Herbal Treatment for Malaria

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QUESTION

Can any form of malaria be treated by herbs or plants, and how long does it take to recover from malaria?

ANSWER

Actually, two of the most important kinds of anti-malarial medication are derived by substances found naturally in plants, though they need to be processed in certain ways before the full pharmaceutical effect is felt.

Quinine, administered intravenously, is currently the first-line treatment for complicated malaria (i.e. when the patient has a history of high fever, plus additional severe symptoms such as impaired consciousness). It is derived from the bark of trees of the genus Cinchona, which are native to the tropical rainforests of western South America. Long known to native populations for its medicinal properties, it became known to Europeans in the early 17th century when the Countess of Chinchón, the wife of the viceroy of Peru at the time, was cured by it, having been suffering from what was likely malaria.

Similarly, artemisinin, currently used in combination with other anti-malarial compounds as the first-line treatment against non-complicated malaria (these combinations are known as artemisinin-based combination therapies, or ACTs), is derived from wormwood, a shrub native to Asia but now found throughout the world. As with the Cinchona trees, traditional healers in China had used wormwood to treat fever for thousands of years, but its use had been forgotten in modern times, until its rediscovery in the 1970s. Nowadays, artemisinin is not recommended for treatment alone, as it is feared this will lead to resistance developing, and so it is only used in the combination therapies described above.

If treated promptly, and with the correct form of medication, recovery from malaria can take only a few days. If not, recovery can take much longer (even up to weeks), and in the case of P. falciparum malaria, the most deadly kind, the infection can become life threatening in only a day or two. P. knowlesi (found in parts of south-east Asia), though less fatal than P. falciparum, can also become severe rapidly, and so prompt treatment is especially necessary for these two kinds of malaria.

Malaria’s Scientific Name

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QUESTION

What is malaria’s scientific name?

ANSWER

The genus name for the single-celled parasite which causes malaria is Plasmodium. In the genus, there are five species which infect humans: Plasmodium falciparum (the most deadly kind), P. vivax, P. ovale, P. malariae and P. knowlesi.

Malaria Drug Binding Site

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QUESTION

What is malaria, and drug binding site?

ANSWER

Malaria is caused by a single-celled protozoan parasite of the genus Plasmodium. Five kinds of Plasmodium are known to infect people: P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.

There is no one drug binding site with respect to malaria: different anti-malarial drugs have different modes of action, and not all are well described. I will briefly outline the proposed mechanism of action of two of the most common types of anti-malarials: artemisinin (and derivatives) and chloroquine (quinine is thought to act similarly to chloroquine).

Artemisinin is thought to have anti-malarial properties by virtue of possessing an endoperoxide moiety, or double oxygen bridge (-Carbon-Oxygen-Oxygen-Carbon). In the presence of intracellular free ion, this moiety is converted by a chemical reaction to “free radicals”, atoms with unpaired electrons which are highly reactive. The free radicals act as alkylating agents and induce cell death, but only those that are already pathologically crippled, for example due to malaria infection. Another hypothesis is that the free radicals directly damage the malaria parasite.

Chloroquine is thought to act by causing buildup of the toxic by-product of hemoglobin metabolism, heme – the malaria parasite usually converts heme to hemozoin, a non-toxic crystal, and stores it in the digestive vacuole. When chloroquine diffuses into an infected red blood cell, it reacts with heme to “cap” it, preventing further conversion into hemozoin. Moreover, chloroquine also converts hemozoin into a highly toxic substance called the FP-Chloroquine complex. This build-up of toxicity leads to breakdown of the cell membrane, and eventual cell death and autodigestion.

Dangerous

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QUESTION

Why malaria so dangerous?

ANSWER

Malaria can be dangerous for a number of different reasons, some of which relate to each other. First of all, there are five different types of malaria that infect humans, and each varies in terms of its severity and potential for severe consequences. Even within these types, the severity of the disease caused (termed “virulence” by scientists and doctors), can even vary by strain or geography. Generally, the most dangerous form of malaria is caused by Plasmodium falciparum. One reason why this species of malaria is so dangerous is that is replicates very quickly in the blood. This means that infection levels can build up very quickly; if a person infected with P. falciparum does not get diagnosed and treated within a few days of feeling sick, the infection can progress to a point where the disease becomes very severe. This rapid accumulation of infection is also observed with P. knowlesi, a much rarer form of malaria found in south-east Asia. The parasites of P. knowlesi have a 24-hour reproductive cycle in the blood, the quickest for any type of malaria that infects humans. However, P. falciparum also has other characteristics which make it even more dangerous, and which do not occur with P. knowlesi. For example, when P. falciparum infects red blood cells, it causes their shape to change, and makes them “sticky”. This stickiness causes the red blood cells to become lodged in the blood vessels leading in to major organs, in a process known as sequestration. Sequestration creates blockages of these blood vessels, reducing blood flow and resulting in oxygen deprivation. When this process occurs in the blood vessels in the brain, the outcome is known as cerebral malaria, characterised by impaired consciousness, coma and even death. It is this pathology which is associated with most cases of severe malaria, and causes the most number of deaths.

However, if treated promptly with the correct drugs, even P. falciparum malaria is usually easily controlled. Therefore, one of the additional reasons why malaria is so dangerous is that in many places, and particularly sub-Saharan Africa, people do not have access to medication, or not the right types of medication. Many strains of P. falciparum have become resistant to chloroquine, once the first line treatment for malaria, and so this drugs is now ineffective in many cases. Instead, the World Health Organisation recommends now that artemisinin-based combination therapies (ACTs, such as Coartem) should be given as first-line treatment against all uncomplicated malaria, to prevent additional resistance from developing.

Symptoms and Causes of Malaria

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QUESTION

What are the symptoms and causes of malaria?

ANSWER

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).

There are five kinds of malaria known to infect humans: Plasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi. The symptoms of malaria differ depending on the type of malaria; P. falciparum  is the most deadly and severe form of the disease. General symptoms of malaria include  include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells.

Symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs.

What are the causes of malaria?

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QUESTION

What are the causes of malaria?

ANSWER

Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Usually, people get malaria by being bitten by an infective female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites. About 1 week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten.

Because the malaria parasite is found in red blood cells of an infected person, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her unborn infant before or during delivery (“congenital” malaria).

There are five kinds of malaria known to infect humans: Plasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.

Post-infection Malaria Medication

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QUESTION

My daughter has recently returned from a trip to Borneo. Even with aggressive preventive anti-mosquito behaviour (long sleeves/pants, deet applications and mosquito netting) but not anti-malarial medication, she received over 30 bites. She is now exhibiting some symptoms (body aches, headache and severe fatigue). She has an appointment at the doctors in 2 days time. Is there some kind of post-trip medication (like doxycycline) she can take as a precaution even if the malarial test comes back negative at this early of a time. Thanks.

ANSWER

The important thing to note here is that if your daughter has symptoms of malaria, then she should be diagnosed and, if positive, treated with medication aimed at curing active malaria. Doxycycline is NOT a drug used for the treatment of malaria, so there is no point taking it if she is already exhibiting symptoms.

Furthermore, some types of malaria found in Borneo (notably P. falciparum and P. knowlesi) can become more severe very quickly – 2 days may be too long to wait. If you live in an area where malaria transmission occurs, you may be able to buy a self-testing kit (also known as a rapid diagnostic test, or RDT) for malaria in a local pharmacy. Otherwise, if your daughter’s symptoms get worse, you should take her to an emergency room and explain her travel history and subsequent risk of having malaria.

There is no substitute for taking prophylactic malaria medicine; it might be that if your daughter had started taking prophylactic medicine as soon as she started receiving multiple mosquito bites, then she may have been protected to some degree. However, malaria has a latent period, and so she would have had to continue taking the medication for a period of time after returning home as well – with doxycycline, this means taking the drug for a further four weeks.

How many types of malaria are there?

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QUESTION

How many types of malaria are there?

ANSWER

There are four species of malaria parasite that commonly infect humans. These are: Plasmodium falciparum, P. vivax, P. ovale and P. malariae. In addition, a fifth species, P. knowlesi, is starting to draw public health attention as an infection in humans in south-east Asia, and particularly Borneo – previously, it was thought to only infect macaque monkeys.

Apart from these five species, there are many other species of Plasmodium, which infect other primates (including gorillas, chimpanzees and orangutans), rodents, birds and reptiles. A closely related group of parasites, called Hepatocystis, infects monkeys, squirrels, hippopotamus and bats.

Malaria Cure

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QUESTION

What is the cure for malaria?

ANSWER

Malaria can be cured with a number of different medications, depending on then type of malaria and how far the disease has been progressed.

For standard, non-complicated Plasmodium falciparum malaria, the World Health Organisation recommends use of artemisinin-based combination therapies (ACTs), such as Coartem. This is due to increasing levels of resistance to chloroquine in many parts of the world. Indeed, even though chloroquine is still used in many places as first-line treatment against P. vivax, P. malariae, P. ovale and P. knowlesi uncomplicated malaria, there is some evidence that resistance to this treatment is also emerging, for example in P. vivax in parts of south-east Asia.

In cases where malaria infection has progressed to a stage where oral administration of medication is not possible, or where cerebral symptoms are suspected, the usual treatment option is intravenous quinine.

In addition, P. vivax and P. ovale malaria parasites are able to produce forms (called hypnozoites) which can become dormant in liver hepatocyte cells after the blood stages of the infection have been cleared. These dormant forms can become reactivated weeks or even months or years after the initial infection, which is called a “relapse” of the infection. One drug, called primaquine, is able to kill these liver stages, and so patients with either of these types of malaria should also discuss the possibility of taking primaquine.

Apart from these first-line treatments, there are other medications which are used against malaria, both prophylactically as well as for treatment. These include orally-administered quinine, pyrimethamine, mefloquine, proguanil, atovaquone and sulfonamides.

For more information, see the WHO recommendations for malaria treatment.


Slight Malaria

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QUESTION

Does “slight malaria”  mean you have malaria?

ANSWER

You have malaria if you are infected with the Plasmodium parasites that cause malaria. However, having a few of the parasites does not mean you experience symptoms of the disease.  Some forms of malaria, like P. malariae, can persist in a patient without causing any symptoms. However, in some cases, particularly P. falciparum and also P. knowlesi, a slight initial infection can rapidly increase in a severe, heavy infection, requiring immediate treatment. So it is important to to always consider a diagnosis alongside clinical symptoms as well as an appreciation of the different types of malaria and how they can progress.