Parasitic Infections – Malaria

Malaria has been known to be the most devastating infectious parasitic disease known to human kind for centuries. An estimate of 438,000 malaria deaths have been reported around the world in 2015 and approximately 69% (306,000) were children less than 5 years of age. Of all malaria deaths that have been reported, 90% were reported from African regions and rests were from South-East Asia region and the Eastern Mediterranean region (Ahiboh et al., 2008).

Malaria poses a great threat to pregnant women and their fetuses. In areas with high transmission of malaria, it has been estimated that at least 25% of pregnant women are infected with malaria, which account for more than 20% of all maternal deaths. Malaria accounts for over 10,000 maternal and 200,000 neonatal deaths per year globally (WHO, 2010).

Malaria infection in pregnant women results into clinical complications, such as anemia, pulmonary edema, hypoglycemia, cerebral malaria, puerperal sepsis, and some time death too.

The Consequences of malaria during pregnancy in fetus are abortion, still birth, intra uterine growth retardation (IUGR), premature delivery, and low birth weight (LBW).

Low Birth Weight of the infant has been suspected to be the cause of poor cognitive and neuro-sensory development of the child (WHO, 2010). WHO recommends that in areas of high malaria transmission, people should be provided with insecticide-treated mosquito nets and intermittent preventive treatment (IPT) with sulphadoxine–pyrimethamine should be given as a part of antenatal care.

Placenta, which is the interface between mother and fetus, plays important role in successful pregnancy outcome and growth of the fetus that is critically dependent on the placenta.

Malaria Parasite

Malaria remains a leading cause of ill health, causing an estimated 243 million cases of clinical malaria and 863,000 deaths (WHO, 2010). More than 85% of malaria cases and 90% of malaria deaths occur in Africa, south of Sahara. In Africa, the vast majority of cases and deaths occur in young children (World Health Organization, 2010).

Malaria is usually transmitted through the bite of an infected female anopheles mosquito. Plasmodium malariae causes the mildest and most deadly form of malaria infection (Ahiboh et al., 2008). Plasmodium knowlesi is the species of plasmodium most recently identified as agent of human malaria (Singh et al., 2004).

Plasmodium falciparum is the plasmodium species responsible for 85% of malaria cases, The Sporozoites, that is, the infective plasmodial stage is injected together with saliva into subcutaneous capillaries, disappear from the blood within approximately 45 minutes of the bite and then it enters liver parenchymal cells (hepatocytes). Within the hepatocytes, each sporozoite starts a phase of asexual reproduction resulting in the formation of a schizont, which contains thousands of merozoites.

The rupture of mature schizonts generates the liberation of merozoites into the bloodstream. The hepatic phase of parasite development (hepatic schizogony) lasts on average between 5.5 (Plasmodium falciparum) and 15 days (Plasmodium malariae). In case of Plasmodium vivax and Plasmodium ovale infections, a proportion of parasites may remain dormant in hepatocytes as hypnozoites for several months up to 5 years.

From the clinical point of view, the hepatic schizogony is asymptomatic, as only a few numbers of liver cells is infected (Gilles, 1993). Once in the bloodstream, merozoites reach and invade red cells rapidly to start a process of asexual multiplication (erythrocyticschizogony). Within the red blood cell, merozoites mature to trophozoites and schizonts, which then rupture liberating the new generation of merozoites to invade other red blood cells and thus continue the erythrocytic cycle.

At the time of schizont rupture, the release of malaria parasites and erythrocytic material into the circulation induce the pathophysiology process of malaria and the onset of symptoms. The activation of the cytokine cascade is responsible of many of the symptoms and signs of malaria.

History of Malaria Parasite

The parasite responsible for malaria has been in existence for 50,000–100,000 years, and the population size of this parasite did not increase until about 10,000 years ago, concurrently with advances in agriculture (Harper and Armelagos, 2011) and the development of human settlements. Malaria parasite in humans looks similar to the parasite in chimpanzees. Evidences suggests that the Plasmodium falciparum malaria may have originated in gorillas. (Durand, 2011).

Malaria in Rome was pervasive that it was referred to as “” (Sallares, 2002) and it may have led to the decline of the Roman Empire (Gomzis, 2002). Various regions in ancient Rome were considered to be at risk of this disease because of the unpleasant conditions present for malaria vectors.

These areas such as southern Italy, the Island of Sardinia, the Pontine Marshes , the lower regions of coastal Etruria and the city of Rome along the Tiber. The presence of stagnant water in these places was preferred by mosquitoes for breeding grounds. Irrigated gardens, swamp-like grounds, runoff from agriculture, and drainage problems from road construction led to the increase of standing water. (Hays, 2005)

British doctor Ronald Ross received the Nobel Prize for Physiology or Medicine in 1902 for his work on malaria.

The term malaria was derived from the Medieval Italian: mala —” bad air””; the disease was originally called ague or marsh fever due to its association with swamps and marshland. (Recter