Lecture 9 notes: Malaria and AIDS orphans in Africa LECTURE NOTES AND SUPPLEMENTARY READING NOTES

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Lecture 9: Malaria and AIDS orphans in Africa
July 16, 2012
-most dangerous animals in perspective:
-venomous snakes @ 250,000 fatalities/year
-scorpions @ 2000 fatalities/year
-big cats @ 800 fatalities/year
-crocodiles @ 800 fatalities/year
-mosquitos @ 1-3 million fatalities/year
-plasmodium falciparum:
-strain of malaria that is particularly virulent
-appears to directly affect the central nervous system
-can cause neurological sequelae and epilepsy
-sequelae = a condition that is the consequence of a previous disease or injury
-most common form of malaria occurs 85% in sub-Saharan Africa
-malaria in context:
-350-500 million infections in humans
-one to three million deaths annually
-has killed more people than all wars and other plagues combined
-transmitted by Anopheles mosquitos
-vaccination efforts have failed
-famous author Wilbur Smith: I WAS BORN OF BRITISH STOCK ON JANUARY 9, 1933 IN NORTHERN
RHODESIA, NOW ZAMBIA, IN CENTRAL AFRICA. As an infant of eighteen months I was struck down by
cerebral malaria, delirious for ten days. The doctors told my parents that it was probably better if I died,
because if I survived I would be brain damaged. Despite the primitive medical facilities available in Africa
in those days, their prognosis proved correct; I survived and am now only mildly crazy.”
-pathogenesis:
-the Protozoan parasites live inside cells, where they are largely hidden from the immune
response
-infection has a profound effect on the immune system and can cause immune suppression
-dendritic cells suffer a maturation defect following interaction with infected erythrocytes and
become unable to induce protective liver-stage immunity
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-endemic areas for malaria (found esp. around equator):
-treatment:
-malaria is now tolerant of older treatments:
-quinine-based (gin and tonic)
-sulfadoxine pyrimetharine
-artimisinin (China) is now widely used
-7-day course is recommended and followup and monitoring recommended
-malaria in kids:
-CNS manifestations:
-severe infection + cerebral malaria
-severe infection + hypoglycemia
-hypoglycemia is induced by quinine
-severe anemia
-high fever
-drug induced behavioural changes
-neurocognitive morbidity of malaria:
-previously, malaria was considered mainly in terms of mortalityor how many people it killed
each year
-now research shows that besides mortality, it also has a high rate of morbidity
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-morbidity is an epidemiological word that is used to describe the burden of a disease on the
person infected with it
-so why has it taken so long to find out that malaria has a high morbidity, and that it has neurocognitive
sequelae?
-90-10 problem: (90% of research funding is spent on 10% of the diseases in the world
-or 90% is spent on 10% of the world’s population
-research has been spotty and poorly conducted
-the neurocognitive impairment study:
-authors estimate that approximately 188.6 million children in exposure/transmission zones for
cerebral malaria (CM)
-case fatalities, even under ideal clinical management are very high
-an estimated rate of children within easy reach of a hospital is less than 1/1000
-prom complex computations, they estimate that approx. 59-66,000 survivors of CM per year
-gross swelling and vascular constriction leading to severe hypertension
-systematic review:
-the authors conducted a systematic review of published papers to gain insights into the
neurocognitive sequelae of CM
-systematic review is special means of identifying trends from analysing results of many datasets
-what were the admitting symptoms:
-severe anemia, respiratory distress, recurrent convulsions, loss of consciousness
-how many have neurological sequelae?
-estimated that @ 10% of neurological problems following discharge
-some are seen at the time of discharge, others appear much later
-however, they could deduce the following:
-4.4 odds that there were epileptic symptoms
-24% had at least one impairment
-this places the estimated # of survivors with persistent neurological impairment @
1300-7500 per year
-limitations of the studies:
1) differences in definitions of neurological sequelae
2) differences in clinical complications
3) selection bias: studies are selective about who they enroll
4) differences in assessment: hinges on the ability of researchers to identity
5) confounding factors:
-premorbid condition of the child
-concurrent factors, such as iron deficiency
-changes with time in presentation of symptoms
-so what do we know?
-in Africa, there is a little accurate data to estimate the burden of neurocognitive impairment
caused by malaria
-based on data, approximately 1000 children per year are left with neurological sequelae
-this means that CM sequelae may be one of the most important causes of acquired disability in
Africa
-what does all this mean?
-there is a highly preventable epidemic of a chronic disease that occurs early in life and may
manifest throughout life
-treatment is relatively costly:$20-$30 US per year (something like $2000-3000 for Canadians)
-these children with motor impairment are unlikely to attend school
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Document Summary

Appears to directly affect the central nervous system. Most common form of malaria occurs 85% in sub-saharan africa. Lecture 9: malaria and aids orphans in africa. Famous author wilbur smith: i was born of british stock on january 9, 1933 in northern. As an infant of eighteen months i was struck down by cerebral malaria, delirious for ten days. The doctors told my parents that it was probably better if i died, because if i survived i would be brain damaged. Despite the primitive medical facilities available in africa in those days, their prognosis proved correct; i survived and am now only mildly crazy. Sequelae = a condition that is the consequence of a previous disease or injury. Has killed more people than all wars and other plagues combined. The protozoan parasites live inside cells, where they are largely hidden from the immune response. Infection has a profound effect on the immune system and can cause immune suppression.

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