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PATHOLOGY ANG MANAGEMENT OF MALARIA
Malaria is one of the major scourges of mankind in the developing world. Man and malaria seems to have evolved together
and it has been known to Mankind for millennia. The disease supposedly had its origins in the jungles of Africa where it is still very rampant (WHO, 1996). Charaka and Sushrutha, the two leading lights of Indian System medicine, ‘Agurveda" gave vivid description of malaria and even associated it with mosquito bites. In 1696 Morton presented the first detailed description of the clinical picture of malaria and its treatment with Cinchoma. In 1980, Chloroquine resistance by Plasmodium falciparum appeared in Coastal Tanzania and Kenya and spread over most of Africa in the 1980s.Seven years after, Dr. Manuel Elkin Pat arroyo, a Colombian biochemist developed the first synthetic vaccine against the P. falciparum parasite with its efficacy yet to be proven It is estimated that there are 300-500 million clinical cases and 1.5-2.7 million deaths due to malaria each year. This disease threatens nearly 40% of the world population mostly in the tropics and subtropics. It is an infectious disease transmitted by the female anopheles mosquito.When injected into the body system, it undergoes a cycle in which Red Blood Cells are invaded and later on ruptures, hence causing the clinical symptoms of Malaria. When the female anopheles mosquito bites man, inoculates the sporozoites into the Human Blood stream spreading the infection. This mosquito bites man between 5pm and &pm with the maximum intensity at midnight. Other modes of transmission include Blood transfusion, Mother to Child transmission and via needle stick injury. These symptoms include a cold stage during which you have sensations of cold and shivering, a hot stage in which you have fever, headaches, vomiting, seizures in young children and finally a sweating stage in which sweat returns to normal temperature and there is tiredness. Four species of Plasmodium infect man of which three (Plasmodium. Ivax, Plasmodium.ovale, Plasmodium malariae) may cause serious illness, but are rarely fatal. The fourth species Plasmodium.falciparum is the most highly pathogenic and causes much more severe and progressive illness in non immune persons, often leading to coma and death a few days (Garcia, 1997).Plasmodium Ivax is the most common species worldwide being found in South America, Mexico, the Middle East, Northern Africa, India, Pakistan, Sri Lanka, Papua, New Guinea and the Solomon Islands. It is also found in parts of South East Asia, Indonesia, Philippines, Madagascar, tropics and Subtropical Africa, Korea and China. This species has a wider distribution in temperature and sub-tropical areas because of its capability to develop in mosquitoes at lower temperatures (Chessbrough, 1998).Malaria are endemic in more than 90 countries today. In endemic areas, the heaviest toll of morbidity and mortality falls on young children. Other high-risk group are pregnant women and non-immune travelers, refugees of laborers all entering endemic area. Malaria is a relatively mild condition in adults due to the acquisition of specific immunity. According to WHO (1996), about 1,200 cases of malaria are diagnosed in the United States each year. Most of these are imported by military personnel and travelers to, or immigrants from countries where Malaria is common. Imported malaria in tourists, business travelers and immigrants is an increasing problem in Europe and United States. The worsening problems of resistance of the parasite to the limited number of available drugs to treat or prevent the disease has led to increasing difficulties for decision making on their optimal use. Plasmodium falciparum is responsible for the alarming drug resistant strains in most endemic areas. All the clinical pictures of malaria are caused by the erythrocytic schizogony in blood which is classified as either complicated or severe malaria. Plasmodium falciparum malaria has cerebral malaria, black waterfever, anemia, hypoglycemia, algid malaria as complications just to name a few. Some genetic factors that protect against malaria include persons with the hemoglobin genotype HbAS (Sickle Cell trait) and New born infants in their first few months of life who are protected against P. falciparum. Persons with ovalocytosis, B (beta) thalassaemia trait, certain Human leukocyte Antigens (HLA) and in people with Glucoase-6-phospahate dehydrogenase deficient cells are protected against certain malaria forms. An effective management of this disease will depend largely on the efficiency of the laboratory. Malaria control involves the control of three living beings, Man, who is the moving target, the moving mosquito and the non flying eggs and their environment. Man’s role is the most important link to malaria control involving early diagnosis and treatment, Radical treatment and ensuring compliance and the use of chemoprophylaxis. Vector control involves source reduction of their breeding sites.There are no simple solutions to this problem and its unlikely that a single strategy for control will be applicable to all countries and all epidemiological situations, thus a rational approach to the problem is required in combination with intensive efforts on different approaches to control it. It is recommended that people should be more educated on the signs, symptoms, treatment, prevention and control as it’s the only strategy to curb the spread of this disease.
Published: November 17, 2007
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