Malaria

Lecture No 6

Definition

History of malaria

Malaria is probably one of the oldest diseases known to mankind that has had profound impact on our
history.

Hippocrates was probably the first malariologist. By 400BC, he described the various malaria fevers of
man.

Roman scholar Marcus Terentius Varro (116-27 BC) suggested that swamps breed "certain animalcula
which cannot be seen with the eyes and which we breathe through the nose and mouth into the body,
where they cause grave maladies."

History of malaria

In 1696 Morton presented the first detailed description of the clinical picture of malaria and its
treatment with cinchona.

By early 17-th century, Italian physician Giovanni Maria Lancisi made some astounding observations on
malaria. In 1716, he first described a characteristic black pigmentation of the brain and spleen in the
victims of malaria.

History of malaria

Finally, it was Charles Louis Alphonse Laveran, a French physician working in Algeria and a student of
Pasteur, who identified the malaria parasite in 1888.

In 1885 Camillo Golgi, an Italian neurophysiologist, established that there were at least two forms of the
disease, one with tertian periodicity (fever every other day) and one with quartan periodicity (fever
every third day).

Etiology

Plasmodium vivax,

P. falciparum,

P. ovale

P. malariae

Comparison of malarial parasites

Transmission of Malaria

Transmission by vector

Blood transfusion (Transfusion malaria)

Mother to the growing fetus (Congenital malaria)

Needle stick injury

Host factors:

People of West African origin are strikingly non-susceptible to P. vivax infections. It has been found that
P. vivax merozoites penetrate the red cells after binding to the Fya and Fyb receptors, which are the
Duffy blood group antigen alleles. In the West African population, this blood group antigen is an extreme
rarity and this explains the phenomenon.

The sickle cell trait (heterozygous state) has been found to confer protection against the complications
of P. falciparum malaria (at a ratio of 1:10 compared to non-sickle cell children, in a controlled study).
Decreased availability of oxygen in the presence of abnormal hemoglobin, faster clearance of sickled
cells by the spleen, decrease in the intracellular pH, leakage of potassium, rigidity of cell membrane in
the presence of Hb S may all contribute to the resistance.

Hemoglobin F also has protective effects against severe malaria. In beta thalassemia, fetal hemoglobin
levels are high.

In Melanasian ovalocytosis, the rigid membrane of the red cells prevents entry of the parasites.

Natural history of

Differential diagnosis

Complications of malaria

1. Cerebral malaria

2. Shock

3. Heamoglobinuria

4. Renal failure

5. Severe anemia

6. Complicating infections

Diagnosis of Malaria

Diagnosis of Malaria
+ = 1–10 per 100 thick fields.

++ = 11-100 per 100 thick fields.

+++ = 1–10 per thick field.

++++ = >10 per thick field.

Anti Malarial Drugs:

Chloroquine (iv, im, sc)

Quinine

Pyrimethamine/ Sulphadoxine

Mefloquine

Halofantrine

Artemisinin Derivatives

Chloroguanide (Proguanil)

Tetracyclines

Atovaquone plus Proguanil (Malarone™)

Pervention

Personal Protection Against Mosquitoes