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Malaria

Definition:- Malaria is a disease caused by obligate intracellular protozoa of the genes Plasmodium. The four species of Plasmodium that are capable of infecting humans are P.malariae, P. vivax, P.falciparum and P.ovale. The parasites are transmitted to humans by the female mosquitoes (Anopheles). The ensuing illness is generally characterized by paroxysms of fever and chills, anemia and splenomegaly. P.falciparum is the species associated with cerebral malaria.

History:- The disease affected prehistoric humans and fossil mosquitoes have been found in geological strata 30 million years old. It was finally named by the Italians in the 18th century mal aria meaning foul air but the reference to periodic fever are found in early Hindu and Chinese writings. The first major breakthrough in understanding the etiology of the disease was in 1880 when Laveran, a French Army Surgeon in Algeria first described gametocytes of P.falciparum in the fresh blood of malarial patients. The transmission through mosquitoes was shown by Ronald Ross a British Army Surgeon in India. With the description of the pre erythrocytic forms in liver cells by Shortt the complete cycle was established.

Epidemiology:- Malaria transmission involves the interaction between the malaria parasite, the human host, anopheline vector and the environment (physical, biological and socio-economic). The level of transmission is determined by seasonal incidence, characteristics of local vector mosquitoes, the susceptibility of local human population and the climatic and environmental conditions that affect vector breeding. Human genetic factors, nutritional factors and the environment influence the infection.

Treatment:- The choice of specific drug and the regimens depends upon the Plasmodium species causing infection, drug sensitivities etc. The drugs in current use are: Artemisinins, Chloroquine, amodiaquine, halofantrine, mafloquine, primaquine.


Prevention and large scale control:-

An integrated approach to control Malaria is aimed at

  1. Prevention of man-mosquito contact by using insecticide-treated bed nets, protective clothing, repellents etc.
  2. Prevention or reduction of breeding of mosquitoes by eliminating stagnation of water.
  3. Destruction of larvae using chemical and biological larvicidesor larvivorous fishes.
  4. Destruction of adult mosquitoes by residual spraying.
  5. Chemo prophylaxis
  6. Vaccines: These have been under development and would probably become available in the next decade.

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