Monday, April 15, 2013

Medical Mondays: Malaria, bugs, and blood

Hey guys! I wanted to blog about malaria because, well, I've been watching River Monsters and that English chap with the charming accent and bad teeth got a bad case of malaria.

One of my favorite authors, Laura Ingalls Wilder, described getting malaria in her book Little House on the Prairie. (They called it fever 'n ague, and though it came from eating watermelons that grew in the night air. Ma and Pa Ingalls had a huge fight over that little bit of false information.)

When I worked at Bellevue, it wasn't uncommon to get a patient who'd been traveling from Africa with the following symptoms:

  • shaking chills and fever that cycled every 2-3 days
  • headaches and joint pain
  • hemolytic anemia (low red blood cell count due to bursting red cells)
  • jaundice, or yellowing of the skin or eyes
  • enlarged spleen (it's job is to clear out the broken red cell bits)
Malaria, and parasites in general, are fascinating. We've heard of the "eat or be eaten" survivalist mentality in the wild kingdom, but we don't usually consider the microscopic guys that are trying to use (and sometimes eat) us as well. 
The round purple things are red blood cells.
The purple banana thingies are P. falciparum (source: Wikipedia)
What is malaria caused by?
A microorganism called Plasmodium. Plasmodium falciparum and plasmodium vivax are responsible for most deaths due to malaria in the world. 

How does the parasite infect us?
This gal, the female anopheles mosquito. She carries infected blood with the parasites and spreads it around. So generous of her! Not.
Anopheles mosquito, drinking so much blood that it's coming out the other end. GROSS.
Also, sorry if this picture just made you itch like mad. (Source: Wikipedia)
Can malaria kill you?
Yes. The infections in sub-saharan Africa are deadliest; malaria from other parts of the world aren't as deadly. 

Let's say I'm healthy, and I get bit by that THING. What happens?
The parasites (sporozoite stage) in the mosquito saliva enter your blood. They end up in your liver, where they multiply and turn into the next stage (merozoite stage). Those bust open your liver cells and infect your red blood cells, where more merozoites are made, and some male and female forms (gametocytes). When your red blood cells bust open spilling out more parasites, that's when those shaking chills and fever start to happen. When a mosquito bites the now unhappily-infected-you, the male and female gametocytes get sucked by the mosquito, and they end up making more sporozoites and the whole thing starts over again. 

Man, and that's the watered down version! 

For a more detailed diagram and about 10 more life cycle terms I sorta skipped over, click here

How is it diagnosed?
Classically, it's diagnosed by looking at a smear of the patient's blood under a microscope. It looks like that picture up above, or you can see the parasites within the actual red blood cells. There are also Rapid Diagnostic Tests available, but not all hospitals around the world have them as they're expensive.

How do you treat it?
Back in the 17th century (maybe even as early as the 1500s), it was discovered that the bark of the Cinchona tree could cure malaria.
Cinchona flowers (Source: Wikipedia)
The compound in it responsible for this is called quinine. Quinine is so cool--in fact I did a Medical Mondays on quinine! Nowadays, most types of malaria are resistant to quinine, and synthetic versions of it are used (such as mefloquine). 

Another medication, artemisinin, is also used and was used as far back as 200 BC in China for the treatment of malaria. 

Artemisinin plant
Nowadays, several different medications are used to treat malaria, almost always in combinations. It's hard to keep up with. Here is a nice update on treatment. 

See the skinny, sickle-shaped red blood cell in the center?

One last cool medical factoid: 
You might have heard of sickle cell anemia. This is a disease in which blood cells turn into a sickle shape, and it causes all sorts of problems. People who have two sets of sickle genes can be quite sick, but those that only have the trait, or one sickle cell gene, are resistant to getting malaria. Traditionally, most people with sickle cell trait live in places where malaria is endemic. So it's believed that mutation occurred and was kept as an evolutionary advantage for people in these areas. (Parasites are less likely to complete their life cycle, because the abnormal red cells are cleared out of the circulation faster). Cool! 

This may be all the malaria you can handle with your monday morning coffee, so I'll stop now. But please stop by the CDC to learn more about prevention, traveling, treatment, and mosquito-y stuff. 

HA! And you thought vampires were bad...


Old Kitty said...

I'm down for a scientific research thingy where I'll be asked to stick my hand in a vat of mosquitoes!! I can't wait!!! LOL!!

These particular mozzies are TOUGH!! Ooh and it's the female mozzies of this species one must look out for! Take care

Shelly said...

I well remember the scene as Laura Ingalls Wilder wrote about it! Loved those books.

And oh, when we're not in drought, like we are now, we have those darn mosquitoes. What a fascinating element to work into a plot~

Shelley Munro said...

Ugh! I've had cerebral malaria, and I've never felt so sick in all my life. I caught it in Pakistan and ended up spending a week in hospital in New Delhi. I was taking medication. Another guy on our trip wasn't taking anything and he was medivaced back to the US with renal failure.

The buzz of a mosquito makes me jumpy these days!

Natalie Aguirre said...

Thanks for just sharing the watered down version.

Dianne K. Salerni said...

Urg, I may have lost my appetite for breakfast a little. But it's interesting that the sickle cell trait is resistant to malaria, yet in itself can be deadly. Evolution is a tricky thing.

A Lady's Life said...

My Mom lost her vision from malaria. Not nice.
These little mosquitoes are little vampires causing many problems to a lot of people

Kerri Cuevas said...

It's official, this is the first Medical Monday that I've been grossed out lol. Just the thought of a bug doing that to someone makes me want to squash them all the more. If you see me clapping outside, I'm really squishing bugs!

Connie Keller said...

A friend of ours who's a doctor in Africa got a really bad case of malaria. He says that he gave himself an iv with meds, etc., just before he passed out, wondering whether he'd ever wake up. Thankfully, he did.

Clarissa Draper said...

Why do you think I drink so much Gin and Tonic! ;) Actually, the amount of quinine in G&T is very little nowadays and I'm not sure it would help much.

Linda Gray said...

I love Medical Mondays! So interesting about the sickle cell trait, and I did not know that most malaria types are now resistant to quinine--bummer. I remember back in college health class being taught that it was discovered that quinine overdose (found in soldiers in malaria-prone countries who countered their risk of getting malaria with lots and lots of quinine water--no doubt combined with gin as often as possible) actually resulted in false diagnoses of syphilis. That still sounds crazy to me. Do you know if it's true?

mshatch said...

Very interesting actually and not at all gross - well, a little, but it didn't bother me!

Karen Lange said...

I did not know this, thanks for the info. Makes we want to go out and buy some citronella candles! :)

Alex J. Cavanaugh said...

I think I will just cross off visiting anyplace I might catch it!

M. R. Pritchard said...

I just had one of those: "omg omg I just wrote about malaria the other day," moments.
I just wrote about malaria in my WIP :)

Roland D. Yeomans said...

Malaria killed 8,000 in New Orleans in 1853 as I detail in the beginning of RITES OF PASSAGE. In 1823, cholera nearly did in New Orleans before then. New Orleans was a city of the dead and the dying in 1853. "Bronze John" or "Black Vomit" as Malaria was called in New Orleans was greatly feared ... and, as you say, misunderstood. Great post, Roland

LD Masterson said...

I've never been a fan of mosquitoes and this certainly doesn't change that.

The part about the sickle cell is really interesting. A cell mutation which alone provides partial immunity to one illness but in sets can cause a very serious one - fascinating.

Deb Salisbury said...

How fascinating! Another reason to love mosquitoes. Not!!! :-)

Barbara Watson said...

Your closing line...perfect. :-)

Cold As Heaven said...

One of the advantages of living far north is no malaria.

Cold As Heaven

JEFritz said...

Eek, that sounds like a bad one. I thought the biology lesson was cool :). Of course, I am a huge nerd.

Elizabeth Varadan, Author said...

I found this absolutely amazing! One of my brothers (both are now deceased) traveled to Africa years and years ago and contracted Malaria. Luckily, the treatments worked and he enjoyed good health most of his remaining years. But reading your descriptions of how the microorganisms causing it worked made me think of all those "alien" movie spin-offs. Whew!

Elizabeth Seckman said...

Creepy stuff! OFF anyone?

Gina Gao said...

Malaria is a disease that is pretty scary once we know how easily it can be transmitted.

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