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A Presentation on Malaria
Slide 2: Introduction
Malaria is one of the deadly infectious diseases globally. It is related to poverty and most prevalent in developing countries. According to WHO (2021), malaria is caused by female anopheles mosquitoes through bites. In 2019, there were approximately 229 million malaria cases globally, with 409,000 deaths, of which 67% were children below five years (WHO, 2021). African continent carried the highest burden of malaria with 94% cases and deaths. The year experienced total funding of $3 billion, with governments from burdened countries using $900 million to control the disease (WHO, 2021). The figures show that malaria is a public health concern that is an obstacle to the affected country's economy. Therefore, experts need to explore the disease to come up with lasting solutions of its control to reduce the increasing mortality rate.
Slide 3: What Causes Malaria?
Malaria infections result from female anopheles mosquitoes that produce diverse symptoms that may be severe and cause death, but it is curable when treated early and correctly. Malaria clinical symptoms are caused by asexual erythrocytic parasites whose waste products accumulate in the bloodstream in the form of hemozoin pigment, which is toxic and infects red blood cells. The infected RBC produces invasive merozoites, which fill the bloodstream. Hemozoin and toxic substances kindle macrophages to develop cytokines and soluble substances, producing fever and rigors. Plasmodium parasite causes interference with vascular endothelium in the blood vessel walls to inhibit the free circulation of the blood. When infected erythrocytes undergo sequestration in the brain vessels, it causes cerebral malaria, a severe type of disease related to its high mortality rates. The disease also targets the skeletal muscle system, causing muscle aches, contractures, fatigue, pain, and weakness (Marrelli & Broto, 2016). In extreme cases, it causes coronary artery occlusion, affecting the cardiac muscles that aid the heart to pump blood to the rest of the body. Skeletal and cardiac muscles become weak due to RBC sequestration, which results from serum creatine kinase as well as decreased muscle mass of crucial contractile proteins (Marrelli & Broto, 2016).
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Slide 4: Pathophysiology
When RBC are infected by the malaria parasite, they transport the parasite to every part of the body through blood flow, making it a multisystem disease. The completion of the malaria cycle, known as schizogony, lasts between twenty-four and seventy-two hours, depending on the parasite species (Kakkilaya, 2015a). Merozoites and glycosylphosphatidylinositol (GPI) are released through lysis into the bloodstream, which activates endothelial cells to produce cytokines as well as inflammatory mediators, like tumor necrosis factor lymphotoxin, nitric oxide, and interleukin-1. The main parasite toxin is the GPI tail which comprises MSP-1, 2, and 4 (Kakkilaya, 2015a) . The body responds to the parasite and toxic substances by producing cytokines that cause headaches, fever, nausea, diarrhea, and joint and muscle aches. Additionally, plasmodial DNA is associated with pro-inflammatory factors that cause cytokinemia and extreme fever (Kakkilaya, 2015a) . The DNA comes in the form of hemozoin within the RBC to interrelate with toll-like receptors to produce pro-inflammatory cytokines that induce COX-2-upregulating prostaglandins that cause fever. Hemozoin also causes apoptosis in growing erythroid cells in the bone marrow, leading to anemia.
Slide 5: Pathology
Malaria causes significant changes to the blood and blood-manufacturing system, which comprises the spleen plus liver. Secondary alterations happen in other body systems based on the category and rigorousness of an infection. However, pathological alterations are extra prominent in P. falciparum species which causes severe malaria characterized by multisystem disorder presented through sepsis syndrome ( Kakkilaya, 2015b) . The red blood cells are the most affected, being the principal site for malaria infection. The parasites consume intracellular proteins, alter RBC membranes, and expose cryptic surface membranes to the parasites. P. falciparum species lead to the interaction of healthy and infected RBC to form rosettes, and consequently, RBC aggregates in the brain and heart ( Kakkilaya, 2015b) . The aggregates interfere with blood microcirculation and metabolism in the brain, causing cerebral malaria.
Slide 6: Risk Factors
The most significant risk factor is visiting or living in areas infested with malaria-causing mosquitoes. According to CDC (2021), these areas include Sub-Saharan Africa, Asia, Pacific Islands, and Central and South America. The harshness of danger differs based on local intervention measures to control malaria, seasonal changes, and precautions individuals take to control mosquito bites, such as using mosquito nets. There are people with an increased risk of contracting the severe elements of the disease; infants, the geriatric population, travelers from zones without malaria, and pregnant women and their unborn children. The risk is reduced through preventative measures and medical care.
Slide 7: Types of Malaria
Malaria can be severe or uncomplicated. According to the CDC (2019), uncomplicated malaria occurs for six to ten hours and comprises shivering, fever, headaches, seizures, and sweating as temperature balances to normal range. The symptoms appear on the second day when attacked by P falciparum, vivax, and ovale parasites and on the third day when infested by P malariae parasite. The most prevalent symptoms include fever, sweating, vomiting, and body aches. In high-risk areas, residents treat the disease without seeking medical confirmation successfully. On diagnosis, findings include high temperature, perspiration, enlarged spleen and liver, jaundice, and elevated respiratory rate. Severe malaria involves organ failure and blood abnormalities. It manifests through cerebral malaria, severe anemia, hemoglobinuria, acute respiratory distress syndrome, blood coagulation abnormalities, low blood pressure, kidney failure, hyperparasitemia, and metabolic acidosis (CDC, 2019). It requires emergency and urgent treatment to save the patient’s life.
Slide 8: Malaria Complications
Severe malaria causes complications those result in deaths, especially in infants and the geriatric population. It is most fatal when caused by Plasmodium species which is prevalent in Africa. WHO (2021) reported approximately 94% of malaria deaths in Africa in 2019, mainly to children below five years. Deaths from malaria are caused by multiple complications. They include cerebral malaria , which causes brain swelling, damage, seizures, comma, and consequently death; breathing problems through the accumulation of fluids in the lungs causing breathing difficulties and pulmonary edema; organ failure such as kidney damage and spleen rupture, which are life-threatening; Anemia due to inadequate RBC to supply oxygen to body tissues and low blood sugar (hypoglycemia which results to coma and death (CDC, 2021).
Slide 9: Malaria Diagnosis
Malaria diagnosis is difficult, and most clinicians use presenting symptoms to diagnose the disease. There are different types of diagnosing malaria. They include clinical diagnosis , which involves the use of presenting symptoms and physical examination; a microscopic diagnosis which involves examining patient’s blood using a microscope to identify the parasites; antigen detection , which involves using immunologic test kits; a molecular diagnosis which detects malaria-causing parasites using polymerase chain reaction and; serology which detects development of antibodies that develops in the human body to fight against malaria parasites (CDC, 2018).
Slide 10: Prevention
Malaria control begins with eliminating vectors that cause the disease to reduce its transmission. Vector control interventions involve using insecticide-treated mosquito nets and residual spraying using approved mosquito-killing sprays (WHO, 2021). Sleeping under well-treated nets reduces the possibility of mosquito nets through a physical and insecticide barrier effect. Using nets is the cheapest prevention technique that can cover high-risk populations. However, the world is still far from adopting the strategy to prevent malaria, with only 46% of the population protected using the nets (WHO, 2021). Residual spraying involves using insecticides to protect individuals from mosquitoes by spraying their houses once or twice annually. However, mosquitoes develop resistance from the insecticides, making the intervention less successful. Travelers from low-risk areas use anti-malarial drugs, such as chemoprophylaxis, to prevent malaria when traveling to high-risk areas. The drugs suppress blood-stage malaria infections to control the disease. It is given in the form of an injection, days before the travel, to allow the body to build immunity to fight the disease. Pregnant mothers also receive three doses of sulfadoxine-pyrimethamine as a preventative treatment during the pregnancy period (WHO, 2021). The treatment is given after the first trimester as a routine vaccination.
Slide 11: Anti-malarial Drug Resistance
Malaria treatment experiences barriers due to drug resistance. P. falciparum developed resistance from chloroquine and SP medications, undermining malaria control strategies and reducing chances for survival when an individual is sick (WHO, 2021). As a result, which recommended that regular drug monitoring to determine their efficacy is critical to ensure there is early detection for drug resistance to facilitate response and control. Despite measures to control drug-resistant parasites, additional pockets keep on emerging in new geographical areas, making it crucial to develop malaria control based on the landscape. Thus, effective malaria control would be to eliminate vectors fully by removing factors that trigger their survival, such as clearing bushes and still water near residential areas to control their breeding.
Slide 12: Surveillance and Elimination
Surveillance is tracking malaria and responses from multiple programs aimed at controlling it depending on the information received. Most countries experiencing malaria burden have weak surveillance systems that cannot analyze the disease and its trends, posing difficulties in optimizing response to outbreaks. Stronger surveillance would enable effective malaria response after outbreaks and resurgence to control it. Eliminating malaria is a community effort through taking deliberate activities through population education. Countries are on their path to zero malaria to reduce the malaria burden.
Slide 13: Vaccines against Malaria
Malaria has only one vaccine to date, RTS, S, that reduces malaria infections and removes patients with severe malaria from a life-threatening condition in infants. The vaccine controls the P. falciparum parasite that is severe and prevalent in Africa. The vaccine is provided through a routine immunization program to children to ensure they achieve full malaria immunity. The vaccine is under a pilot program to study the role of the four doses in improving public health by reducing infant deaths. The pilot program involves Kenya, Ghana, and Malawi in partnership with PATH and GSK to safely give the vaccine and conduct surveillance to enhance effective and timely response in case of a setback. The vaccine may become a breakthrough for malaria control from childhood, thereby reducing the malaria burden globally.
References
CDC (2018). Malaria Diagnosis (United States) . Retrieved June 10, 2021, from https://www.cdc.gov/malaria/diagnosis_treatment/diagnosis.html
CDC (2019). Malaria disease . Retrieved June 10, 2021, from https://www.cdc.gov/malaria/about/disease.html
CDC (2021). Malaria . Retrieved June 10, 2021, from https://www.cdc.gov/malaria/about/faqs.html
Kakkilaya, B. (2015). Malaria pathophysiology and pathology . Malaria Site. Retrieved June 10, 2021, from https://www.malariasite.com/pathophysiology/
Marelli, M. & Brotto, M. (2016). The effect of malaria and anti-malarial drugs on skeletal and cardiac muscles. Malaria Journal . Retrieved June 10, 2021, from https://malariajournal.biomedcentral.com/articles/10.1186/s12936-016-1577-y
WHO (2021). Malaria . Retrieved June 10, 2021, from https://www.who.int/news-room/fact-sheets/detail/malaria
