What is MALARIA?
Malaria is a preventable and treatable disease. It is a public health problem today in more than 100 countries inhabited by some 2,400 million people -- 40 percent of the world's population. Malaria is estimated to cause 300- 500 million clinical cases and over one million deaths each year. Every 30 seconds, a child somewhere dies of malaria. In any given year, nearly ten percent of the global population will suffer a case of malaria. Most survive after an illness of 10-20 days. Children are especially vulnerable to malaria. In Africa, where 80% of malaria cases are treated at home, the disease kills one child in twenty before the age of five. Pregnant women are also at high risk. They have an increase risk of disease and death, as well as adverse impacts for their developing babies- including low birth weight, growth retardation, still births and death. In African countries, up to 60% of hospital admissions may be for malaria; that's 6 out of 10 admissions! Travelers to Sub-Saharan Africa have the greatest risk of both getting malaria and dying from their infection. All travelers to any countries with malaria risk may get this potentially deadly disease, and thus taking proper precautions is essential. Other high-risk groups include refugees, displaced persons, or labour forces entering into endemic areas. Malaria is transmitted in large areas of Africa, Central and South America, the island of Hispaniola (includes Haiti, Jamaica and the Dominican Republic), Asia (including the Indian subcontinent, Southeast Asia and the Middle East), Eastern Europe, and the South Pacific.
Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells. Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines. Key interventions to control malaria include: prompt and effective treatment with artemisininbased combination therapies; use of insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitoes.
 A number of medications are available to prevent malaria in travelers to malaria-endemic countries (prophylaxis). jaundice.
Signs and symptoms
Symptoms of malaria include fever. ovale. causing symptoms that typically includefever and headache. and can indeed be a cause of poverty and a major hindrance to economic development. hemoglobinuria. An estimated 655. retinal damage. occurring every two days
. accounting for 2. Resistance has developed to several antimalarial drugs. the study estimates that 1.Malaria is a mosquito-borne infectious disease of humans and other animals caused byeukaryotic protists of the genus Plasmodium.000 people died from malaria in 2010. malariae is generally a milder disease that is rarely fatal. falciparum while the disease caused by P. A variety of antimalarial medicationsare available. or by mosquitocontrol measures such as spraying insecticides and draining standing water (where mosquitoes breed). which is superior to quinine in both children and adults. However. There were an estimated 225 million cases of malaria worldwide in 2009. a 2012 meta-study from the University of Washington and University of Queensland estimates that malaria deaths are significantly higher. and theAmericas. knowlesi is a zoonoticspecies that causes malaria in macaques but can also infect humans. Malaria is commonly associated with poverty. Malaria transmission can be reduced by preventing mosquito bites by distribution of mosquito netsand insect repellents. in severe cases progressing to coma or death. Despite a clear need. P. Five species of Plasmodium can infect and be transmitted by humans. Plasmodium falciparum—responsible for the most severe form of malaria—causes the vast majority of deaths associated with the disease. no vaccine offering a high level of protection currently exists. arthralgia (joint pain).238.000 who died in 2009 according to the World Health Organization's 2011 World Malaria Report. including much of Sub-Saharan Africa. Severe disease is largely caused by P. anemia (caused by hemolysis). vomiting. andP. Asia. Severe malaria is treated with intravenous or intramuscular quinine or. and about 60% of these are young children under the age of five. Efforts to develop one are ongoing. P.000 people died from malaria in 2010. and convulsions. since the mid2000s. The disease results from the multiplication ofPlasmodium parasites within red blood cells. a decrease from the 781. It is widespread intropical and subtropical regions. shivering. Ninety percent of malaria-related deaths occur in sub-Saharan Africa. The classic symptom of malaria is cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting four to six hours. the artemisinin derivative artesunate.23% of deaths worldwide. most notably chloroquine and artemisinin. vivax. Published in The Lancet.
however. In the most severe cases of the disease. Malaria parasites contain apicoplasts. P. It causes widespread anemia during a period of rapid brain development and also direct brain damage. a sign indicating severe brain damage. falciparum infection can cause recurrent fever every 36–48 hours or a less pronounced and almost continuous fever. In endemic areas. and hemoglobinuria with renal failure may occur. For reasons that are poorly understood. falciparum. but that may be related to high intracranial pressure. children with malaria frequently exhibit abnormal posturing. ovaleinfections. P. ovale.While P. Splenomegaly(enlarged spleen). Over the longer term. Renal failure is a feature ofblackwater fever. complete with their own functioning genomes. malariae. In humans malaria is caused by P. This neurologic damage results from cerebral malaria to which children are more vulnerable. Malaria has been found to cause cognitive impairments. Severe malaria can progress extremely rapidly and cause death within hours or days. with the exception of P. reptiles. knowlesi. Cause
A Plasmodium sporozoite traverses the cytoplasm of a mosquito midgut epithelial cell in this false-colour electron micrograph. vivax and P.
Malaria parasites are members of the genus Plasmodium (phylum Apicomplexa). where hemoglobin from lysed red blood cells leaks into the urine. Cerebral malaria is associated with retinal whitening. malariae. chimpanzees and rodents. treatment is often less satisfactory and the overall fatality rate for all cases of malaria can be as high as 10%.hypoglycemia. P. These apicoplasts are thought to have originated through theendosymbiosis of algae and play a crucial role in various aspects of parasite metabolism. monkeys. hepatomegaly (enlarged liver). falciparum account for about 90% of deaths from malaria. which may be a useful clinical sign in distinguishing malaria from other causes of fever. Consequences of severe malaria include coma and death if untreated—young children and pregnant women are especially vulnerable. vivax and P.There have been documented human infections with several simian species of malaria. Severe malaria is almost exclusively caused by Plasmodium falciparum. and every three days for P. even with intensive care and treatment. especially in children. cerebral ischemia. knowlesi. P. infections by P. for
. ParasiticPlasmodium species also infect birds. and usually arises 6– 14 days after infection. an organelle usually found in plants. fatality rates can exceed 20%.in P. these are mostly of limited public health importance. severe headache. vivax is responsible for the largest number of malaria infections worldwide. developmental impairments have been documented in children who have suffered episodes of severe malaria.
it releases sporozoites that migrate through the mosquito's body to the salivary glands.example in fatty acid biosynthesis. which. Then. First.
The parasite's secondary hosts are human and other vertebrates.e. The exoerythrocytic phase involves infection of the hepatic system. alongside saliva. the parasite gametocytestaken up in the blood will further differentiate into male or female gametes and then fuse in the mosquito's gut. They usually start searching for a meal at dusk. the merozoites infect red blood cells. When the oocyst ruptures. female mosquitoes of theAnopheles genus are the primary. The females of the Anopheles genus of mosquito prefer to feed at night. They infect liver cells (hepatocytes). if taken up by a mosquito. A mosquito infects a person by taking a blood meal. whereas the erythrocytic phase involves infection of the erythrocytes. thus beginning the erythrocytic stage of
. This produces anookinete that penetrates the gut lining and produces an oocyst in the gut wall. or liver. and escape back into the bloodstream. After a potential dormant period in the liver. which.
Malaria develops via two phases: an exoerythrocytic and an erythrocytic phase. definitive hosts and act as transmission vectors. the sporozoites move to the liver and infecthepatocytes.
The life cycle of malaria parasites in the human body. sporozoites enter the bloodstream. A mosquito becomes infected when it takes a blood meal from an infected human. rupture the liver cells. when the mosquito takes a subsequent blood meal. As of 2003. i. When an infected mosquito pierces a person's skin to take a blood meal. Only female mosquitoes feed on blood while male mosquitoes feed on plant nectar. these organisms differentiate to yield thousands of merozoites. thus males do not transmit the disease. or red blood cells. will infect the insect and continue the life cycle. following rupture of their host cells. Sexual forms (gametocytes) are also produced. The sporozoites are injected into the skin. This type of transmission is occasionally referred to as anterior station transfer. escape into the blood and infect red blood cells. 466 proteins have been found to be produced by apicoplasts and these are now being investigated as possible targets for novel antimalarial drugs. Young mosquitoes first ingest the malaria parasite by feeding on an infected human carrier and the infected Anopheles mosquitoes carry Plasmodium sporozoites in their salivary glands. although this is rare. multiplying asexually and asymptomatically for a period of 8–30 days. and will continue throughout the night until taking a meal. and migrate to the liver. where they are then ready to infect a new human host. Once ingested. Within minutes of being introduced into the human host. where they multiply into merozoites. sporozoites in the mosquito's saliva enter the bloodstream and migrate to the liver. where they develop into ring forms. Malaria parasites can also be transmitted by blood transfusions. trophozoites and schizonts which in turn produce further merozoites.
Uncomplicated malaria is treated with oral drugs. less invasive specimens. falciparum infection recommended by WHO is the use of artemisinins in combination with other antimalarials artemisinin-combination therapy (ACT) to avoid the development of drug resistance against artemisinin-based therapies. The most effective strategy for P. Severe malaria requires the parenteral administration of antimalarial drugs. vivax requires both treatment of blood stages (with chloroquine or ACT) as well as clearance of liver forms with primaquine. Until recently the most used treatment for severe malaria was quinine but artesunate has been shown to be superior to quinine in both children and adults. malariae is usually treated on an outpatient basis. a patient with malaria can expect a complete recovery.
Further information: Diagnosis of malaria The mainstay of malaria diagnosis has been the microscopic examination of blood using blood films. Areas that cannot afford laboratory diagnostic tests often use only a history of subjective fever as the indication to treat for malaria. Several such amplification cycles occur. classical descriptions of waves of fever arise from simultaneous waves of merozoites escaping and infecting red blood cells. the parasites multiply further. modern techniques using antigen tests or polymerase chain reaction have been discovered. P. Infection with P. The treatment of malaria depends on the severity of the disease. Treatment of severe malaria also involves supportive measures. Although blood is the sample most frequently used to make a diagnosis. Treatment ofP. Within the red blood cells. Thus. whether patients can take oral drugs or must be admitted depends on the assessment and the experience of the clinician.More recently. both saliva and urine have been investigated as alternative.
Further information: Antimalarial medication When properly treated. again asexually. The parasite escapes from the liver undetected by wrapping itself in the cell membrane of the infected host liver cell.the life cycle.
. though these are not widely implemented in malaria-endemic regions. ovale or P. vivax. periodically breaking out of their hosts to invade fresh red blood cells.