Is Malaria a Bloodborne Pathogen?Greg Garner
It’s an infectious disease that spans the globe, affecting millions every year. It’s plagued mankind for an unknown number of millennia. Wherever man has traveled, it’s traveled with it, a constant companion.
It’s malaria, and it’s one of the greatest public health issues worldwide.
In this article, I’ll address what malaria is, discuss how it works and its transmission, and answer common questions about the disease. I’ll address questions such as “What is a pathogen?”, “Is malaria a bloodborne pathogen?”, and “Is malaria still a problem?”
What Is Malaria?
Malaria is an infectious disease spread by mosquitoes. It affects a variety of animals and humans.
Malaria is also called a plasmodium infection. This is because the Plasmodium parasite causes the disease.
There are over 150 species of the malaria parasite, that infect many different species of vertebrates. Five species infect humans and cause malaria: Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and Plasmodium knowlesi. Of these, Plasmodium falciparum poses the greatest risk to humans and is the deadliest.
While Plasmodium knowlesi is sometimes not included as a species that can infect humans, it is the primary infector for humans in Southeast Asia, especially in Malaysia Borneo. Plasmodium knowlesi is zoonotic, meaning it can jump from a non-human animal to humans. In the case of Plasmodium knowlesi, it often affects macaques native to Southeast Asia.
What Is a Pathogen?
A pathogen is any organism that can spread disease. Pathogens include viruses, prions, fungi, viroids, protozoans, and bacteria. Pathogens spread through a broad number of ways such as via airborne particles, bodily fluids, skin contact, touching a contaminated surface, and through feces.
What Is a Bloodborne Pathogen?
A bloodborne pathogen is a disease-causing microorganism such as bacteria and viruses. Bloodborne pathogens spread through blood. There are many types of bloodborne pathogens. Some common examples include syphilis, Hepatitis B, Hepatitis C, Ebola, and HIV (Human Immunodeficiency Virus). Malaria is a bloodborne pathogen, meaning it can spread through blood.
Transmission of Malaria
Malaria transmits to humans by bites from infected female mosquitoes of the Anopheles genus. When a mosquito bites an infected person, they take in malaria parasites along with the person’s blood. They then spread the malaria parasites to a new person. The parasites mix with the mosquito’s saliva and are then injected into the new host. This is the primary method of transmission.
However, transmission can also spread via needles, organ donation, blood transfusion, or from a mother to her child during delivery.
Malaria is not spread from one person to another like the flu or common cold. It is also not sexually transmitted.
A Brief History of Malaria
In 1880, Dr. Charles Louis Alphonse Laveran, a French military physician, discovered malaria. Dr. Laveran discovered the plasmodium protozoan that causes malaria while examining a blood smear from a deceased malaria patient. He would later win a Nobel Prize for his contribution to medicine.
However, the disease had existed for millennia. It even spread to Rome sometime in the first century AD, where it was brought by Greek traders and colonists who settled in Italy. Some speculate it was even a contributing factor to the fall of Rome.
Later, it spread to the U.S. via the slave trade. It found a new group of vulnerable hosts in both the Native Americans and the European settlers, who had no previous exposure or immunity to the disease. Malaria would become widespread throughout the New World.
Malaria’s elimination in the U.S. came in 1952, but only after years of public health intervention, such as large scale drainage projects and the use of insecticides. Prior to that, it was a serious health issue for the southeastern U.S.
Malaria’s greatest presence has been in Africa. Sub-Saharan Africa (the portion of Africa south of the Sahara Desert) has been home to the majority of the world’s malaria cases and deaths. Throughout history, malaria has plagued this portion of the continent. This is due to a variety of factors: weather that allows year-round transmission, lack of treatment and prevention resources, the predominance of the most serious malaria parasite (Plasmodium falciparum), and the effectiveness and widespread distribution of the Anopheles gambiae mosquitoes.
The Stages of Malaria
The malaria parasite undergoes several life stages while within a human host.
During a bite from an infected Anopheles mosquito, Plasmodium parasites are injected into the blood in the form of sporozoites, cells that infect their host. The sporozoites pass into the liver, where they multiply asexually over the next 7-10 days. They mature into schizonts, a type of cell that ruptures and releases merozoites (offspring parasites).
Merozoites infect red blood cells and develop into trophozoites. The trophozoites divide and develop, then rupture the red blood cells, releasing mature merozoites. The new merozoites infect new cells, repeating the cycle.
An Anopheles mosquito bites again, ingesting the parasite (microgametocytes and macrogametocytes), which multiples while in its stomach (the sporogonic cycle) and generate zygotes. The zygotes then turn into ookinetes, which invade the midgut wall of the mosquito and develop into oocysts. Once mature, the oocysts rupture, releasing sporozoites. The sporozoites make their way to the saliva glands of the Anopheles mosquito. The sporozoites are then injected into a new human host via a mosquito bite, and the life cycle of malaria continues.
Malaria Signs and Symptoms
The onset of malaria symptoms typically begins seven days to two weeks after infection. However, in some extreme cases, symptoms may not show until up to a year later.
Common malaria symptoms may include fever, vomiting, headaches, sweating, chills, and fatigue. These symptoms may be flu-like in nature. Of these malaria symptoms, paroxysm-the cyclical pattern of feeling cold, shivering, and then experiencing fever and sweating, is the most infamous. This cycle occurs either every two (Plasmodium vivax, Plasmodium ovale) or three days (Plasmodium malariae), or every 36-48 hours (Plasmodium falciparum). For Plasmodium knowlesi, paroxysm may be every 24 hours (quotidian).
Additional symptoms may include back pain, muscle aches, diarrhea, dry cough, and shortness of breath.
The most reliable and effective method of diagnosing malaria is through examining blood smears through a microscope. This method requires examining a drop of the patient’s blood on a microscope slide. However, this is time-consuming and labor-intensive. It is also difficult to implement on-site.
Various rapid diagnostic tests (RDTs) are available to detect antigens from malaria parasites. These tests provide results in 15 minutes or less.
Affected and Vulnerable Groups
Malaria can affect anyone. It is very common in tropical locations such as South Asia, South America, and especially sub-Saharan Africa. However, it can occur in other parts of the world. Approximately 2000 cases occur in the U.S. each year. Tourists and immigrants from affected areas make up the vast majority of cases in the U.S.
Pregnant women, infants, and young children are most likely to have severe and life-threatening cases of malaria. This is due to having little or no immunity to the disease. Pregnant women affected by malaria may give birth to children with low birth weights or give birth to premature children.
Malaria prevention primarily deals with mosquito elimination and bite prevention, especially in vulnerable groups such as young children and pregnant and nursing women.
Mosquito nets are a common and simple protective measure. These nets are treated with insecticides and are designed for use with beds. This netting prevents mosquito bites.
Antimalarial drugs are also effective at reducing the risk of developing malaria. These drugs can reduce the risk for people who travel to high-risk areas.
Currently, there is only one approved vaccine for malaria prevention. The RTS,S vaccine (Mosquirix) has shown partial protection against the disease. It is currently used in a pilot program for the prevention of the disease in children. However, it requires four doses. The first dose is given at the 5-month mark, then the second and third doses are given at monthly intervals. The fourth and final dose is given 15-18 months after the third dose. The World Health Organization will determine the effectiveness of the vaccine over the coming years.
Malaria is divided into two types: uncomplicated, and severe. Uncomplicated malaria patients can be treated on an outpatient basis, allowing the patient to recover at home. Patients with severe malaria require hospital admission. Severe malaria patients should be given continuous parenteral infusion.
Antimalarial medications are used to treat malaria. Depending on what part of the world you are in, different antimalarials are used. This is because some parasites become resistant to certain drug treatments. For example, chloroquine was used for many years in the treatment of malaria, but Plasmodium falciparum has been shown to develop a resistance against it.
Aside from the previously mentioned chloroquine, popular antimalarial medications include doxycycline, quinine, and mefloquine. In the U.S., the CDC has specific guidelines for malaria treatment. These guidelines recommend the proper dosage for adults and children.
Malaria may be fatal if left untreated. Malaria can cause anemia, which is a medical condition where red blood cells are unable to carry oxygen throughout the body. This leads to fatigue and drowsiness. Untreated malaria may also lead to jaundice, seizures, kidney failure, and coma.
Without proper diagnosis and treatment, malaria can be fatal. This is especially true of Plasmodium falciparum. In cases of severe malaria, fatality rates range from 10-40%.
Fortunately, if diagnosed and treated quickly, most patients will make a full recovery. With proper treatment, long term effects are uncommon.
Is Malaria Still a Problem?
Malaria is still a major health issue. In many developing countries it is a leading cause of death and disease. Roughly half of the world’s population lives in at-risk areas for malaria.
Furthermore, it is possible to become reinfected with malaria, even if you have already had malaria in the past.
As a result, malaria is still a global health issue that infects an estimated 200-300 million people per year and kills 1-3 million of the infected. Fortunately, there has been some success fighting the disease, with an estimated 1.5 billion malaria cases prevented in the past two decades, due to the distribution of mosquito nets, medicine, and rapid testing in key countries.
Barriers to Malaria Eradication and Treatment
There are several barriers to eradicating malaria. The parasite, as well as the mosquito that carries it, can become resistant to certain medications and insecticides. DDT, a popular insecticide, is no longer effective due to the mosquitoes developing a resistance to it.
Access to adequate healthcare can drastically reduce the effects of the disease. In one study, the incidence of hospitalized malaria more than doubled as travel time to the nearest primary care provider increased.
In recent decades, we have made great progress towards eradicating the disease. Some claim malaria may be eradicated as soon as 2050.
Is Malaria a Bloodborne Pathogen?
If you have ever wondered, “Is malaria a bloodborne pathogen?” or “How is malaria treated?” I hope I’ve answered your question. Malaria has been a widespread disease for ages, but proper diagnosis and treatment can prevent fatalities and serious health issues. Until malaria’s eradication, this is our best course of action.
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