How Many Types of Human Malaria?

QUESTION:

How many types of malaria infect humans?

ANSWER:

There are four main types of malaria which infect humans: Plasmodium falciparum, P. vivax, P. malariae and P. ovale. P. ovale additionally can be split into two sympatric sub-species, P. o. curtisi and P. o. wallikeri. Each of these five kinds has a subtly different life cycle which results in slight variations in symptoms and also in treatment. For more information on this, check out the Q&As on malaria symptoms and malaria treatment; CDC is also a site worth checking out.

Additionally to the four species above, there are observations of a number of other Plasmodium species being able to infect humans, although much less frequently. The most reported of these is P. knowlesi, found in SE Asia, which usually infects macaque monkeys but is capable of crossing over into humans and causing severe quotidien malaria, and may even result in death. The number of cases of P. knowlesi appears to be on the rise in some regions, although the cause of this is not quite clear. For an introduction to P. knowlesi, you should read Christina Faust’s blog.

The list of other species of Plasmodium that have been reported to infect humans (sometimes only experimentally in the lab) includes P. brasilianum, P. cynomolgi, P. eylesi, P. inui, P. rhodiani, P. schwetzi, P. semiovale, P. simium and P. tenue.

Seaweed May Hold Secrets to Fighting Malaria

Julia Kubanek, an associate professor at the Georgia Institute of Technology, holds samples of a tropical seaweed whose surface chemicals are being studied for their potential antimalarial properties. Photo by Gary Meek, Courtesy Georgia Tech.

A group of chemical compounds used by a species of tropical seaweed to ward off fungus attacks may have promising antimalarial properties for humans. The compounds are part of a unique chemical signaling system that seaweeds use to battle enemies – and that may provide a wealth of potential new pharmaceutical compounds.

Using a novel analytical process, researchers at the Georgia Institute of Technology found that the complex antifungal molecules are not distributed evenly across the seaweed surfaces, but instead appear to be concentrated at specific locations – possibly where an injury increases the risk of fungal infection.

A Georgia Tech scientist will report on the class of compounds, known as bromophycolides, at the annual meeting of the American Association for the Advancement of Science (AAAS) Feb. 21, 2011 in Washington, D.C. The research, supported by the National Institutes of Health, is part of a long-term study of chemical signaling among organisms that are part of coral reef communities.

“The language of chemistry in the natural world has been around for billions of years, and it is crucial for the survival of these species,” said Julia Kubanek, an associate professor in Georgia Tech’s School of Biology and School of Chemistry and Biochemistry. “We can co-opt these chemical processes for human benefit in the form of new treatments for diseases that affect us.”

More than a million people die each year from malaria, which is caused by the parasite Plasmodium falciparum. The parasite has developed resistance to many antimalarial drugs and has begun to show resistance to artemisinin – today’s most important antimalarial drug. The stakes are high because half of the world’s population is at risk for the disease.

“These molecules are promising leads for the treatment of malaria, and they operate through an interesting mechanism that we are studying,” Kubanek explained. “There are only a couple of drugs left that are effective against malaria in all areas of the world, so we are hopeful that these molecules will continue to show promise as we develop them further as pharmaceutical leads.”

In laboratory studies led by Georgia Tech student Paige Stout from Kubanek’s lab – and in collaboration with California scientists – the lead molecule has shown promising activity against malaria, and the next step will be to test it in a mouse model of the disease. As with other potential drug compounds, however, the likelihood that this molecule will have just the right chemistry to be useful in humans is relatively small.

Other Georgia Tech researchers have begun research on synthesizing the compound in the laboratory. Beyond producing quantities sufficient for testing, laboratory synthesis may be able to modify the compound to improve its activity – or to lessen any side effects. Ultimately, yeast or another microorganism may be able to be modified genetically to grow large amounts of bromophycolide.

The researchers found the antifungal compounds associated with light-colored patches on the surface of the Callophycus serratus seaweed using a new analytical technique known as desorption electrospray ionization mass spectrometry (DESI-MS). The technique was developed in the laboratory of Facundo Fernandez, an associate professor in Georgia Tech’s School of Chemistry and Biochemistry. DESI-MS allowed researchers for the first time to study the unique chemical activity taking place on the surfaces of the seaweeds.

As part of the project, Georgia Tech scientists have been cataloging and analyzing natural compounds from more than 800 species found in the waters surrounding the Fiji Islands. They were interested in Callophycus serratus because it seemed particularly adept at fighting off microbial infections.

Using the DESI-MS technique, researchers Leonard Nyadong and Asiri Galhena analyzed samples of the seaweed and found groups of potent antifungal compounds. In laboratory testing, graduate student Amy Lane found that these bromophycolide compounds effectively inhibited the growth of Lindra thalassiae, a common marine fungus.

“The alga is marshalling its defenses and displaying them in a way that blocks the entry points for microbes that might invade and cause disease,” Kubanek said. “Seaweeds don’t have immune responses like humans do. But instead, they have some chemical compounds in their tissues to protect them.”

Though all the seaweed they studied was from a single species, the researchers were surprised to find two distinct groups of antifungal chemicals. From one seaweed subpopulation, dubbed the “bushy” type for its appearance, 23 different antifungal compounds were identified. In a second group of seaweed, the researchers found 10 different antifungal compounds — all different from the ones seen in the first group.

In the DESI-MS technique, a charged stream of polar solvent is directed at the surface of a sample under study at ambient pressure and temperature. The spray desorbs molecules, which are then ionized and delivered to the mass spectrometer for analysis.

“Our collaborative team of researchers from the Department of Biomedical Engineering and the College of Sciences has worked within the Bioimaging Mass Spectrometry Center at Georgia Tech to better understand the mechanisms of chemical defenses in marine organisms,” said Fernandez. “This is an example of cross-cutting interdisciplinary research that characterizes our institute.”

Kubanek is hopeful that other useful compounds will emerge from the study of signaling compounds in the coral reef community.

“In the natural world, we have seaweed that is making these molecules and we have fungi that are trying to colonize, infect and perhaps use the seaweed as a substrate for its own growth,” Kubanek said. “The seaweed uses these molecules to try to prevent the fungus from doing this, so there is an interaction between the seaweed and the fungus. These molecules function like words in a language, communicating between the seaweed and the fungus.”

Source: Newswise

 

Malaria Countries and Map

Geographic Distribution of Malaria Around the World

Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfalls. Malaria is transmitted in tropical and subtropical areas, where:

  • Anopheles mosquitoes can survive and multiply
  • Malaria parasites can complete their growth cycle in the mosquitoes (“extrinsic incubation period”).

Temperature is particularly critical. For example, at temperatures below 20°C (68°F), Plasmodium falciparum (which causes severe malaria) cannot complete its growth cycle in the Anopheles mosquito, and thus cannot be transmitted. [Read more…]

Malaria Treatment

Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • mefloquine (Lariam®)
  • quinine
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)
  • artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

  • The type (species) of the infecting parasite
  • The area where the infection was acquired and its drug-resistance status
  • The clinical status of the patient
  • Any accompanying illness or condition
  • Pregnancy
  • Drug allergies, or other medications taken by the patient

If you have or suspect you have malaria, you should contact your doctor immediately.

Source: Centers for Disease Control (CDC)

A Research Agenda for Malaria Eradication: Drugs

Abstract: Antimalarial drugs will be essential tools at all stages of malaria elimination along the path towards eradication, including the early control or “attack” phase to drive down transmission and the later stages of maintaining interruption of transmission, preventing reintroduction of malaria, and eliminating the last residual foci of infection.Drugs will continue to be used to treat acute malaria illness and prevent complications in vulnerable groups, but better drugs are needed for elimination-specific indications such as mass treatment, curing asymptomatic infections, curing relapsing liver stages, and preventing transmission. [Read more…]

WHO’s World Malaria Report Shows Rapid Progress Toward Targets

A massive scale-up in malaria control programmes between 2008 and 2010 has resulted in the provision of enough insecticide-treated mosquito nets (ITNs) to protect more than 578 million people at risk of malaria in sub-Saharan Africa.

Indoor residual spraying has also protected 75 million people, or 10% of the population at risk in 2009. The World Malaria Report 2010 describes how the drive to provide access to antimalarial interventions to all those who need them, called for by the UN Secretary-General in 2008, is producing results.

Downward trend in malaria

In Africa, a total of 11 countries showed a greater than 50% reduction in either confirmed malaria cases or malaria admissions and deaths over the past decade. A decrease of more than 50% in the number of confirmed cases of malaria was also found in 32 of the 56 malaria-endemic countries outside Africa during this same time period, while downward trends of 25%–50% were seen in eight additional countries. Morocco and Turkmenistan were certified by the Director-General of WHO in 2009 as having eliminated malaria. In 2009, the WHO European Region reported no cases of Plasmodium falciparum malaria for the first time.

Results: the best in decades

The WHO Director-General, Dr Margaret Chan, highlighted the transformation that is taking place, “The results set out in this report are the best seen in decades. After so many years of deterioration and stagnation in the malaria situation, countries and their development partners are now on the offensive. Current strategies work.”

“The phenomenal expansion in access to malaria control interventions is translating directly into lives saved, as the WHO World malaria report 2010 clearly indicates,” said Ray Chambers, the UN Secretary-General’s Special Envoy for Malaria. “The strategic scale-up that is eroding malaria’s influence is a critical step in the effort to combat poverty-related health threats. By maintaining these essential gains, we can end malaria deaths by 2015.”

Strategies to fight malaria

The strategies to fight malaria continue to evolve. Earlier this year, WHO recommended that all suspected cases of malaria be confirmed by a diagnostic test before antimalarial drugs are administered. It is no longer appropriate to assume that every person with a fever has malaria and needs antimalarial treatment. Inexpensive, quality-assured rapid diagnostic tests are now available that can be used by all health care workers, including at peripheral health facilities and at the community level. Using these tests improves the quality of care for individual patients, cuts down the over-prescribing of artemisinin-based combination therapies (ACTs) and guards against the spread of resistance to these medicines.

Fragility of malaria control

While progress in reducing the burden of malaria has been remarkable, resurgences in cases were observed in parts of at least three African countries (Rwanda, Sao Tome and Principe, and Zambia). The reasons for these resurgences are not known with certainty but illustrate the fragility of malaria control and the need to maintain intervention coverage even if numbers of cases have been reduced substantially.

Work remains to attain targets

The report stressed that while considerable progress has been made, much work remains in order to attain international targets for malaria control.

  • Financial disbursements reached their highest ever levels in 2009 at US$ 1.5 billion, but new commitments for malaria control appear to have levelled-off in 2010, at US$ 1.8 billion. The amounts committed to malaria, while substantial, still fall short of the resources required for malaria control, estimated at more than US$ 6 billion for the year 2010.
  • In 2010, more African households (42%) owned at least one ITN, and more children under five years of age were using an ITN (35%) compared to previous years. Household ITN ownership reached more than 50% in 19 African countries. The percentage of children using ITNs is still below the World Health Assembly target of 80% partly because up to the end of 2009, ITN ownership remained low in some of the largest African countries.
  • The proportion of reported cases in Africa confirmed with a diagnostic test has risen substantially from less than 5% at the beginning of the decade to approximately 35% in 2009, but low rates persist in the majority of African countries and in a minority of countries in other regions.
  • By the end of 2009, 11 African countries were providing sufficient courses of ACTs to cover more than 100% of malaria cases seen in the public sector; a further 5 African countries delivered sufficient courses to treat 50%–100% of cases. These figures represent a substantial increase since 2005, when only five countries were providing sufficient courses of ACT to cover more than 50% of patients treated in the public sector.
  • The number of deaths due to malaria is estimated to have decreased from 985 000 in 2000 to 781 000 in 2009. Decreases in malaria deaths have been observed in all WHO regions, with the largest proportional decreases noted in the European Region, followed by the Region of the Americas. The largest absolute decreases in deaths were observed in Africa.

In summary, the report highlights the importance of maintaining the momentum for malaria prevention, control, and elimination that has developed over the past decade. While the significant recent gains are fragile, they must be sustained. It is critical that the international community ensure sufficient and predictable funding to meet the ambitious targets set for malaria control as part of the drive to reach the health-related Millennium Development Goals by 2015.

Full Report:  World Malaria Report 2010

Source: World Health Organization (WHO)

Research Leads to Promising Malaria Drug Candidate

A chemical that rid mice of malaria-causing parasites after a single oral dose may eventually become a new malaria drug if further tests in animals and people uphold the promise of early findings. The compound, NITD609, was developed by an international team of researchers including Elizabeth A. Winzeler, Ph.D., a grantee of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

“Although significant progress has been made in controlling malaria, the disease still kills nearly 1 million people every year, mostly infants and young children,” says NIAID Director Anthony S. Fauci, M.D. “It has been more than a decade since the last new class of antimalarials — artemisinins — began to be widely used throughout the world. The rise of drug-resistant malaria parasites further underscores the need for novel malaria therapies.”

Dr. Fauci adds, “The compound developed and tested by Dr. Winzeler and her colleagues appears to target a parasite protein not attacked by any existing malaria drug, and has several other desirable features. This research is also a notable example of successful collaboration between government-supported scientists and private sector researchers.”

The study, in the Sept. 3 issue of Science, was led by Thierry T. Diagana, Ph.D., of the Novartis Institute for Tropical Diseases (NITD), and Dr. Winzeler. Dr. Winzeler is affiliated with The Scripps Research Institute and the Genomic Institute of the Novartis Research Foundation, La Jolla, Calif.

Work on what eventually became NITD609 began in Dr. Winzeler’s lab in 2007. Scientists screened 12,000 chemicals using an ultra-high throughput robotic screening technique customized to detect compounds active against Plasmodium falciparum, the most deadly malaria parasite. The screen identified a chemical with good parasite-killing abilities and the potential to be modified into a drug. Medicinal chemists at the NITD then synthesized and evaluated about 200 versions of the original compound to arrive at NITD609, which could be formulated as a tablet and manufactured in large quantities. NITD609 is one of a new class of chemicals, the spiroindolones, which have been described in recently published research by Dr. Winzeler and colleagues as having potent effects against two kinds of malaria parasites.

“From the beginning, NITD609 stood out because it looked different, in terms of its structure and chemistry, from all other currently used antimalarials,” says Dr. Winzeler. “The ideal new malaria drug would not just be a modification of existing drugs, but would have entirely novel features and mechanism of action. NITD609 does.”

In the current study, the scientists detail attributes of NITD609 that suggest it could be a good malaria drug. For example

  • In test-tube experiments, NITD609 killed two species of parasites in their blood-stage form and also was effective against drug-resistant strains. In humans, malaria parasites spend part of their life cycle in the blood and part in the liver.
  • The compound worked faster than some older malaria drugs, although not as quickly as the best current malaria drug, artemisinin.
  • Other laboratory tests showed that NITD609 is not toxic to a variety of human cells.

When given orally to rodents, the compound stayed in circulation long enough to reach levels predicted to be effective against malaria parasites. According to Dr. Winzeler, if NITD609 behaves similarly in people, it might be possible to develop the compound into a drug that could be taken just once. Such a dosage regimen, she says, would be substantially better than the current standard treatment in much of the world in which uncomplicated malaria infections are treated for three to seven days with drugs that are taken between one and four times daily.

“We were excited by the potential NITD609 showed in the first series of test-tube experiments, ” says Dr. Winzeler. “We became even more enthusiastic when our co-investigators at the Swiss Tropical Institute in Basel tested NITD609 in a mouse model of malaria.”

Typically, she says, rodents infected with the mouse malaria parasite, Plasmodium berghei, die within a week. But a single large dose of NITD609 cured all five infected mice that received it, while half of six mice receiving a single smaller dose were cured of infection. Three doses of the smaller amount of NITD609 upped the cure rate to 90 percent.

The researchers also compared NITD609 with other malaria drugs in P. berghei-infected mice. “No other currently used malaria drug was as potent,” says Dr. Winzeler. NITD609’s effectiveness in relatively few doses is a key point in its favor, she adds. A novel malaria drug that works in as few doses as possible leaves less opportunity for parasites to develop drug resistance.

Additional tests in animals are under way and NITD609 could enter early-stage safety testing in humans later this year, says Dr. Winzeler. But, she adds, many drug candidates fail in clinical trials and thus it will be important for the community to continue to work on developing other potential antimalarial compounds.

To learn how parasites might develop resistance to this potential drug, the researchers also exposed parasites to sublethal levels of NITD609 continuously for several months until drug-resistant strains emerged. Then they analyzed those strains and determined that resistance results from a single change in one of the parasite’s genes. The gene contains the code to make a protein called PfATP4, which allows substances to cross cell membranes. No other anti-malaria drugs act on the PfATP4 protein, notes Dr. Winzeler. Having information in hand about the genetic basis for NITD609 resistance at this early stage of the compound’s development is advantageous, she adds, because it will allow scientists to rapidly detect drug-resistant strains in clinical settings if the compound is eventually approved as a drug for human use.

Source: NIH

NITD609 Compound May Be Promising Malaria Drug Candidate, Say Researchers

A chemical that rid mice of malaria-causing parasites after a single oral dose may eventually become a new malaria drug if further tests in animals and people uphold the promise of early findings. The compound, NITD609, was developed by an international team of researchers.

“Although significant progress has been made in controlling malaria, the disease still kills nearly 1 million people every year, mostly infants and young children,” says NIAID Director Anthony S. Fauci, M.D. “It has been more than a decade since the last new class of antimalarials—artemisinins—began to be widely used throughout the world. The rise of drug-resistant malaria parasites further underscores the need for novel malaria therapies.”

Dr. Fauci adds that the compound “appears to target a parasite protein not attacked by any existing malaria drug, and has several other desirable features. This research is also a notable example of successful collaboration between government-supported scientists and private sector researchers.”

The study, in the Sept. 3, 2010 issue of Science, was led by Thierry T. Diagana, Ph.D., of the Novartis Institute for Tropical Diseases (NITD), and Dr. Winzeler. Dr. Winzeler is affiliated with The Scripps Research Institute and the Genomic Institute of the Novartis Research Foundation, La Jolla, Calif.

Work on what eventually became NITD609 began in Dr. Winzeler’s lab in 2007. Scientists screened 12,000 chemicals using an ultra-high throughput robotic screening technique customized to detect compounds active against Plasmodium falciparum, the most deadly malaria parasite. The screen identified a chemical with good parasite-killing abilities and the potential to be modified into a drug. Medicinal chemists at the NITD then synthesized and evaluated about 200 versions of the original compound to arrive at NITD609, which could be formulated as a tablet and manufactured in large quantities. NITD609 is one of a new class of chemicals, the spiroindolones, which have been described in recently published research by Dr. Winzeler and colleagues as having potent effects against two kinds of malaria parasites.

“From the beginning, NITD609 stood out because it looked different, in terms of its structure and chemistry, from all other currently used antimalarials,” says Dr. Winzeler. “The ideal new malaria drug would not just be a modification of existing drugs, but would have entirely novel features and mechanism of action. NITD609 does.”

Source: NIH