Malaria

Facts

·         More than 2 billion people live in countries where there is malaria.

·         Every year 300–500 million people get sick from malaria in the world… and over 2 million die.

·         Malaria is spread mainly by the Anopheles mosquito (discovered in 1898), some species of spiders, and can also be spread by blood transfusions and street-drug paraphernalia.

·         Quinine:  first isolated in 1820 from the bark of the quinchona tree.

·         After repeated bouts of malaria treated with larger and larger doses of quinine, the patient develops blackwater fever— this happens when quinine binds onto red blood cells and the immune system reacts as though the red blood cells are infected and kills them.

·         Many new malaria drugs have been developed.

·         Drugs work in much the same way.  Malarial cells contain crystals rich in iron left from the digested red blood cells.  This iron is poisonous to the malarial cell but the cell contains a specific enzyme that builds up the crystals and seals them off from the rest of the cell.  Drugs stop action of this enzyme and iron disperses through the merozoite and kills it.

·         Because the drugs work only during the merozoite stage the drugs have to be taken continuously to catch the parasites at this specific stage of development.  Many stains of malaria have become resistant to most malaria drugs.

Lifecycle:

Malaria is caused by protozoa of the genus Plasmodium:  P. falciparum, P. vivax, P. malariae, and P. ovale, all transmitted to humans by mosquito vectors.  Falciparum malaria causes the most severe form of the disease and is the only life threatening strain.

1.  Bite - An Anopheles mosquito jabs its proboscis like a hypodermic needle through the skin into a capillary and at the

same time injects saliva containing anticoagulants so that the blood does not clot while the mosquito feeds.  If the

mosquito is infected it simultaneously injects Plasmodium sporozoites into the bloodstream.

2.  Sporozoites circulated in the blood to the liver where they transform into schizonts.

3.  These emerge from the liver; invade red blood cells where they feed on hemoglobin and mature into merozoites and

multiply profusely.

4.  The red blood cell ruptures, releasing heme (malaria pigment), cell debris, and more merozoites.  This destruction

deprives the body of oxygen and also brings on fever.  If the merozoites are not destroyed by phagocytes they will enter other red blood cells.

5.  Once the merozoites emerge from the red blood cells they swell from time to time and release male and female

‘gametocytes’--thrashing, whiplike creatures.  At this point feeding mosquitoes take in gametocytes with the blood of their prey. 

6.  In the mosquitoes gut the male and female gametocytes mate producing ‘zygotes’ which form cysts on the

mosquito’s stomach wall.

7.  In 1-3 weeks the cysts break open, releasing sporozoites that make their way to the mosquito’s salivary glands,

ready to begin the cycle over again.

P. vivax, P. ovale, and P. malariae may live for years in the liver—chronic carrier state. 

·         P. vivax and P. ovale cause forms of malaria that can cause a new outbreak of illness, sometimes after dozens of years.  They form ‘hypnozoites’ (little sleeping animals) in the liver which remain dormant—what signals them to activity is unexplained.  P. malariae may also recur after many years but so far ‘hypnozoites’ have not been found in the liver or anywhere in the body in this form.  Hypnozoites allow the parasites to survive during the winter when mosquitoes are not active.

P. falciparum, the most virulent form of malaria, does not relapse.  This form is limited to the tropics where mosquitoes are active all year round.  Falciparum parasites reproduce in larger numbers than the other forms and large numbers of destroyed red blood cells crowd and may block capillaries, bursting them; this can cause cerebral inflammation (cerebral malaria).  In pregnancy this type of malaria can damage the placenta and cause miscarriage.  In severe infections the kidneys may be destroyed and blood pours directly into the urine (blackwater fever).

Infection:

·         Incubation period is from 12-30 days.

·         Produces chills, fever, headache, and myalgia.

·         Acute attacks occur when erythrocytes rupture and have 3 stages:

·         Cold Stage, lasting 1-2 hours with severe chills and shaking.

·         Hot Stage:  Lasts 3-4 hours with a high fever up to 107 degrees F. (41.7 degrees C.)

·         Wet Stage:  Lasts 2-4 hours, characterized by profuse sweating.

·         Paroxysms occur every 48-72 hours when caused by P. malariae

·         Paroxysms occur every 42-50 hours when caused by P. vivax and P. ovale.

·         Hemolytic anemia (caused by destruction of red blood cells) is present in all but the mildest infections.

P. falciparum produces persistent high fever, partial paralysis, convulsions, delirium, and coma; coughing, coughing of blood; vomiting, abdominal pain, diarrhea, bloody (black) feces; diminished or no urination and uremia (a toxic condition of the blood produced by renal insufficiency).

·         Blackwater fever is a complication in which massive intravascular hemolysis causes jaundice, hemoglobinuria (hemoglobin free from red blood cells in urine), a tender and enlarged spleen, acute renal failure, and uremia.  The tissues are suffocated and death may follow; it is fatal in about 20% of patients.

Immune System:

·         The proteins (antigens) on the outside of the malarial cell body are different during the different stages of development.

·         The stages change so rapidly that it is difficult for the immune system to build up a large number of antibodies before the form changes again.  Also, at each of the 8 or 9 stages of the life cycle, the parasite is capable of subtly altering itself through random mutations.

·         Immunity can be developed but for complete immunity to take place it is important that the natural course of the disease to remain uninterrupted by administration of drugs.

·         Parasites cannot be attacked by the phagocytes while they are inside the red blood cells, only when the RBC ruptures.

·         Quinine suppresses phagocytosis (could drugs make the case worse if the strain is resistant?)

·         Vaccine:  In the early 1990’s a biochemist, Dr. Manuel Patarroyo, combined parts of genes of three different stages of Plasmodium to create a synthetic protein.  This could act as a vaccine; it has been shown to be harmless to humans but will stimulate the production of antibodies that may reduce malarial infections by about 50%.

Treatment for Malaria:

1.  Lemon Water:  Drink plenty of fluids, especially lemon water.  2MR 48:  “I use lemon juice freely, it is the best

thing you could use for rheumatism, for your head, and for malaria.”

1.       Hydrotherapy

a.       General Revulsive to the liver/spleen area (the top of the fomentation should come just under the breast area). Hot fomentation to the sides:  Wrap fomentation around the sides as much as possible.  Leave on for 3 minutes.  Cold application:  Use a lot of ice for very cold water if possible.  Give 2 minutes of cold with brisk friction using a thick towel. If there is no ice use 2 towels, renewing the cold towel as soon as it warms, probably about every 20 seconds—it may be necessary to have a second person work with you in giving this treatment.   Alternate with 3 complete sets of changes.  Keep head cold and the HFB hot.  During the last fomentation give the patient a brisk cold mitten friction (CMF)  to the arms, pour cold over the feet and CMF the legs; then remove the fomentation and CMF the liver/spleen area; end by removing the back fomentation and CMF the back.  This treatment should be given 1-2 hours before the expected rise in temperature begins (signalled by chills).  Most malaria cases follow a pattern for chills and fever, but in some cases they are irregular.  Give the treatment as soon as chills begin if not before.  Wait 4 hours before giving another treatment.  Four treatments per day may be given and more during the night if necessary.

b.       Wet Sheet Packs or Wet Sheet Rub and CMF may be used to help control fever. 

c.       Hot Mitten Friction or Hot Evaporating Sheet Pack may be used if the patient is chilling(or give the General Revulsive).  A hot fomentation may be used on the feet to increase peripheral circulation and help prevent the chilly sensation during treatment.

d.       CMF and cold baths help stimulate the immune system also.  CMF, cold towel rub, and cold half bath with friction have produced good results in Africa; begin several hours before the chill is due.

e.       Hot Foot Bath followed by 2 fomentations to abdomen (brief); start a very cold and vigorous CMF when 2nd fomentation is applied.  Let rest for 1 hour afterwards.

f.        Hot & Cold Fomentations to spine, followed by H & C percussion douche to spine, splenic and hepatic areas and legs; may stand in HFB and give hot shower during cold douche.

g.       Hot pail pour to lower spine and legs followed by cold shallow rubbing bath.

NOTE:  In malaria it has been shown that the white blood cells (WBCs) tend to congregate in the spleen, leaving the peripheral circulation.  Cold applications cause contraction of this organ which mobilizes the WBCs and also helps prevent visceral congestion of the RBCs  which increases the time it takes for parasites to reenter a RBC (during chilling there is stasis of the RBCs in the internal organs as the blood flow decreases in the peripheral blood vessels).  With stimulation of the peripheral blood vessels, phagocytes are distributed and energized. 

h.       Other treatments that have been found useful:

                                                  i.      An enema before giving the first hydro treatment.

                                                ii.      Hot and Cold shower.

                                              iii.      Cold sitz baths of 10 minutes duration.

General:

The shorter the time between the procedure and the anticipated chill, the better the results.

Treatments should be continued until all signs of malaria have disappeared.

Ways to Boost Our Immune System:

Garlic, Goldenseal, and Echinacea will help boost the immune system.

Get outdoor exercise, sunlight, and fresh air if possible.

Prevention:

Improved nutrition, improved living conditions, good sanitation, and immunizations.

Anopheles mosquito doesn’t like the daytime; lives in the forest.  Usually comes out between dusk and dawn.