Injections for Malaria Treatment?

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QUESTION

I have a friend that just told me that she has Malaria. She said she has to go to the hospital every day for an injection for around the next 2 weeks. Is this a typical treatment. Why not just take pills? I`m just trying to wrap my head around this and understand the different treatments.

ANSWER

This is certainly not typical treatment for malaria. Uncomplicated malaria is usually treated with oral medication, and the type depends on the type of malaria you have. The most severe form of malaria, Plasmodium falciparum, is often resistant to chloroquine (still the first-line drug of choice for P. malariae, P. knowlesi and P. ovale infections, as well as for P. vivax in most parts of the world) and so first-line treatment is now usually an artemisinin-based combination therapy (ACT), such as Coartem.

As far as I am aware, it is only in cases of complicated, severe malaria that intravenous or intramuscular treatment is used (usually quinine), and in those cases, treatment would not be administered on an outpatient basis. It may be that your friend has a specific medical requirement for a non-oral form of medication, but it is definitely unusual!

Is Malaria Fatal?

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QUESTION

Can you die from malaria?

ANSWER

Yes. If left untreated, certain types of malaria in particular can cause severe complications, and can even lead to death. Plasmodium falciparum is the most dangerous form of malaria and is responsible for 90% of the approximately 700,000 annual deaths caused by malaria.

However, P. vivax infections can also be very serious, and more recently, cases of P. knowlesi in south-east Asia have been shown to develop into severe disease very rapidly, thus making it dangerous for people who are not close to health care services and thus delay getting treatment.

The people most at risk from severe malaria are children under the age of five and pregnant women, as well as travellers to malarial areas who are not taking adequate preventative measures (such as not taking anti-malaria medication or not sleeping under a long-lasting insecticide treated bednet).

However, malaria is still dangerous to all people, so if you think you might be infected, it is crucial to seek out diagnosis immediately, so that you can be quickly given appropriate treatment. If diagnosed early, malaria is usually very easily treated and full recovery occurs quickly.

How is Malaria Treated

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QUESTION

How is malaria treated?

ANSWER

This answer is copied from an earlier question about the various available cures for malaria.

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.

 

Who introduced malaria in which century?

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QUESTION

Who introduced malaria in which century, how does it cause malaria and what is the virus’ name?

ANSWER

Malaria wasn’t introduced; it has been evolving alongside humans for thousands, if not millions of years. The first known mention of malaria by humans is in an ancient Chinese medical text, from 2700 BCE (before common era). Other ancient people, such as the Romans and the Greeks, knew the symptoms of malaria and described it in writing.

Malaria is actually not caused by a virus, but a single-celled animal called a protozoan. The genus name of the protozoans that cause malaria is Plasmodium, and there are five main species that infect humans: P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.

The malaria parasites cause the disease by entering into red blood cells and multiplying; when they have reproduced, they burst out of the red blood cell, destroying it. The patient’s blood is therefore rapidly full of malaria parasites, their waste products, plus bits of destroyed red blood cell; this produces an extreme immune reaction which causes many of the symptoms of malaria. In infection with P. falciparum, the most deadly and severe kind, infection with the parasite causes red blood cells to sequester in tiny red blood cells within major organs, causing reduced oxygen flow and complications. When this occurs in the brain, the result is cerebral malaria, which can result in convulsions and even a coma.

Pathophysiology of Malaria

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QUESTION

What is the pathophysiology of malaria?

ANSWER

Malaria causes disease through a number of pathways, which depend to a certain extent on the species. Malaria is caused by a single-celled parasite of the genus Plasmodium; there are five species which infect humans, being Plasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi.

All these species are introduced into the human blood stream through the bite of an infected mosquito; the life stage of malaria at this point is called a “sporozoite”, and they pass first to the liver, where they undergo an initial stage of replication (called “exo-erythrocytic replication”), before passing back into the blood and invading red blood cells (called “erythrocytes”, hence this is the “erythrocytic” part of the cycle). The malaria parasites that invade red blood cells are known as merozoites, and within the cell they replicate again, bursting out once they have completed a set number of divisions. It is this periodic rupturing of the red blood cells that causes most of the symptoms associated with malaria, as the host’s immune system responds to the waste products produced by the malaria parasites and the debris from the destroyed red blood cells. Different species of malaria rupture the red blood cells at different intervals, which leads to the diagnostic cycles of fever which characterise malaria; P. vivax, for example, tends to produce cycles of fever every two days, whereas P. malaria produces fever every three.

In addition, Plasmodium falciparum produces unique pathological effects, due to its manipulation of the host’s physiology. When it infects red blood cells, it makes them stick to the walls of tiny blood vessels deep within major organs, such as the kidneys, lungs, heart and brain. This is called “sequestration”, and results in reduced blood flow to these organs, causing the severe clinical symptoms associated with this infection, such as cerebral malaria.

More details on the exact biochemical mechanisms for sequestration and its effect on the pathology of the infection can be found on the Tulane University website.

 

Does all malaria kill without treatment?

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QUESTION:

Does all malaria kill without treatment?

ANSWER:

No. There are five main species of malaria which infect humans: Plasmodium falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi. Of these, P. falciparum is the most deadly, and can often cause death if left untreated.

The other four may also result in death, but more rarely, and usually only in high risk individuals, such as young children, pregnant women and people with weakened immune systems. Given the seriousness of the symptoms and the possibility of death in all cases, it is very important to seek medical advice if you suspect you have malaria. Once given accurate diagnosis of which type of malaria you have, you can be given appropriate treatment.

Epidemiology of Malaria

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QUESTION:

Epidemology of malaria

ANSWER:

I’m afraid that without a bit more detail in the question, it is difficult to answer – there are many facets to the epidemiology of malaria, from the distribution of the disease globally to its prevalence in different age and risk groups among human populations. Human migration and movement can also play a large role in the epidemiology of malaria, as can mosquito vector behaviour and population dynamics.

Malaria is also known to vary widely based on climatic conditions, and there are concerns that climate change will affect what we know about the epidemiology of malaria, making it harder to control. There are also cases of cross-over between human forms of malaria and those from other primates, such as with Plasmodium knowlesi in macaques in south-east Asia. If you re-submit a more specific question, I’ll be happy to answer it more fully!

Current Status of Malaria

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QUESTION:

What is the current status on malaria? And does P.knowlesi spp. pose a greater threat compared to the others? Does the number malaria cases increase every year globally? Is P. knowlesi spp. more dangerous than the others and why?

ANSWER:

I’ll answer your question about Plasmodium knowlesi first. So far, it is considered a relatively minor source of malaria in humans, as its natural host are macaque monkeys and so it is usually thought of as a “zoonotic” disease.Between 2000-2008, there were only been about 400 reported cases of P. knowlesi, all restricted to south-east Asia, and mainly Borneo. These figures are low compared to other forms of malaria, such as P. falciparum, which in Africa alone accounts for millions of cases a year, and close to a million fatalities. However, there are some causes for concern with regards to P. knowlesi.

First of all, it appears to be an emerging human infection; the first cases were traced back to the 1960s, with the number of cases increasing in recent years. While some of this increase is likely the result of higher accuracy diagnosis and awareness about malaria, it is also hypothesised that the increasing population density in forested areas of south-east Asia may also be leading to greater numbers of people being exposed to this parasite. Secondly, although easily treated with anti-malarial drugs, the life cycle of P. knowlesi is such that it reproduces very rapidly in the human host, causing cycles of fever every 24 hours (a so-called “quotidian fever”). This means that the infection can progress rapidly, becoming severe in a matter of days, and therefore requiring prompt treatment. Finally, although locally restricted to south-east Asia, P. knowlesi has become the dominant form of malaria in some of these areas, notably Sarawak. As such, although currently not a major source of malaria in the global human population, it is locally important to public health and moreover, more research is needed to determine why the number of cases has been on the rise.

As for your questions about the status of malaria globally, the number of cases annually is estimated to be around 250 million. The vast majority of these are in Africa. Over 700,000 people, mainly children under five, die from malaria each year. As for whether the number of cases is increasing or decreasing, this is hard to determine. For one, a large number of cases are not reported every year, making accurate estimates difficult. Secondly, the world’s population is growing, and it is growing at the greatest rate in Africa, where the majority of malaria cases occur. As such, even if the proportion of people with malaria decreases over time, due to health initiatives such as distributing long-lasting insecticide treated bednets or free treatment, the total number of cases may still rise. Another problem we face in the fight against malaria is climate change: as the world’s patterns of rainfall and temperatures change, new areas become susceptible to malaria transmission, putting more people at risk. However, what is very encouraging is that deaths from malaria seem to be decreasing on a global scale.

Malaria No More is an organisation dedicated to eliminating deaths from malaria by the year 2015; more information about their methods and some of their success stories can be found on the Malaria No More website.

What pathogenic organisms cause malaria?

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QUESTION:

What pathogenic organism causes the disease?

ANSWER:

Malaria is caused by single-celled organisms, called protozoans, of the genus Plasmodium. Different forms of malaria are caused by different species of Plasmodium. The most severe and deadly form is caused by P. falciparum, which is responsible for 90% of the global deaths from malaria, the majority of these in Africa, and mostly in young children. Other species of Plasmodium which commonly infect humans include P. vivax, P. ovale and P. malariae. Recently, a fifth form, P. knowlesi, has been found infecting rural communities in south-east Asia.

The disease is caused when the parasite enters the patient’s red blood cells, reproduces rapidly and then bursts out of the cell, destroying it in the process. The resultant immune response, combined with the chemicals and debris produced by theparasites, induces the fever, nausea, aches and other symptoms of a malaria infection.

What are the strains of malaria?

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QUESTION:

What are the different strains of malaria?

ANSWER:

Malaria is caused by small, single-celled parasites called protozoans, and specifically ones of the genus Plasmodium. There are many, many species of Plasmodium, which infect a wide variety of different species, from lizards and birds to rodents, bats and primates. Of all the species of malaria, four main ones infect humans – these are P. falciparum, P. vivax, P. ovale and P. malariae. A fifth species, P. knowlesi, usually infects macaque monkeys in South East Asia but has been known to cross over to humans. Each of these species causes slightly different manifestations of the disease in humans, and even within the species, there are regional strains and variations. Probably the most distinct internal division within a malaria species is within P. ovale, where two sub-species are currently recognised: P. ovale curtisi and P. ovale wallikeri. These two forms are identical morphologically (that is, in the way they look under the microscope) but can be differentiated genetically.