, fall ill every 2 weeks and always diagnosed with malaria.I’m getting really fed up and need a permanent solution to all of this. I want to live a healthy life and I’m tired of being on malaria drugs. How do I overcome malaria permanently?

ANSWER

It is very unusual to be reinfected so constantly with malaria. First of all, how are you getting diagnosed? You should be getting a blood test, and not relying on symptoms only; the symptoms of malaria are very general and it could be that you are suffering from something else entirely.

The two main methods for accurate diagnosis are blood smear and rapid diagnostic test. The blood smear is used throughout the world, but can sometimes miss light infections (though if you feel sick, your infection is likely heavy enough to be detected by this method). The problem is that it requires a trained technician to take the sample, prepare it properly, and read it thoroughly and accurately. In my experience, many clinics, especially if they are rushed and busy, will not take the time to read a blood slide properly, and will just diagnose malaria without looking. This is really bad!

It is very important to be properly diagnosed, so you can get the correct treatment, and if you don’t have malaria, you can be diagnosed for something else. The second kind of diagnostic is a rapid diagnostic test, or RDT. This looks for antibodies to malaria in your blood, and is very sensitive and quick. In an ideal world, you should try to have both done, to cross-check the results.

The next thing is to check whether you are receiving the correct treatment for the type of malaria that you have (if you are positively diagnosed with malaria). In many parts of the world, malaria has become resistant to some of the main medications used against it. Notably, this is the case in many places with Plasmodium falciparum, the most dangerous kind of malaria, which has become resistant to chloroquine in many parts of the world, to sulfadoxine-pyrimethamine (sold as Fansidar in many places) and also to mefloquine (sold as Lariam) in some places. As such, the World Health Organisation NEVER recommends these treatments be given as first line drugs against P. falciparum malaria—instead, they recommend artemisinin-combination therapies (ACTs), such as Alu, Coartem or Duo-Cotecxin. If you have been diagnosed with P. falciparum, you must try to take these kinds of drugs first. No resistance to ACTs has been reported, so if you take the full dose correctly, as prescribed by your doctor (and check to make sure the drugs are not expired), then you should be cured of malaria.

However, treatment does not stop you from getting infected again, and this is where prevention comes it. Preventing malaria is a cornerstone of control efforts. Since malaria is transmitted by a mosquito, preventing mosquitoes from entering the house, and particularly stopping them from biting you at night, is crucial. Screening all doors and windows can help stop mosquitoes from getting in, and in high transmission areas, many people will also spray inside their houses every once in a while with insecticides to kill any lingering insects.

In addition, sleeping under a long-lasting insecticide treated bednet can drastically reduce the number of mosquitoes that are able to bite you at night. If you already have a net, it may be worth re-dipping it in insecticide (usually permethrin) to make sure it is still working effectively. The mosquitoes that transmit malaria feed at night, so if you are walking around outside in the evenings or at night, it is important to try to wear long-sleeved clothing, to prevent them from accessing your skin.

All of these efforts will help prevent you from getting malaria again in the future.

High Count of Malarial Antibodies

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QUESTION

In 2007 we travelled to Kenya and Zanzibar. We took the normal anti-malarial tablets and were unaware of having been bitten. My older son has recently had a full medical and one of the blood tests which he had to repeat came back with a high count for malaria antibodies for Plasmodium falciparum. The doctor told him that he had had malaria at some time. We are puzzled as he has never been ill since returning. Can this happen? On the other hand my younger son has not been fully fit since returning from the trip, flu like symptoms, lack of energy etc. He has had several blood tests including one for glandular fever but nothing has shown up. Should he be tested for malarial antibodies? Could this be the reason he has had recurrent bouts of illness.

ANSWER

It is certainly possible to be exposed to malaria, but for your body to successfully fight the infection before it can reproduce and establish, thus the person will never experience the full illness. This is likely what happened with your elder son. As for your younger one, malaria tends to be an acute illness rather than a long-lasting chronic one, particularly the types of malaria that are found in East Africa.

Since your elder son was exposed and seems to have antibodies to malaria, I don’t think an antibody test will be particularly illuminating with regards to diagnosing your younger son. It would be better to have the doctors test him for malaria using the traditional thick and thin blood smears, which are then looked at under the microscope. This test will better inform the doctors whether your son has an active malaria infection, and will also be able to determine the species of malaria he has (if positive), and thus what treatment would be most effective for him. Again, though you should do this test to rule out malaria for sure, I think it is unlikely that your son has been experiencing symptoms caused by malaria for this length of time.

Malaria Fever

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QUESTION

My Father aged 65 years was diagnosed with 2 types of malaria almost a week back. he has been given medicines but temperature is fluctuating and not coming down. all other organs are functionining properly except platelet count which is little less.

Now he has been suggested new medicines for a duration of 14 days.
How fast can he recover from this malaria and when will the fever come down?

ANSWER

When patients are given the appropriate treatment against malaria, the fever is usually reduced very quickly and the patient will start to recover after a few days. The right kind of treatment depends on the severity of the infection and the type (or, in your father’s case, types) of malaria the patient is infected with.

If your father was infected with P. falciparum alongside another type of malaria (probably P. vivax, P. malariae or P. ovale), then he should have first received an artemisinin-based combination therapy (ACT) drug first. These drugs combine artemisinin or a derivative (such as artemether, artesunate or dihydroartemisinin) with another anti-malarial, such as lumefantrine. Common brand names of these ACTs include Coartem, Alu and Duo-Cotecxin.

There are no reported cases of resistance to these combination therapies at present, so if your father continued to feel sick after completing this treatment, he should be re-tested for malaria; it is possible that the malaria parasites were killed, and his continuing fever was an after effect either of the medication or just an indication that the body was recovering from the infection.

If he was re-tested and found positive, then other second-line drugs can be prescribed. However, it is important to note that malaria is resistant to chloroquine in many areas, and so this drug is not suitable for treatment in these places. Similarly, resistance is widespread to sulfadoxine-pyrimethamines, such as Fansidar, and in south-east Asia, P. falciparum is also resistant to mefloquine (Lariam) in some cases. As such, your father’s doctor should be careful to prescribe him an appropriate treatment for the area in which he is living.

In addition, if your father was found to be co-infected with either P. vivax or P. ovale, then there is a chance of later relapse into malaria again, weeks or even months after the initial infection has been treated. This is because the parasites in these types of malaria can form dormant stages in the liver, where they escape being killed by the normal forms of treatment. In this case, your father should ask about the possibility of being treated with primaquine; the course is normally 14 days, so it may be that this is what his doctors have currently given him. If so, this will kill the dormant liver stages and prevent relapse. Prior to taking primaquine, patients should be tested for G6DP deficiency, as patients with this condition may become dangerously anaemic when they take primaquine.

How Long Does it Take for Malaria to Affect the Body?

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QUESTION

How long does malaria take to actually affect you?

ANSWER

When you are bitten by a mosquito that is infected with the parasites that cause malaria, some of the parasites enter your blood stream in the mosquito’s saliva. After that, it will take at least one week, and usually between two and four weeks, before you start to feel the symptoms of the disease. This is because the parasite first goes to the liver, where it infects liver cells and undergoes replication. These cells mature into a form called merozoites, which then re-enter the blood stream, and start to infect red blood cells. The stage in the liver is not symptomatic for the patient, and is known as the pre-patent stage; once the merozoites start infecting and killing red blood cells, the patient will begin to feel sick, and the infection is said to have become patent.

Malaria Help from U.S. Nurses

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QUESTION

What can American nurses do to help those with malaria?

ANSWER

It is great that you are interested in helping the fight against malaria. One very valuable thing that nurses can do, given their crucial medical training, is volunteer overseas in places that are hard-hit by malaria. Websites such as this: Volunteer Abroad post these kinds of opportunities when they become available. Other, longer-term, volunteering opportunities are also available through governmental programs such as Peace Corps.

Closer to home, nurses can help to galvanize their communities to raise awareness about malaria. Another large-scale effort throughout the United States has been to try to raise money to buy long-lasting insecticide treated bednets for communities around the world, and particularly in sub-Saharan Africa, which are especially at risk of malaria. You could hold a fund-raising event in your community, or perhaps get involved with the initiatives in other ways. Many organizations are working towards bednet distribution, and links to just a couple of them are here:

Malaria No More

Project Mosquito Net

What is Malaria

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QUESTION

What is malaria?

ANSWER

Malaria is a serious and sometimes fatal disease caused by a parasite, of the genus Plasmodium, that commonly infects a certain type of mosquito (of the genus Anopheles) which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. Four kinds of malaria parasites can infect humans: Plasmodium falciparum, P. vivax, P. ovale, P. knowlesi and P. malariae. Infection with P. falciparum, if not promptly treated, may lead to death. Although malaria can be a deadly disease, illness and death from malaria can usually be prevented.

Malaria Life Cycle

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QUESTION

What is the life cycle of malaria?

ANSWER

Malaria is caused by a single celled organism in the genus Plasmodium. Five species of Plasmodium infect humans, but all follow a very similar life cycle, including two separate cycles of asexual reproduction in the human host (one in the liver, called the exo-erythrocytic cycle, and one in the blood, and specifically inside red blood cells, known as the erythrocytic cycle) and a sexual reproductive stage inside the mosquito definitive host (usually called the “vector”). A schematic of the full life cycle is below, courtesy of the CDC (www.cdc.gov).

malaria life cycle CDC

Schematic of the malaria life cycle, courtesy of CDC (www.cdc.gov)

Scientific Name of Malaria

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QUESTION

what is the scientific name of malaria?

ANSWER

Malaria is caused by a single celled parasite of the genus Plasmodium. Five species infect humans, and their scientific names are Plasmodium falciparum (the most severe and deadly kind), P. vivax, P. ovale, P. malariae and P. knowlesi.

Malaria Parasite Classification

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QUESTION

What is the classification of malaria?

ANSWER

Malaria is caused by a single celled protist of the genus Plasmodium. This genus is part of a Phylum of single-celled protist organisms called Apicomplexa.

The Apicomplexans mostly posses an organ called an apicoplast, which is part of an apical structure designed to aid entry into a host cell. The Apicomplexa is split into two Classes, of which Plasmodium belongs to the Aconoidasida (lacking a structure called a conoid, which is like a set of microtubules), and then to the Order Haemosporidia, which contains parasites which invade red blood cells. Within this Order, Plasmodium belongs to the Family Plasmodiidae, which all share numerous characteristics, including asexual reproduction in a vertebrate host and sexual reproduction in a definitive host (a mosquito, in the case of the Plasmodium species that infect all mammals, including humans).

In the case of human malarias, the definitive host is often referred to as the vector. The family contains about twelve genera, of which one is Plasmodium, which itself is now often divided up into numerous sub-genera, and then again into hundreds of different species, of which five infect humans (P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi).