Malaria

You all might be familiar with the term Malaria and not just this u also know that it's caused by mosquito bites. So this is our topic of discussion for today. By the end of this article, you will know much more about...

Malaria is an acute disease also known as plasmodium infection because it is caused by a parasite name plasmodium which can be spread to humans through the bite of female Anopheles mosquitoes. As the mosquito bites your parasite is released into your bloodstream, which causes malaria.

A very Interesting fact is that the parasite that causes this disease is not one of a type but rather has different classifications.

Plasmodium falciparum
Plasmodium vivax
Plasmodium malaria
Plasmodium ovale
Plasmodium knowlesi

Out of all these parasites p.falciparum & p.vivax are the deadliest and p.falciparum is mostly found in the continent of Africa and p.vivax is mostly found in areas outside of Sub-Saharan Africa.

History

A Chinese document from around 2700 BC, Mesopotamian clay tablets from 2000 BC, Egyptian papyri from 1570 BC, and Hindu scriptures from the sixth century BC all make mention of a sickness that was almost definitely malaria. Although such historical data should be handled with caution, we are making progress as we enter later centuries. The early Greeks were well aware of the characteristic ill health, malarial fevers, and enlarged spleens prevalent in marshy places, including Homer circa 850 BC, Empedocles of Agrigentum around 550 BC, and Hippocrates around 400 BC.

For over 2500 years, people believed that malaria fevers were caused by miasmas rising from swamps, and it is widely assumed that the word malaria comes from Italian malaria, which means "spoiled air," though this has been questioned. The identification of bacteria by Antoni van Leeuwenhoek in 1676, the accusation of microorganisms as the origin of infectious diseases, and the establishment of the germ theory of infection by Louis Pasteur and Robert Koch in 1878–1879 all contributed to a greater focus on the source of malaria. Shortly after Ronald Ross originally implicated mosquitoes as the first source of avian malaria and Charles Louis Alphonse Laveran discovered the parasites themselves in 1880 and then for human malaria by Ronald Ross in 1898, were scientific studies possible?

German troops in East Africa suffered greatly from malaria during World War I as a result of the Allies' control over Java and its precious quinine stockpiles. Following Armistice, the German government ordered a quest for a quinine substitute, determined to never run out of malaria medications again. I.G. Farben, a division of Bayer Dye Company, served as the operational hub. Chemists at Farben tried thousands of substances before settling on a few that were effective. Plasmochin (pamaquine), the first promising agent, was introduced in 1926. Atabrine followed in 1932. (quinacrine, mepacrine). Plasmochin, an eight-amino quinoline, was immediately discontinued due to toxicity; however, primaquine, a chemically similar drug, is now used to treat latent P. vivax and P. ovale liver parasites. Atabrine was superior in many aspects and remained in the blood.

What is the main Cause?

Malaria is caused by the bite of a single-celled parasite of the genus plasmodium which comes into the bloodstream and then travels to the liver then matures and starts to infect the RBCs in different organs of the human body.

In detail:

When a female Anopheles mosquito bites a person who has malaria, sporozoites of the Plasmodium parasite are released into the bloodstream.
Sporozoites enter the human liver quickly.
Over the next 1 week, the sporozoites multiply in the cells of the liver asexually, causing no symptoms.
In an animal model, merozoites, which are parasites, are discharged from the liver cells in vesicles, travel through the heart, and settle inside lung capillaries. The vesicles eventually disintegrate, allowing the merozoites to progress to the blood stage of development.
Merozoites invade red blood cells (erythrocytes) in the bloodstream and multiply until the cells burst. They then infiltrate more erythrocytes. This cycle is repeated, resulting in fever each time parasites escape and infiltrate blood cells.
Some infected blood cells exit the asexual multiplication cycle. The merozoites in these cells mature into gametocytes, the sexual forms of the parasite that circulate through the bloodstream, as opposed to reproducing.
When a mosquito bites an infected person, it consumes the gametocytes, which develop into mature sex cells known as gametes.
Female gametes that have been fertilized develop into ookinetes, which move actively and pierce the mosquito's midgut wall to generate oocysts on the outside.
The oocyst develops thousands of active sporozoites. When the oocyst finally bursts, sporozoites are released into the mosquito's body cavity and move on to the salivary glands
The human infection cycle is restarted when a mosquito bites another person.

There are few regions In the world where malaria is very common, let's see where

Malaria commonly occurs in developing countries and in areas where the temperatures are warm with high humidity which commonly includes

Africa, Central and South America, Caribbean islands, South East Asia, and islands in the central and South Pacific Ocean. According to the World health organization in 2016, there were 216,000,000 cases of malaria in almost 91 countries around the globe.

Also, know the most Susceptible persons for having a malarial infection

In 2021, 50% of the world’s population was at risk of having malaria. Some of which are the following groups at the highest risk of having a malarial infection.

Children
Pregnant women
Travelers
Patients with HIV/AIDS
People with low immunity

How will you identify if you have Malaria?

It's very easy to find the disease by its common signs and symptoms. A good diagnosis is made based on good observation of signs and symptoms. One should be aware of Malarial symptoms too.

Malaria can develop in 10 days to 1 month following infections appearing in every stage and others, it may take weeks to show its symptoms. Following are some of the symptoms/clinical features of malaria;

Malaise- the feeling of being ill
Fever- Increase in body temperature
Chills- Feeling cold
Headache- a painful sensation in the head
Vomiting- Expelling the stomach content through the mouth
Cough- Sudden expulsion of air through the mouth
Diarrhea- Loose or watery stools
Jaundice- Yellowish skin
Hepatic dysfunction- Liver failure
Enlargement of Liver and Spleen
Anemia- Lack of blood in the body
Thrombocytopenia- low level of platelet
Cerebral malaria which includes coma, seizure
Shock- Reduce blood and oxygen level in body parts
Muscle and abdominal pain
Fatigue- feeling tired
Rapid heart rate and breathing

Mosquito transmission cycle

An uninfected mosquito bites a person having malaria and becomes infected, then this infected mosquito bites a healthy human to transmit a malarial parasite in his body.

Once the parasite enters the body of humans it travels to the liver where it can enter as an active or inactive/dormant form. In the liver with time the parasite matures. After they get grown parasites to vacate the liver and then infect your red blood cells. This is the stage where people typically develop the clinical symptoms of the malarial infection.

If an infected mosquito bites a human at this point, it will become infected with your malaria parasites and became infected and in this way, it can spread malaria to other healthy human beings.

Another mode of transmission

Biting of an infected mosquito to a human being is not the only transmission of malaria because the parasite affects the red blood cells people can also catch malaria from infected blood, including

From mother to newborn child
Blood transfusions
Sharing noodles used for injection

Pathology

Firstly, the RBCs which are infected by malaria parasites are susceptible to hemolysis and anemia. Which are more dangerous in patients having splenomegaly and folic acid deficiency.

In infected red blood cells containing malaria, parasites can adhere to vessels of the brain, kidney, liver, and lungs. Due to this CBC blood vessels become congested and destroy organs.

Complications of Malaria

As we already know that malaria is an acute infectious disease that can cause several life-threatening complications which are as follows

Swelling of blood vessels of the brain that cause cerebral malaria, coma, seizures
Collection of fluid in the lungs that cause a problem in breathing
Destruction of red blood cells
Increase in blood sugar level
Death due to rupture of major organs of the body like liver, kidney, spleen

Several Investigation to Diagnose Malaria:

Blood film investigation: Thin and thick, a blood film or taken and stained with Giema stains and examined under a microscope. These blood films help in confirming the diagnosis, identification of the type of parasite, consentparasitesparasitesasitese, and blood stages of the parasite

PCR-DNA detection test: PCR also known as polymerase chain reaction is useful for determining whether a patient has been infected with the new type of malarial parasite or with the old or same type of parasite

Fluorescence microscopy:

Malaria is detected in what ways?

Your physician will analyze you and enquire about your signs and last travel incidents. To assess for malaria parasites, your healthcare professional will pull a specimen of your blood and dispatch it to a lab. Your physician will be able to specify whether you have malaria and what type of parasite is to accuse for your signs. This data will be utilized by your healthcare practitioner to select an adequate course of effort.

Treatment of malaria

Malaria should be treated as soon as possible. Mainly antimalarial drugs are used to cure and prevent the relapse of malaria.

Objective and Use of Antimalarial Drugs

The major objectives of output malarial infections are

To Prevent clinical attack of malaria.
To Treat clinical attacks of malaria.
To entirely eradicate the parasite from the Patient’s body.
To cut down human-to-mosquito transmission.

These objectives are achieved by killing the parasite at its different stages of the life cycle in the human host.

Antimalarial that depict erythrocytic schizogony named erythrocytic schizontocides

Antimalarial that act on pre erythrocytic in the liver is called Tissue schizontocides

Antimalarial, which kills gametocytes in the blood called gametocides

Following are the antimalarial drugs used to treat malaria

1. 4-Aminoquinolines

~Chloroquine

~Amodiaquine

2. Quinoline-methanol

~Mefloquine

3. Cinchona alkaloid

~Quinine

~Quinidine

4. Biguanide

~Proguanil

5. Diaminopyrimidine

~Pyrimethamine

6. 8-Aminoquinoline

~Primaquine

7. Sulfonamide

~Sulfadoxine

8. Antibiotics

~Doxycycline

9. Amino-alcohol

~Lumefantrine

10. Naphthoquinone

~Atovaquone

Anti-malarial therapy is given in the following form:

1. First prophylaxis- Th pre-erythrocytic stage (in the liver) which is the reason for malarial illness and clinical episodes is the target for this objective. Primaquine is simple prophylactic for all species of malaria

2. Suppressive prophylaxis- The drugs which suppress the erythrocytic phase and the attack of malarial fever can be used as prophylactic. Chloroquine, proguanil, and doxycycline have been used for suppressive prophylaxis.

3. Clinical cure- The erythrocytic schizontocide is used to terminate an episode of malarial fever. These are

high efficacy drugs- Artemisinins, Chloroquine, Quinine, Mefloquine, Atovaquone, Lumefantrine. These drugs can be utilized individually to deal with episodes of malarial fever.
low efficacy drugs- Proguanil, Pyrimethamine, Sulfonamides, Tetracycline, and Clindamycin. These are used only in combination for clinical cure.

4. Radical cure- in the case of vivax and ovale malaria drugs, which attack the exoerythrocytic stage given together with a clinical curative achieve total eradication of parasites from the patient's body. This cure is needed in relapsing malaria. The drug of choiceimaquinene daily for 2 weeks

5. Gametocidal- This guides to the elimination of male and female gametes from a patient's blood. Primaquine is gametocidal to all species

Side Effects of Antimalarial Drugs

Gastrointestinal issues like nausea and vomiting
Abdominal pain- mainly caused by Primaquine
Headaches
Insomnia
Seizures
Itching
Uneasiness
Impairment of vision- mainly caused by Chloroquine
Dizziness
Sinus Bradycardia- mainly caused by Mefloquine
Anemia
Hearing problems-mainly caused by quine

Prevention of malaria

Protection from mosquitoes: Mosquitoes are the main reason cause malaria so to avoid mosquito bites following things must be done.
apply insect repellent to the exposed skin which contains 20 to 30% off (DEET)
wear full sleeve clothes and long pants mostly during nighttime
use mosquito net in your room near your bed
maintain proper cleanliness around your living area and don’t let water deposit near it

Meditation: When you are planning to travel to an area, the malariallarial infection is common always talk to you Dr

And take the prescribed medimedicationng with you against malaria travelers from different countries may receive different prescribed medicine dep-depending thefferencesesiinprothe totoolsetprotocol and the availability of medicine in different countries of the world.