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Lecture 8

HLTB21H3 Lecture Notes - Lecture 8: Primaquine, Headache, Proguanil


Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat
Lecture
8

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HLTA01 Lecture 8 Notes Thursday, November 8th, 2012
Malaria
*NOT A ZOONOTIC DISEASE*
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Overview
Malaria is a fever plague
Malaria killed more than half of the people who have ever lived on this planet, and still does
Today, every 10 seconds a person dies of Malaria, mostly children under the age of 5, living in
Africa
Malaria infections are on the rise, and as the fever plague spreads, it will continue to affect us in
the places we live, work, travel to and fight in
History
Old disease
o Dates back to 2700 BC, written in the ‘Nei Chang’ documents
o Dates back to the 4th century (470-380 BC), also written in the Hippocratic corpus
First document that was written about the splenetic changes due to malaria and
about the ingestion of stagnant water
"Those who drink [stagnant water] have always large, stiff spleens and hard,
thin, hot stomachs, while their shoulders, collarbones, and faces are emaciated;
the fact is that their flesh dissolves to feed the spleen..."
Hippocratus went as far as the define the different types of Malaria
Reoccurring fever every 3rd day: Benign tertian malaria
Every 4th day: Quatrain malaria
o Both known up to present day, due to the different parasites
(from the same family) causing the disease
Noted those living near marshes had enlarged spleens
Roman Fever (27 BC) Due to Malaria
o Belief: resulting from poisonous vapours that emanate from ‘Roman Campagna’
Miasma ‘Bad air’
Mal’aria means ‘bad air’
Reached Spain and Russia by 12th century
Reached England by 14th century
Reached New World by 15th century
o Belief that European settlers brought Malaria to New World from Africa
By 1800’s, Malaria was worldwide
By the 19th century: Prevalent in the Mississippi Valley, North Eastern US, American subtropics,
and tropics including the Caribbean
Malaria in Literature
Written about ‘The Inferno’ by Dante (1265-1321):

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o "As one who has the shivering of the quartan so near,/ that he has his nails already
pale/ and trembles all, still keeping the shade,/ such I became when those words
were uttered."
o He died of Malaria
William Shakespeare (1564 1616)
o Mentioned in 8 of his plays “ague”
English word for ‘malaria
Demonstrates how much of an epidemic it was back then
Charles Louis Alphonse Laveran (1845-1922)
o First person to identify parasite
o Observed infected red blood cells of an infected individual under microscope
Observed black-brown malaria pigment and mobile filaments
Process he called exflagellation (1880)
William MacCallum and Eugene Opie
o Correctly interpreted their observations: the gametocytes of Haemoproteus in the
blood, when ingested by a biting fly, release the gametes in the stomach, where
fertilization takes place, producing a wormlike zygote, the ookinete
Robert Koch (1898)
o Argued that human malaria was caused by a mosquito bite but was unsuccessful in
his efforts
Ronald Ross and Patrick Manson
o Credited for discovering the cycles and etiology of malaria
o Ronald Ross was an MD interested in Malaria Knew that it was intestinal
infection
Was mentored by Manson; Ross performed a series of experiments in India
o Ross examined the stomachs of thousands of mosquitoes
There are different mosquitoes that act as vectors, and firstly observed the
wrong types
Finally examined correct type and observed:
Wart-like oocysts that developed 4 -5 days after feeding on
infected blood
Stripes or ridges that develop 7 8 days later
Made mosquitoes feed on infected individuals, were transferred
over, and then infected mosquitoes fed on Ross and his son
o Observed in his infected blood that it was in fact malaria
o Was then treated and cured on mild malaria
Discovered:
Infectious stages in the mosquito salivary glands in the birds,
sparrows
Giovanni Battista Grasi (1898)
o Reported that the Anopheles claiger (type of mosquito), was the vector/carrier of
human malaria

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Epidemiology (WHO, 2006)
Estimated that Malaria has killed more than half the people who have ever lived on this planet
Estimated that every 10-30 seconds, a person dies of malaria
Globally, 300-500 million cases of Malaria each year
o ~90% of the cases are from Africa
2-3 million deaths annually
o Majority is among children aged 5 years or younger
Weak immunity; can’t handle symptoms death occurs
Currently endemic in over 100 countries
o In order for there to be an epidemic, the specific types of mosquitoes that are vectors
must be present in that country
Most prevalent in rural tropical areas below elevations of 1000m
o Ideal breeding grounds for mosquitoes and malaria
Plasmodium falciparum is found mostly in the tropics
o Most dangerous type of malaria most likely to cause death
P. falciparum and P. vivax account for 95% of infections
o P. vivax is distributed more widely than P. falciparum, but it causes less morbidity and
mortality
Malaria deaths are poorly reported very underestimated
Areas of Concern:
Figure 1:
(Sub-Sahara Africa)
o Above: Areas related to sensitivity to different drug treatments
Figure 2:
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