Celtnet Medicine — Malaria Information
Celtnet Medicine Malaria Information

Welcome to the Celtnet Medicine information site. This page, part of the Parasitic Diseases section is dedicated to information about Malaria. As a disease, it it endemic to the tropical regions of the world and kills 650 million people every year, the majority of those being children under 5. I have a particular interest in the disease as both my wife and son (who are West African) suffer from the disease. Malaria is a recurring disease, and, as with anyone affliceted by the most aggressive form (found in West Africa) they have a 1 in 10 chance of dying from a new malarial episode.

Not only is malaria debilitating when it strikes, it is also an economic burden for any region where it is endemic. It wipes away a protion of the population, makes the working population sick and placs a medical burden on the economy as a whole.


Global Distribution of Malaria Endemic Regions

As you can see from the map on the left, Malaria is endemic to much of the tropical regions of the world. However, the severity of the disease and its effects vary from continent to continent. The worst forms are to be found in tropical sub-Saharan Africa (this excludes South Africa). This is also the region where malaria is most resistant to standard quinine-based drugs and this is the problem in treating most malaria cases as the only drugs commonly available are Quinine and Novoquine which are becoming less and less effective. Admittedly, most adults with Malaria develop some level of resistance, yet a bad bout of the disease can lead to liver complicatons, jaundice and even death. As Stefan has had liver complicatons this time, this is what I am desperately concerned about.

What is Malaria?

Plasmodium falciparum parasite

Malaria is a parasitic infection caused by the protozoan parasites, Plasmodium. Each year, it causes disease in approximately 650 million people and kills between one and three million, most of them young children in Sub-Saharan Africa. Malaria is commonly-associated with poverty, but is also a cause of poverty and a major hindrance to economic development. Indeed, the most virulent for of the disease, caused by the parasite Plasmodium falciparum is also the commonest form of the disease in Sub-Saharan Africa.

Malaria is one of the most common infectious diseases and an enormous public-health problem. The disease is caused by protozoan parasites of the genus Plasmodium (Plasmodium falciparum is shown here). The most serious forms of the disease are caused by Plasmodium falciparum and Plasmodium vivax, but other related species (Plasmodium ovale, Plasmodium malariae, and sometimes Plasmodium knowlesi) can also infect humans. This group of human-pathogenic Plasmodium species is usually referred to as malaria parasites.

Malaria itself is what's known as a vector-borne infectious disease in that the malarial parasite cannot directly infect humans. Rather, malarial parasites are transmitted by female Anopheles mosquitoes. The parasites themselves infect and multiply within the red blood cells and as a result they cause symptoms that include anaemia (light headedness, shortness of breath, tachycardia etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and in severe cases, coma and death. The symptoms of malaria include fever, shivering, arthralgia (joint pain), vomiting, anemia caused by hemolysis, hemoglobinuria, and convulsions. There may be the feeling of tingling in the skin, particularly with malaria caused by P falciparum. The classical symptom of malaria is cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting four to six hours, occurring every two days in P vivax and P ovale infections, while every three days for P malariae. P falciparum can have recurrent fever every 36–48 hours or a less pronounced and almost continuous fever. As the parasites mature and the red blood cells in which they have been growing rupture jaundice can occur (yellowing of the skin or whites of the eyes) and this is often accompanied by anaaemia.

Anopheles gambiae mosquito

Anopheles gambiae is probably the most well-known species in the genus Anopheles, a genus of approximately 400 species of insects, some 35 of which transmit Plasmodium parasites. Anopheles gambiae is the most well known of these as it's the most common vector for the most aggressive and lethal form of malaria, Plasmodium falciparum. It is only the female Anophelid mosquitoes that transmit malaria, as males live for only a week, feeding on nectar and other sources of sugar. Females will also feed on sugar sources for energy but usually require a blood meal for the development of eggs. After obtaining a full blood meal, the female will rest for a few days while the blood is digested and eggs are developed. This process depends on the temperature but usually takes 2–3 days in tropical conditions. Once the eggs are fully developed, the female lays them and resumes host seeking. This cycle repeats itself until the female dies and if the female feeds on a host suffering from malaria the parasite itself develops within the female and uses that mosquito as a vector.

Anopheles gambiae mosquito

Plasmodium parasites have two forms: male (microgametocytes) and female (macrogametocytes) that are ingested by an Anopheles mosquito during a blood meal. Whilst in the mosquito's stomach, the microgametes penetrate the macrogametes generating zygotes. The The zygotes in turn become motile and elongated (ookinetes) allowing them to invade the midgut wall of the mosquito where they develop into oocysts. These oocysts grow, rupture, and release sporozoites , which make their way to the mosquito's salivary glands. Inoculation of the sporozoites into a new human host perpetuates the malaria life cycle.

During a blood meal, a malaria-infected female Anopheles mosquito inoculates sporozoites into the human host. Sporozoites infect liver cells and mature into schizonts, which rupture and release merozoites. (Of note, in P vivax and P ovale a dormant stage [hypnozoites] can persist in the liver and cause relapses by invading the bloodstream weeks, or even years later.) After this initial replication in the liver (exo-erythrocytic schizogony ), the parasites undergo asexual multiplication in the erythrocytes (erythrocytic schizogony). Merozoites infect red blood cells. The ring stage trophozoites mature into schizonts, which rupture releasing merozoites. Some parasites differentiate into sexual erythrocytic stages (gametocytes). Blood stage parasites are responsible for the clinical manifestations of the disease.

As the malaria sporocytes can lie dormant in the liver once a person is infected with malaria they can have recurring bouts of malaria and if the infection is with Plasmodium falciparum then there is a 1:10 chance that one of these attacks may be fatal. If the infected person is a child then these recurring attacks can lead to brain damage as the parasite and the damaged red blood cells imaair with the development of a growing brain. Malaria is also extremely dangerous for a pregnant woman and can cause spontaneous abortions.

Malaria is a true curse and if you have read this page then I hope you understand a little better why I am so concerned about my wife and son and how their plight has made me understand more about this potentially crippling and often fatal disease.



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