How is Malaria Cured?

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QUESTION

How is malaria cured?

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.

Symptoms of Malaria

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QUESTION

What are the main 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 recurrence of the infection.

Chloroquine Resistant Malaria

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QUESTION

What is chloroquine resistant malaria?

ANSWER

Chloroquine-resistant malaria is exactly what it sounds like—particular types of malaria which are not cured by treatment with chloroquine.

Chloroquine was first discovered in the 1930s in Germany and began to be widely used as an anti-malaria post-World War II, in the late 1940s. However, resistance to the drug also rapidly emerged, with the first cases of Plasmodium falciparum not being cured by administration of chloroquine being reported in the 1950s.

Since then, resistance has spread rapidly (since obviously it is beneficial to the parasite to be resistant, so various mutations conferring this protection have arisen multiple times in different areas in the world and also been passed on preferentially to new generations of malaria parasites), and now chloroquine resistant P. falciparum can be found globally in malaria-endemic areas.

Chloroquine resistance in Plasmodium vivax has also now arisen, though more recently—the first reports came from 1989, in Australia, in travellers returning from Papua New Guinea. Now, chloroquine resistant forms of P. vivax are found in multiple locations in south-east Asia, such as Myanmar and India, as well as from Guyana in South America.

Nowadays, other drugs, and notably ones containing artemisinin-based compounds, are preferentially used to treat uncomplicated malaria and especially in areas where chloroquine resistance is known to occur. However, due to fears of resistance to these compounds also developing, the World Health Organisation recommends that artemisinin-based compounds only be administered in conjunction with other anti-malaria drugs, such as lumefantrine (which in combination with artemether forms the widely-used anti-malarial treatment Coartem). These combinations are known as artemisinin-based combination therapies, or ACTs for short.

History of Fighting Malaria

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QUESTION

What are some examples of attempts of fighting this disease that happened in the past?

ANSWER

The battle against malaria has been going on, in one form or another, for literally thousands of years. The ancient Chinese mention the symptoms of the disease in a medical scroll as early as 2700 BCE – even more remarkably, a herb called Artemesia has been used in traditional Chinese medicine for more than 2000 years to treat malaria, and compounds extracted from that same herb are the basis for some of the most effective modern medications, known as artemisinin-based combination therapies (ACTs). Indigenous tribes in the Americas also had traditional medicines to treat malaria; having conquered the New World, the Spanish learned of a bark, from the Cinchona tree, which could cure malaria. Quinine, extracted from this same tree bark, is still used today to treat malaria.

However, back then the causes of malaria were not known—it wasn’t until the late 19th century that a more complete understanding of malaria would emerge. The first key development in this process was the observation of the parasites that cause malaria in a patient’s blood, which was first done by Charles Louis Alphonse Laveran in 1880.

A few years later, in 1897, a British army doctor called Ronald Ross discovered that the parasite was transmitted via the bite of infected mosquitoes, of the genus Anopheles. This latter finding allowed for the emergence of the first programmes for malaria control, which focused on vector control, through insecticide use and elimination of water bodies used by the mosquito larvae. An early example of the success of this approach came in the building of the Panama Canal; started in 1906, progress was initially slow, due to the enormous proportion of workers who fell ill from yellow fever and malaria. With vector control, the number of cases plummeted, and the canal was finally opened in 1914.

While prophylactic quinine had also been part of the control strategy during the building of the Panama Canal, it played a much more secondary role to vector control. Using similar strategies, focusing primarily on killing adult mosquitoes through insecticide spraying (mainly DDT), the United States of America successfully eliminated malaria from its shores in the early 1950s. Prior to this, transmission had occurred across most of the south-east of the country.

In the last 50 years, access to early diagnosis and effective treatment have gained a more prominent role among many malaria control strategies, although prevention is still seen as crucial. Many developing countries, where malaria is still rife, have set up national control programmes, which seek to ensure that all communities have access to adequate care and information about malaria prevention.

A key tool in the prevention arsenal has been the long-lasting insecticide treated bednet; sleeping underneath one prevents bites from the mosquitoes that carry malaria, which are most active in the evenings and at night, especially in children and pregnant women, who are among the people most at risk from infection. Bednet distribution has been a major focus of many malaria campaigns, and very successful in many places; in 2008, for example, bednet coverage was estimated at over 80% of the at-risk population in Djibouti, Mali, Ethiopia and Sao Tome and Principe.

Treatment for Malaria

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QUESTION:

What is the main medicine to cure malaria and about safety precautions?

ANSWER:

There are a number of medicines used to treat malaria. Traditionally, chloroquine has been the first line drug of choice for uncomplicated, non-resistant malaria. However, several types of malaria, and most notably Plasmodium falciparum, the most severe and deadly kind, has become resistant to chloroquine in many places. In some parts of south-east Asia, Plasmodium vivax has also begun to show worrying signs of chloroquine resistance. In such settings, where resistance to chloroquine is suspected, the first line medications for uncomplicated cases are artemisinin-based combination therapies (ACTs), such as Coartem.

The World Health Organization has recommended that artemisinin only be given in combination with another drug to prevent malaria also becoming resistant to this therapy as well. Cases of malaria which have progressed beyond the grasp of that treatable with oral medication as described above (so-called “complicated” cases, most common with P. falciparum infection) are usually given intravenous quinine as a first-line response.

All of these treatments have been rigorously tested in strictly controlled clinical and field trials, and while they may have side effects, they are generally mild and in most cases, the patient will be given the dose without prior testing for reaction to the drug. One exception is with primaquine, which is sometimes used as a preventative medication against malaria and can also be used to treat the liver stages of P. vivax and P. ovale. Primaquine is known to cause severe haemolysis in people with G6DP deficiency, and so people with a high statistical probability of having this condition (for example due to family history or ethnicity) should be tested prior to being given primaquine.

Drugs for Malaria

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QUESTION

What drugs are used in the treatment of malaria?

ANSWER

There are a number of medicines used to treat malaria. Traditionally, chloroquine has been the first line drug of choice for uncomplicated, non-resistant malaria. However, several types of malaria, and most notably Plasmodium falciparum, the most severe and deadly kind, has become resistant to chloroquine in many places. In some parts of south-east Asia, Plasmodium vivax has also begun to show worrying signs of chloroquine resistance. In such settings, where resistance to chloroquine is suspected, the first line medications for uncomplicated cases are artemisinin-based combination therapies (ACTs), such as Coartem.

The World Health Organization has recommended that artemisinin only be given in combination with another drug to prevent malaria also becoming resistant to this therapy as well. Cases of malaria which have progressed beyond the grasp of that treatable with oral medication as described above (so-called “complicated” cases, most common with P. falciparum infection) are usually given intravenous quinine as a first-line response.

All of these treatments have been rigorously tested in strictly controlled clinical and field trials, and while they may have side effects, they are generally mild and in most cases, the patient will be given the dose without prior testing for reaction to the drug. One exception is with primaquine, which is sometimes used as a preventative medication against malaria and can also be used to treat the liver stages of P. vivax and P. ovale. Primaquine is known to cause severe haemolysis in people with G6DP deficiency, and so people with a high statistical probability of having this condition (for example due to family history or ethnicity) should be tested prior to being given primaquine.

 

Treatment for Malaria

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QUESTION:

How do you treat malaria?

ANSWER:

Malaria can be treated with a number of different types of medication; which one to use depends on the type of malaria you have, as well as whether resistant strains are known to occur in your area. Below I have copied the response I wrote to a similar question on malaria treatment, posted on the 2nd of May, 2011:

In most cases of non-Plasmodium falciparum malaria (the most deadly form of malaria, found throughout the world but most prevalent in sub-Saharan Africa), and even in some places where P. falciparum has not yet developed resistance, treatment with chloroquine is sufficient.

The dosage will depend on body weight (usually approximated by age). Where there is a risk of chloroquine-resistant malaria occurring, treatment of non-complicated cases will usually consist of orally-administered artemisinin-based combination therapy (or ACT) – again, the dosage will depend on age/weight.

For severe malaria, parenteral ingestion of drugs is required. For the treatment of cerebral malaria, caused by P. falciparum, quinine is the traditional drug of choice, though artemisinin has also been shown to be effective. Anti-convulsants and anti-pyretics (to reduce fever) should also be administered.

In cases of infection with P. vivax or P. ovale, the parasite can become dormant in the liver and result in a relapse of the disease if not treated properly. As such, patients with either of these forms of malaria should also be treated with primaquine.

If you have, or suspect you have a health problem, you should visit a physician for a medical diagnosis and treatment.

Malaria Treatment

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QUESTION:

What is the proper treatment for people with malaria symptoms?

ANSWER:

The proper treatment for malaria depends on the type of malaria parasite that the patient is infected with. Therefore, before treatment begins, the patient should be accurately diagnosed.

In most cases of non-Plasmodium falciparum malaria (the most deadly form of malaria, found throughout the world but most prevalent in sub-Saharan Africa), and even in some places where P. falciparum has not yet developed resistance, treatment with chloroquine is sufficient.

The dosage will depend on body weight (usually approximated by age). Where there is a risk of chloroquine-resistant malaria occurring, treatment of non-complicated cases will usually consist of orally-administered artemisinin-based combination therapy (or ACT) – again, the dosage will depend on age/weight.

For severe malaria, parenteral ingestion of drugs is required. For the treatment of cerebral malaria, caused by P. falciparum, quinine is the traditional drug of choice, though artemisinin has also been shown to be effective. Anti-convulsants and anti-pyretics (to reduce fever) should also be administered.

In cases of infection with P. vivax or P. ovale, the parasite can become dormant in the liver and result in a relapse of the disease if not treated properly. As such, patients with either of these forms of malaria should also be treated with primaquine.

If you have, or suspect you have a health problem, you should visit a physician for a medical diagnosis and treatment.

Malaria Treatment

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QUESTION:

Is there any treatment for malaria?

ANSWER:

Yes, treatment is available for malaria and most cases can be cured easily if diagnosed accurately and early. There are several different drugs that are used to treat malaria, and different modes of ingestion.

Most cases of malaria can be treated effectively with oral drugs, usually artemisinin-based combination therapies (which contain a drug called artemisinin, long used in Chinese medicine to treat malaria) or chloroquine. The choice between these will depend on the type of malaria you have (hence the need for accurate diagnosis) as well as whether the area you are in is known to have types of malaria that are resistant to chloroquine. In addition, some types of malaria, notably P. vivax and P. ovale, require an additional drug, known as primaquine, to prevent later relapses of malaria from dormant forms of the parasite, that hide in the liver.

Severe malaria may require the administration of drugs directly into the body, usually intravenously. Quinine is often the first-choice drug at this stage, though artemisinin-based compounds have also been shown to be effective. Severe malaria, sometimes manifesting as cerebral malaria, is usually only caused by P. falciparum, the most deadly of the types of malaria found in humans.

Canadian Researchers Develop Inexpensive Malaria Treatment

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Scientists in Saskatoon, Canada have developed a malaria treatment that will help fight malaria, which kills about one million people each year.

The new developments which will provide an affordable, reliable, and stable treatment for malaria and is likely to save millions of lives, especially those of women and children in Africa. The Honourable Gary Goodyear, Minister of State for Science and Technology, along with Mr. Brad Trost, Member of Parliament for Saskatoon–Humboldt, announced the breakthrough today and highlighted the Government’s research support.

“Our government is committed to improving the health of women and children in developing countries,” said Minister Goodyear. “This new development in the production of a malaria treatment represents a major development in the fight against the disease. It will strengthen Canada’s position as a world leader in health research and provide a reliable and affordable solution.”

Today’s announcement is a result of  The Artemisinin Project, a public-private partnership led by OneWorld Health in collaboration with sanofi-aventis, Amyris, the University of California at Berkeley, and the National Research Council Canada. Artemisinin is a natural compound found in a traditional Chinese medicinal plant grown mainly in Africa and Asia to treat malaria. The Government of Canada’s investment of approximately $869,000 in this research has led to technology that can produce a stable and affordable supply of artemisinin for the developing world on a not-for-profit basis.

“Collaboration on the development of this new technology promises to have a major impact on supply of malaria treatment across the developing world, which will be an important contribution towards the global effort to combat malaria,” said Dr. Richard Chin, Chief Executive Officer of OneWorld Health.

According to the World Health Organization, malaria causes approximately 250 million illnesses and more than one million deaths each year, of which 90 percent occur in Africa, mostly in pregnant women and in children. The disease is endemic in nearly 100 countries, including 28 on the African continent. This project is expected to help treat 200 million cases and prevent over one million deaths annually.

About the National Research Council of Canada’s Artemisinin Research

In 2003, researchers at the National Research Council of Canada (NRC) in Saskatoon set out to identify the genes that control the synthesis of artemisinin. Produced by Artemisia annua (a traditional Chinese medicinal plant), this natural compound is extracted from plants grown in Africa and Asia to treat malaria — a major threat to maternal and child health around the world.

Led by Dr. Patrick Covello, the NRC team identified various genes in the plant’s metabolic pathway that produce artemisinin. Using various microbial and plant platforms, such as yeast and tobacco, they conducted research to find alternative means of supplying low cost artemisinin-based drugs.

The Government of Canada has invested approximately $869,000 in this research. In partnership with Amyris, OneWorld Health and sanofi-aventis, NRC’s technology promises to have a major impact on malaria treatment across the developing world.

The NRC worked in partnership with “The Artemisinin Project,” funded by the Bill & Melinda Gates Foundation. This project is led by OneWorld Health, in collaboration with Amyris Biotechnologies, the University of California at Berkeley, and sanofi-aventis.

In 2004, the Institute for OneWorld Health was awarded $42.6 million from the Bill & Melinda Gates Foundation to develop a new source of artemisinin for distribution to the developing world. OneWorld Health created a collaboration between researchers at the University of California, Berkeley who were using yeast to synthesize high-value natural compounds produced by higher plants and other organisms. This work led to the creation of Amyris, a spin-off company, who also joined the collaboration. The aim of the Artemisinin Project was to identify genes in the artemisinin pathway and develop yeast strains that could produce large amounts of artemisinic acid, a key intermediate for the synthesis of artemisinin.

In 2008, the NRC and Amyris signed a license agreement, allowing the company to incorporate NRC’s discovery of two key genes in the artemisinin pathway into Amyris’ proprietary system, effectively doubling the yield of the end-product.

Subsequent to these research milestones, in July 2010, OneWorld Health announced an additional grant of $10.7 million from the Bill & Melinda Gates Foundation to scale-up production and commercialize the drug. Global pharmaceutical company, sanofi-aventis, is the partner that will formulate the drug for distribution on a not-for-profit basis across Africa and other regions vulnerable to the disease.

About Malaria

Malaria is a life-threatening parasitic disease transmitted by infected mosquitoes. Its symptoms include extreme exhaustion, fits of high fever, sweating, shaking chills and anemia.

Malaria parasites destroy red blood cells in the body, leading to anemia. Without adequate treatment, infected red blood cells block vessels leading to the brain or damage other vital organs, often resulting in death.

Infected people living in highly endemic areas often develop immunity to the disease and become asymptomatic carriers of malaria, contributing to epidemics.

According to the World Health Organization, malaria causes approximately 250 million illnesses and more than one million deaths per year, of which 90 percent occur in Sub-Saharan Africa. Malaria is endemic in nearly 100 countries, including 28 countries on the African continent.

In many countries, malaria is the leading killer of children under 5 years of age. Many children who survive an episode of severe malaria suffer learning impairments or brain damage.

Pregnant women and their unborn children are particularly vulnerable to malaria. More than 45 million women — 30 million in Africa — become pregnant in malaria-endemic areas each year.

During pregnancy, malaria can cause maternal anemia, impaired fetal growth, spontaneous abortion, stillbirth, premature birth and low birth weight. In sub-Saharan Africa, up to 40 percent of low birth weight is due to maternal malaria, resulting in up to 400,000 infant deaths per year.

In many areas, the malaria parasite is increasingly resistant to older, inexpensive, single drugs such as chloroquine. Currently, the most effective treatments involve combinations of artemisinin-based therapies and other antimalarials to prolong each drug’s effectiveness and delay resistance.

The source of artemisinin — Artemisia annua (also known as wormwood) — is cultivated mainly in Africa and Asia. However, because of the agricultural time scale, the delay between increased demand and new supply can be up to 14 months, causing shortages and limiting the ability to control the disease.

Source: National Research Council Canada