Malaria Facts

Malaria is an acute febrile, mosquito-borne blood disease caused by a Plasmodium parasite. It is transmitted to humans through the bite of the female Anopheles mosquito. As P. falciparum matures the infected erythrocytes adhere to microvascular endothelium, a term coined cytoadherence, they constrain vascular function and reduce perfusion. The extent to which the vital organs are affected determine the clinical pattern and outcome of severe falciparum malaria. [1]

Global Malaria Statistics

According to WHO, 216 million cases of malaria were reported globally and caused 445,000 deaths, thus effectively passing as an alarming epidemic. As per the latest report of WHO-UNICEF, India is third among 15 countries having the highest cases of morbidity and mortality due to malaria.[2]

At-Risk Populations

Some population groups like infants, children under 5 years of age and patients with HIV/AIDS are at a greater risk of contracting malaria.[3] Pregnant women, especially primigravid women, are up to 10 times more likely to contract malaria. Gravid women also have a greater tendency to develop severe malaria.[4]

Classification of Malaria

Malaria is considered uncomplicated when symptoms are present but there are no clinical or laboratory signs to indicate severity or dysfunction of organs. Severe malaria typically occurs as a progression of uncomplicated malaria. P. falciparum can cause severe malaria because it multiples rapidly in the blood, and can thus cause severe blood loss (anemia).

Treatment Strategies

Antimalarial drugs are used to curb various symptoms of malaria as well as eradicate the parasite. Current practice in treating cases of malaria is based on the concept of combination therapy (e.g., Coartem). This regimen offers several advantages, some of them being reduced risk of treatment failure, reduced risk of developing resistance, enhanced convenience, and reduced side-effects.[5] Parasite clearance rates are chief measures of anti-malarial drug efficacy. They are particularly important in the assessment of artemisinin resistance. [6] In the erythrocytic schizogony cycle, artemisinins exert action on a wide range of stages-from ring forms to early schizonts, thus have the broadest time window of anitmalarial actions. [7]

WHO Recommendations

WHO recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria caused by the P. falciparum parasite. By combining 2 active ingredients with different mechanisms of action. The choice of ACT should be based on the results of therapeutic efficacy studies against local strains of P. falciparum malaria.

Common Symptoms

Fever is the most common sign during an acute malarial attack and can be accompanied by other auxiliary symptoms such as headache, diarrhea, abdominal pain, vomiting, and nausea. [8]

Need for Further Research

The Indian studies on fever and parasite clearance on patients receiving ACT is inadequate, hence this study is requisite for establishing a correlation between the drug being administered and its outcome.