- Describe the current global burden of malarial disease
- Incorporate knowledge of clinical syndromes associated with malarial disease into diagnosis and initial management
- List medications that may be used in both acute therapy and prevention of malaria with consideration for local resistance patterns
- Outline the social and financial cost of malaria, including the economic impact of clinical disease and control strategies
- Give examples of current strategies for global malaria control, including individual precautions, population-based interventions, and new initiatives in vaccine development
Malaria, or a disease resembling malaria, has been known for approximately 4,000 years in literature and various other historical sources. The name, stemming from the Italian for “bad air,” has surely influenced human populations for longer than recorded history and continues to cause illness and death to this day. Malaria symptoms were noted in ancient Chinese writings dating back to 2700 bc. There are many Greek references to the disease from the 4th century bc onward. Later, several Roman writers attributed malarial diseases to swampy areas. References to malaria, coming as the result of a bite of certain insects, were discussed in the Susruta, an ancient Sanskrit medical treatise.
The first recorded treatment is from a 2nd-century Chinese text, found in a tomb, known as the “52 Remedies.” Treatment included the Qinghao plant, or Artemisia annua (sweet wormwood), that seemed to reduce fevers associated with the illness. In 1971, the active ingredient, Artemisin, was discovered and named by Chinese scientists. What we now call quinine was used by indigenous peoples in Peru and was brought to light by Spanish Jesuit missionaries during the treatment of the Countess of Chincon. Her fever was reduced and she survived. This treatment became known as cinchona or Peruvian bark. German scientist Hans Andersag discovered chloroquine in 1934, and in 1939 dichlorodiphenyltrichloroethane (DDT) was also discovered in Germany by Othmer Zeidler.
In 1880, Charles Luis Alfonse Laveran (a French Army surgeon) was the first to notice parasites in the blood of patients suffering from this febrile illness that would become known as malaria. The species name Plasmodium was given in 1886, and human parasites falciparum, vivax, malariae, and ovale were named in 1890 and 1893. It was in 1897 that Ronald Ross, a British officer in the Indian medical service, demonstrated that malaria came from infected mosquitoes, subsequently identified as various species of female Anopheles. Italian scientist Battista Grassi is also known to have independently demonstrated this vector at nearly the same time.1
Nearly 3.3 billion people, or approximately half of the world’s population, are at risk for malarial infection each year. In the last 10 years there has been significant growth in the fight against malaria. The World Health Organization (WHO) Malaria Report 2011 suggested that it has observed decreasing total incidence, from between 230 and 400 million/year in 2000, down to 216 million cases/year of malaria in 2010. There was a corresponding decrease ...