What is malaria, and how can it be cured?

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QUESTION:

What is malaria? How could we cure it?

ANSWER:

Malaria is a disease caused by parasites of the genus Plasmodium. Transmitted by mosquitoes, there are several different kinds of malaria distributed throughout the tropical and sub-tropical regions of the world, causing somewhere between 300-500 million cases of disease each year, and as many as 1 million deaths. In fact, malaria is one of the biggest killers of children under the age of five in sub-Saharan Africa, one of the regions of the world where the burden from malaria is the highest. Malaria is usually an acute disease, manifesting itself with severe fever, chills, headache and often nausea as well. Some types of malaria can have relapsing episodes over a time period of many years.

Having said this, malaria is easily preventable, through avoiding mosquito bites by wearing appropriate clothing and sleeping under insecticide-treated bednets, or through taking preventative medication (called prophylaxis). Malaria is also treatable once symptoms appear, through ingesting safe, effective and relatively cheap drugs. With such control measures at hand, you may ask why malaria is still such a huge problem in our world; the answer is that delivering control strategies and treatment to populations most at risk is difficult, and often countries with high malaria burdens don’t have efficient and effective health systems in place to coordinate control efforts.

International non-governmental organisations such as the World Health Organisation, as well as a multitude of non-profit organisations such as the Malaria Consortium and Malaria No More, work tirelessly to bring malaria control and treatment to the places that need it most, with the aim to eradicate malaria as a disease of public health importance. There are also many research groups around the world that are striving to create new, more effective medications and drugs. For some time now, there has also been work in progress trying to develop a vaccine against malaria; at this point, there has been little applied success, but with further research and efforts, an immunization against Plasmodium may be forthcoming in the future.


Malaria symptoms

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QUESTION:

When a person is ill he or she will have what symptoms?

ANSWER:

Malaria can have many different symptoms, but the initial signs are similar to a flu-like illness, with high fever, chills, headache and muscle soreness or aches. A characteristic sign of malaria is cyclical fever, with peaks of severity every two or three days. Additionally, some people will experience nausea, coughing, vomiting and/or diarrhea.

Because these symptoms are quite generic of a wide variety of illnesses, if you live in a malaria-endemic region, it is crucial to be tested when you develop such symptoms, rather than assuming it’s just the flu and soldiering on! If you have recently traveled to a malarial area and start to experience these signs of infection, similarly you should inform your doctor of your travel history, as otherwise they might not recognize your symptoms as potentially that of malaria.

If treated rapidly and with the correct medication, malaria is almost always completely treatable; it is only if treatment is delayed that it becomes more serious, with long-lasting and potentially fatal consequences. Similarly, if you take sensible precautions while living or traveling in malarial areas, such as taking prophylaxis (and taking them as per the instructions, for the full required amount of time!), avoiding being bitten by mosquitoes and sleeping under an insecticide-treated bed-net, you vastly reduce your chances of getting infected in the first place.

It’s also worth noting that different species of Plasmodium, the parasite that causes malaria, cause slightly different manifestations of the disease, and also require different forms of treatment. Plasmodium falciparum has a unique way of affecting the red blood cells it infects, which eventually can result in loss of function of internal organs. ‘Cerebral malaria’ is a particularly deadly version of this, whereby the function of the brain is affected. The cycles of fever, mentioned above, are caused by synchronous rupturing of the red blood cells in the body by the malaria parasite; P. falciparum, P. vivax and P. ovale complete this cycle every 48 hours, resulting in fever cycles of roughly two days (though P. falciparum can be unpredictable); P. malariae, on the other hand, has a cycle lasting 72 hours, so three day cycles of fever are expected. Finally, although many types of malaria can be successfully treated with the drug chloroquine, some strains, and notably of P. falciparum, have become resistant to this treatment. In these cases, artemesinin-based treatment is recommended, usually in combination with other therapies (artemesinin-combination therapy, or ACT). P. vivax, in addition, requires an additional drug, called primaquine, which is used to treat lingering liver stages of the parasite, to prevent recurrence of the infection.

Does malaria affect population vigour?

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QUESTION:

How is malaria affecting population vigour at present?

ANSWER:

If I understand your question correctly, you are asking if malaria affects the well-being of populations. In answer, malaria is an extremely debilitating disease in many populations around the world, and is known to severely affect population vigour.

People infected with malaria are likely to miss work or school, and of course are at risk of dying from the disease as well. There is, moreover, an intimate association between malaria and poverty, with malaria both being considered a disease caused by poverty as well as a cause of it – malaria is known to result in lost productivity through absenteeism, permanent neurological damage caused by severe disease episodes, and changes in economic or investment decisions based on presence of malaria.

One estimate is that a combination of the above indirect costs of malaria, together with direct costs on the healthcare infrastructure, cost Africa as much as $12 billion per year in lost economic output. A review on the link between poverty and malaria was written in 2002 by Jeffrey Sachs and Pia Malaney for the scientific journal Nature.

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What age can be affected by malaria?

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QUESTION:

A child of what age can be affected from cerebral malaria or malaria?

ANSWER:

People of all ages can be affected by malaria, which is what makes it such a public health burden in so many places.

Severe symptoms of the disease, such as the manifestation of cerebral malaria that you mention, can also be seen in children of all ages as well as adults. However, generally, younger children tend to have more serious attacks of malaria, and the disease is most deadly in children under the age of 5, who have not had a chance to build up natural, protective immunity to malaria. This lack of immunity is why malaria is also particularly severe in travellers, who have not been exposed during their childhood. Similarly, changes in the body’s immune response and blood chemistry during pregnancy make pregnant women, no matter what their age, very vulnerable to malaria infection.

Where does malaria appear?

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QUESTION:

Where does malaria first appears on the body?

ANSWER:

That’s a very interesting question! You could say that malaria first appears in the blood, since that is how the parasite enters the human body—it passes into our bloodstream when an infected mosquito penetrates the skin to feed on blood.

The life cycle below, courtesy of CDC, explains more about the next stages of infection, and where the malaria parasite also passes within the human body.

The initial migration of malaria parasites is usually into the liver, after which they reproduce and begin to infect red blood cells. It is the cycles of infecting and bursting out of red blood cells, as part of the life cycle, that usually results in the classic cycles of chills, fever and sweating that characterises malaria infection. So in this way, you could say that malaria is first noticed once it begins to infect blood cells, throughout the body.

malaria_lifecycle_CDC

A generalised life cycle of the malaria parasite (courtesy of CDC; www.cdc.gov)

Drinking Milk While Infected with Malaria

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QUESTION:

Can a malaria-infected person drink milk?

ANSWER:

As far as I know, there isn’t a problem with drinking milk while suffering from malaria. In fact, it is generally a good idea to keep as hydrated as possible while feverish (although water or diluted juice would probably be better for hydration). There is also some evidence that drinking milk can settle the stomach while taking medication for malaria, such as chlorquine.

If there are medical professionals who read this and can comment further on the benefits/problems of drinking milk while suffering from malaria, then please comment below!

What are the three stages of a malaria attack?

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QUESTION:

What are the three stages of a typical malaria attack?

ANSWER:

I’m not entirely clear as to what you’re asking with this question; do you mean the stages of infection within the human host, or the successive changes in the symptoms during the fever cycles that characterise a malarial episode?

If you mean the latter, then the three typical stages of symptoms during a malaria attack are characterised by an initial feeling of coldness, which is indicative of the early stages of the fever. This develops into the patient feeling much, much warmer, and even uncomfortably hot—at this point, the patient’s fever can spike dramatically, up to over 40 degrees C. The body combats this fever by sweating profusely—these sweats constitute the third stage of the attack, and have the effect of gradually bringing the patient’s temperature down.

These three stages are repeated at intervals of 24, 48 or 72 hours, depending on the type of malaria. This is due to the cyclical and coordinated bursting of red blood cells, releasing the next life stage of the malaria parasite, and which causes the bulk of the fever in patients.

If you intended to ask about the stages of infection during the life cycle of the malaria parasite, the image below (from CDC), is a very clear and useful guide to the incredibly complex life cycle of Plasmodium species.

generalised malaria life cycle

Generalised life cycle of the malaria parasite (courtesy of CDC: www.cdc.gov)




 

 

What Are the Symptoms of Malaria?

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QUESTION: What are the symptoms of Malaria?

ANSWER: Malaria can have many different symptoms, but the initial signs are similar to a flu-like illness, with high fever, chills, headache and muscle soreness or aches. A characteristic sign of malaria is cyclical fever, with peaks of severity every two or three days. Additionally, some people will experience nausea, coughing, vomiting and/or diarrhea.

Because these symptoms are quite generic of a wide variety of illnesses, if you live in a malaria-endemic region, it is crucial to be tested when you develop such symptoms, rather than assuming it’s just the flu and soldiering on! If you have recently traveled to a malarial area and start to experience these signs of infection, similarly you should inform your doctor of your travel history, as otherwise they might not recognize your symptoms as potentially that of malaria.

If treated rapidly and with the correct medication, malaria is almost always completely treatable; it is only if treatment is delayed that it becomes more serious, with long-lasting and potentially fatal consequences. Similarly, if you take sensible precautions while living or traveling in malarial areas, such as taking prophylaxis (and taking them as per the instructions, for the full required amount of time!), avoiding being bitten by mosquitoes and sleeping under an insecticide-treated bed-net, you vastly reduce your chances of getting infected in the first place.

It’s also worth noting that different species of Plasmodium, the parasite that causes malaria, cause slightly different manifestations of the disease, and also require different forms of treatment. Plasmodium falciparum has a unique way of affecting the red blood cells it infects, which eventually can result in loss of function of internal organs. ‘Cerebral malaria’ is a particularly deadly version of this, whereby the function of the brain is affected. The cycles of fever, mentioned above, are caused by synchronous rupturing of the red blood cells in the body by the malaria parasite; P. falciparum, P. vivax and P. ovale complete this cycle every 48 hours, resulting in fever cycles of roughly two days (though P. falciparum can be unpredictable); P. malariae, on the other hand, has a cycle lasting 72 hours, so three day cycles of fever are expected. Finally, although many types of malaria can be successfully treated with the drug chloroquine, some strains, and notably of P. falciparum, have become resistant to this treatment. In these cases, artemesinin-based treatment is recommended, usually in combination with other therapies (artemesinin-combination therapy, or ACT). P. vivax, in addition, requires an additional drug, called primaquine, which is used to treat lingering liver stages of the parasite, to prevent reoccurrence of the infection.

If anyone wants to add to the above account of symptoms and/treatment, please put your comments below! For example, has anyone had malaria first hand and wants to describe their experience?

— Claire, Editor