HISTORY OF MALARIA

Malaria has infected humans for over 50,000 years, and ''Plasmodium'' may have been a human pathogen for the entire history of the species. Close relatives of the human malaria parasites remain common in chimpanzees. References to the unique periodic fevers of malaria are found throughout recorded history, beginning in 2700 BC in China. The term malaria originates from Medieval Italian: ''mala aria''"bad air"; and the disease was formerly called ''ague'' or ''marsh fever'' due to its association with swamps and marshland. Malaria was once common in most of Europe and North America, where it is no longer endemic, though imported cases do occur.

Scientific studies on malaria made their first significant advance in 1880, when a French army doctor working in the military hospital of Constantine in Algeria named Charles Louis Alphonse Laveran observed parasites for the first time, inside the red blood cells of people suffering from malaria. He, therefore, proposed that malaria is caused by this organism, the first time a protist was identified as causing disease. For this and later discoveries, he was awarded the 1907 Nobel Prize for Physiology or Medicine.

The malarial parasite was called ''Plasmodium'' by the Italian scientists Ettore Marchiafava and Angelo Celli. A year later, Carlos Finlay, a Cuban doctor treating patients with yellow fever in Havana, provided strong evidence that mosquitoes were transmitting disease to and from humans. This work followed earlier suggestions by Josiah C. Nott, and work by Patrick Manson on the transmission of filariasis

In the early 20th century, before antibiotics became available, Julius Wagner-Jauregg discovered that patients with syphilis could be treated by intentionally infecting them with malaria; the resulting fever would kill the malaria spirochetes, and quinine would then be administered to control the malaria. Although some patients died from malaria, this was considered preferable to the almostcertain death from syphilis.

Although the blood stage and mosquito stages of the malaria life cycle were identified in the 19th and early 20th centuries, it was not until the 1980s that the latent liver form of the parasite was observed. The discovery of this latent form of the parasite finally explained why people could appear to be cured of malaria but still relapse years after the parasite had disappeared from their bloodstreams.

ABOUT MALARIA

Malaria is a vector-borne infectious disease caused by a eukaryotic protist of the genus ''Plasmodium''. It is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa. Each year, there are approximately 350500 million cases of malaria, killing between one and three million people, the majority of whom are young children in SubSaharan Africa. Ninety percent of malaria-related deaths occur in Sub-Saharan Africa. Malaria is commonly associated with poverty, but is also a cause of poverty and a major hindrance to economic development.

MALARIA MOSQUITO

MALARIA MOSQUITO

Malaria is one of the most common infectious diseases and an enormous public health problem. Five species of the plasmodium parasite can infect humans; the most serious forms of the disease are caused by ''Plasmodium falciparum''. Malaria caused by ''Plasmodium vivax'', ''Plasmodium ovale'' and ''Plasmodium malariae'' causes milder disease in humans that is not generally fatal. A fifth species, ''Plasmodium knowlesi'', causes malaria in macaques but can also infect humans. This group of human-pathogenic ''Plasmodium'' species is usually referred to as ''malaria parasites''.

Usually, people get malaria by being bitten by an infective female ''Anopheles'' mosquito. Only ''Anopheles'' mosquitoes can transmit malaria, and they must have been infected through a previous blood meal taken on an infected person. When a mosquito bites an infected person, a small amount of blood is taken, which contains microscopic malaria parasites. About one week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person being bitten.

ANOPHELES MOSQUITO

The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (lightheadedness, 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. Malaria transmission can be reduced by preventing mosquito bites with mosquito nets and insect repellents, or by mosquito control measures such as spraying insecticides inside houses and draining standing water where mosquitoes lay their eggs. Work has been done on malaria vaccines with limited success and more exotic controls, such as genetic manipulation of mosquitoes to make them resistant to the parasite have also been considered.

SYMPTOMS OF MALARIA

LIFECYCLE OF MALARIA PARASITE

Symptoms of malaria include fever, shivering, arthralgia (joint pain), vomiting, anemia (caused by hemolysis), hemoglobinuria, retinal damage, and convulsions. The classic 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 for ''P. malariae''. ''P. falciparum'' can have recurrent fever every 3648 hours or a less pronounced and almost continuous fever. For reasons that are poorly understood, but that may be related to high intracranial pressure, children with malaria frequently exhibit abnormal posturing, a sign indicating severe brain damage.

Malaria has been found to cause cognitive impairments, especially in children. It causes widespread anemia during a period of rapid brain development and also direct brain damage. This neurologic damage results from cerebral malaria to which children are more vulnerable. Cerebral malaria is associated with retinal whitening, which may be a useful clinical sign in distinguishing malaria from other causes of fever.

Severe malaria is almost exclusively caused by ''P. falciparum'' infection and usually arises 614 days after infection. Consequences of severe malaria include coma and death if untreatedyoung children and pregnant women are especially vulnerable. Splenomegaly (enlarged spleen), severe headache, cerebral ischemia, hepatomegaly (enlarged liver), hypoglycemia, and hemoglobinuria with renal failure may occur.

Renal failure may cause blackwater fever, where hemoglobin from lysed red blood cells leaks into the urine. Severe malaria can progress extremely rapidly and cause death within hours or days. In endemic areas, treatment is often less satisfactory and the overall fatality rate for all cases of malaria can be as high as one in ten. Over the longer term, developmental impairments have been documented in children who have suffered episodes of severe malaria.

Chronic malaria is seen in both ''P. vivax'' and ''P. ovale'', but not in ''P. falciparum''. Here, the disease can relapse months or years after exposure, due to the presence of latent parasites in the liver. Describing a case of malaria as cured by observing the disappearance of parasites from the bloodstream can, therefore, be deceptive. The longest incubation period reported for a ''P. vivax'' infection is 30 years.

MALARIA DIAGNOSIS

*Microscopic examination of blood films

*Molecular methods

*Rapid antigen tests

MALARIA PREVENTION

Methods used to prevent the spread of disease, or to protect individuals in areas where malaria is endemic, include prophylactic drugs, mosquito eradication, and the prevention of mosquito bites.
The continued existence of malaria in an area requires a combination of high human population density, high mosquito population density, and high rates of transmission from humans to mosquitoes and from mosquitoes to humans. If any of these is lowered sufficiently, the parasite will sooner or later disappear from that area, as happened in North America, Europe and much of Middle East. However, unless the parasite is eliminated from the whole world, it could become reestablished if conditions revert to a combination that favors the parasite's reproduction. Many countries are seeing an increasing number of imported malaria cases due to extensive travel and migration. There is currently no vaccine that will prevent malaria, but this is an active field of research.

*VECTOR CONTROL

*Prophylactic drugs
*Indoor residual spraying

*Mosquito nets and bedclothes

*Vaccination *Other methods