What is malaria?

Malaria is an infectious disease caused by a parasite, Plasmodium, which infects red blood cells. Malaria is characterized by cycles of chills, fever, pain, and sweating. Historical records suggest malaria has infected humans since the beginning of mankind. The name "mal aria" (meaning "bad air" in Italian) was first used in English in 1740 by H. Walpole when describing the disease. The term was shortened to "malaria" in the 20th century. C. Laveran in 1880 was the first to identify the parasites in human blood. In 1889, R. Ross discovered that mosquitoes transmitted malaria. Of the four common species that cause malaria, the most serious type is Plasmodium falciparum malaria. It can be life-threatening. However, another relatively new species, Plasmodium knowlesi, is also a dangerous species that is typically found only in long-tailed and pigtail macaque monkeys. Like P. falciparum, P. knowlesi may be deadly to anyone infected. The other three common species of malaria (P. vivax, P. malariae, and P. ovale) are generally less serious and are usually not life-threatening. It is possible to be infected with more than one species of Plasmodium at the same time. Currently, about 2 million deaths per year worldwide are due to Plasmodium infections. The majority occur in children under 5 years of age in sub-Saharan African countries. There are about 400 million new cases per year worldwide. Most people diagnosed in the U.S. obtained their infection outside of the country, usually while living or traveling through an area where malaria is endemic.

What are malaria symptoms and signs?

The symptoms characteristic of malaria include flulike illness with fever, chills, muscle aches, and headache. Some patients develop nausea, vomiting, cough, and diarrhea. Cycles of chills, fever, and sweating that repeat every one, two, or three days are typical. There can sometimes be vomiting, diarrhea, coughing, and yellowing (jaundice) of the skin and whites of the eyes due to destruction of red blood cells and liver cells. People with severe P. falciparum malaria can develop bleeding problems, shock, liver or kidney failure, central nervous system problems, coma, and can die from the infection or its complications. Cerebral malaria (coma, or altered mental status or seizures) can occur with severe P. falciparum infection. It is lethal if not treated quickly; even with treatment, about 15%-20% die.

How is malaria transmitted?

The life cycle of the malaria parasite (Plasmodium) is complicated and involves two hosts, humans and Anopheles mosquitoes. The disease is transmitted to humans when an infected Anopheles mosquito bites a person and injects the malaria parasites (sporozoites) into the blood. This is shown in Figure 1, where the illustration shows a mosquito taking a blood meal (circle label 1 in Figure 1).

Figure 1: CDC illustration of the life cycles of malaria parasites, Plasmodium spp. SOURCE: CD

Sporozoites travel through the bloodstream to the liver, mature, and eventually infect the human red blood cells. While in red blood cells, the parasites again develop until a mosquito takes a blood meal from an infected human and ingests human red blood cells containing the parasites. Then the parasites reach the Anopheles mosquito's stomach and eventually invade the mosquito salivary glands. When an Anopheles mosquito bites a human, these sporozoites complete and repeat the complex Plasmodium life cycle. P. ovale and P. vivax can further complicate the cycle by producing dormant stages (hypnozoites) that may not develop for weeks to years

Symptom

Anemia Bloody stools Chils Coma Convulsion Fever Headache Jaundice Muscle pain Nausea Sweating Vomiting

Signs and tests

During a physical examination, the doctor may find an enlarged liver or enlarged spleen. Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis.

A complete blood count (CBC) will identify anemia if it is present.

Treatment
Malaria, especially Falciparum malaria, is a medical emergency that requires a hospital stay. Chloroquine is often used as an anti-malarial medication. However, chloroquine-resistant infections are common in some parts of the world Possible treatments for chloroquine-resistant infections include: The combination of quinidine or quinine plus doxycycline, tetracycline, or clindamycin Atovaquone plus proguanil (Malarone) Mefloquine or artesunate The combination of pyrimethamine and sulfadoxine (Fansidar) The choice of medication depends in part on where you were when you were infected. Medical care, including fluids through a vein (IV) and other medications and breathing (respiratory) support may be needed. Expectations (prognosis) The outcome is expected to be good in most cases of malaria with treatment, but poor in Falciparum infection with complications.

Complications
Brain infection (cerebritis) Destruction of blood cells (hemolytic anemia) Kidney failure Liver failure Meningitis Respiratory failure from fluid in the lungs (pulmonary edema) Rupture of the spleen leading to massive internal bleeding (hemorrhage) Calling your health care provider Call your health care provider if you develop fever and headache after visiting the tropics.

Prevention

Most people who live in areas where malaria is common have gotten some immunity to the disease. Visitors will not have immunity, and should take preventive medications. It is important to see your health care provider well before your trip, because treatment may need to begin as long as 2 weeks before travel to the area, and continue for a month after you leave the area. In 2006, the CDC reported that most travelers from the U.S. who contracted malaria failed to take the right precautions. The types of anti-malarial medications prescribed will depend on the area you visit. According to the CDC, travelers to South America, Africa, the Indian subcontinent, Asia, and the South Pacific should take one of the following drugs: mefloquine, doxycycline, chloroquine, hydroxychloroquine, or Malarone. Even pregnant women should take preventive medications because the risk to the fetus from the medication is less than the risk of catching this infection. People who are taking anti-malarial medications may still become infected. Avoid mosquito bites by wearing protective clothing over the arms and legs, using screens on windows, and using insect repellent. Chloroquine has been the drug of choice for protecting against malaria. But because of resistance, it is now only suggested for use in areas where Plasmodium vivax, P. oval, and P. malariae are present. Falciparum malaria is becoming increasingly resistant to anti-malarial medications. For travelers going to areas where Falciparum malaria is known to occur, there are several options for malaria prevention, including mefloquine, atovaquone/proguanil (Malarone), and doxycycline.

Explain The Life Cycle Of Plasmodium In Human Beings?

In human beings infective stage of plasmodium known as sporozoite occurs. These are transferred into the man by female mosquito through its salivary gland. It goes inside the liver and it enlarges it becomes round in shape. They are known as Schizont. They divide by multiple fission and form cryptozoites. This process is known as Schizogony. The cryptozoites are produced in the liver. There is a pre patent period which starts with the infection of sporozoite and extends till the first symptoms of parasites in blood appear. Its duration is of 8 days. After that cryptozoites enter other liver cells and multiply to form meta cryptozoites. This multiple fission that is schizogony also occurs in red blood corpuscles. It is known as erythrocytic schizogony. Than plasmodium passes through different stages such as signet ring stage, amoeboid stage and erythrocytic merozoites. When meta cryptozoites enter red blood cell they become round in shape known as young trophozoite. Than later on it forms a large contractile vacuole which pushes nucleus to one end. It gives a signet ring look to the trophozoite. After this trophozoite ring appearance it becomes amoebic in shape. It secretes enzyme lysolecithin which attacks the red blood cells cytoplasm. This leads to decomposition of hemoglobin to black haemozoin granules. Hemoglobin divides into haematin and globin. Globin is the protein part and haematin is the iron part. Haematin aggregates and globin helps in digestion of nutrition. There are yellow colored granules which occur in the cytoplasm of red blood cells are known as Schuffners dots. Trophozoite under goes mitotic division and it leads to formation of merozoites. Merozoites are released when red blood cells rupture. This leads to occurrence of fever. This time span in which fever is felt and sporozoite enter into human body is referred as incubation period. It varies from 12 to 28 days in different species of plasmodium. Restlessness, loss of appetite, muscular pains, and headache are the symptoms of malaria. These features are also accompanied by chills. They occur as the body temperature starts increasing. After two days the temperature gets normal. Merozoites enter inside the red blood cells and give rise to gametocytes. They can be small or large. Smaller one corresponds to male gametocytes also known as micro gametocytes. Larger ones respond to female gametocytes also known as macro gametocytes.

The life cycle of the malarial parasite

Written by Dr Charlie Easmon, specialist adviser in travel medicine

What is a malarial parasite?

The malarial parasite lives as a parasite in mosquitos.The malarial parasite, Plasmodium, is a very small, single-cell blood organism, or 'protozoan'. It lives as a parasite in other organisms, namely man and mosquito. The parasite is the cause of the tropical disease malaria.The Plasmodium parasite is dependent on a single species of mosquito, Anopheles, which is the only species capable of serving as host for it.

What are the different stages of the parasite's life cycle?

This small single-cell organism has three to four different forms. Each form is specialised in living in a certain place. The gametocyte is the form that infects the mosquito and reproduces itself, as if it were both sexes. When the mosquito has sucked blood containing gametocytes, these pass into the salivary glands of the mosquito, where they develop into a new form, the sporozoite. The infection can then move on. The sporozoite can be passed on to man when the mosquito bites, injecting its saliva into the tiny blood vessels. The sporozoite travels with the blood to the liver and enters the liver cells. In the liver some of the sporozoites divide (tachysporozoites) and become thousands of merozoites. The merozoites are released from the liver to the blood where they are taken up by the red blood corpuscles. Some of these turn into ring-formed trophozoites that split again to form schizonts. Schizonts burst the red blood corpuscles at a certain moment, releasing the merozoites. This release coincides with the violent rises in temperature during the attacks seen in malaria.

The trophozoites that are left over during division can, in the course of the next day, develop into the sexual form, the gametocyte, which can be taken up by a blood-sucking mosquito and start another cycle The incubation period (time from infection to development of the disease) is usually about 10 to 15 days. This period can be much longer depending on whether any antimalarial medication has been taken. Plasmodium ovale and Plasmodium vivax can produce a dormant form, a hypnozoite, that can cause relapses of the disease months and even years after the original disease (relapsing malaria) because it's dormant in the liver cells. This is why it's important after these infections to be treated with primaquine to kill the liver stages. (Primaquine cannot be used by people with a condition called G6PD-deficiency.)

Where does malaria occur?

Malaria occurs where the Anopheles mosquito occurs. The parasite cannot be passed on by any other species of mosquito.Plasmodium falciparum is by far the most widespread malaria in Africa, and at the same time the cause of malignant malaria. It also occurs in specific areas of Asia and South America. P. Vivax is most common in South America and Asia.Remember, it is always best to try to prevent malaria.

Malaria: Life Cycle of Plasmodium

What is an advantage of having two different host species for Plasmodium? The organism causing malaria, Plasmodium, has a two host life cycle. In order to complete the life cycle, Plasmodium must move from mosquito to human and then back to mosquito again. Having two hosts may seem inefficient but it is very common in eukaryotic parasites. If Plasmodium only had a single host, either humans or mosquitoes, it would be difficult for the parasite to move to a new host individual. Eukaryotic parasites generally cannot move from host to host by casual contact. Mosquitoes feed on human blood and the transfer of blood and anticoagulant between humans and mosquitoes allows for the predictable transfer of the parasite.