A Nutty Idea for Controlling the Spread of Malaria

Baron, Ellen Jo
May 2009
Travel Medicine Advisor;May2009, Vol. 19 Issue 5, p25
MALARIA RANKS AMONG THE WORLD'S MOST IMPORTANT INFECTIOUS diseases. The last year for which good statistics have been amassed, 2006, saw 250 million cases and at least one million deaths. The number of new malaria cases in the world each year dwarfs the same statistic for other well-known scourges. AIDS newly infected 2.7 million people and killed approximately 2 million in 2006. Tuberculosis also killed more people than did malaria (~2 million), but new infections were in the range of 4-5 million. Progression in malaria reduction can be attributed to several factors. The expanding use of insecticide-treated bed-nets has greatly reduced transmissions, particularly in sub-Saharan Africa. In the past five years, use of such insecticide-treated bed-nets has increased more than five times. Prevention of malaria reduces the need for antimicrobial treatment and, thus, conserves limited healthcare dollars. Widespread treatment of malaria with combination therapy, particularly utilizing the Chinese herbal medicine artemisinin, also has reduced both morbidity and mortality more than 50% over the last five years. Although the parasite has developed resistance to many Western antimicrobials in response to the widespread use, these drugs seem to regain efficacy when combined with artemisinin, a compound derived from a plant known as Sweet Wormwood (Artemisia annua). Used in ancient times by Chinese herbalists to treat fevers, the herb had fallen out of favor until a Chinese herbal pharmacopeia originally written in 340 A.D. was rediscovered in 1970. One important point often overlooked when malaria statistics are quoted is epitomized by the results of a study conducted several years ago in Ghana. Most diagnoses (from which prevalence statistics are derived) are clinical only. In carefully conducted trials using highly trained laboratory scientists, at best only 15% of cases diagnosed as malaria by physicians (and treated as such) were substantiated by laboratory test results. Other infections, such as bacterial meningitis and sepsis, were the primary true causes of the patients' symptoms. So although it is possible that malaria is not so prevalent as has been thought, it still affects an immense proportion of the populations in tropical countries of both hemispheres. Rapid diagnostic tests are being suggested for resource-poor areas to aid physicians' diagnoses. Unfortunately, a new study from Mali evaluating the efficacy of one rapid test (Paracheck-Pf) compared with laboratory microscopy for Plasmodium falciparum diagnosis found that although the test was 83% sensitive and 79% specific, the "treat all" strategy was more cost-effective than the "test and treat" strategy. This is one of several sandwich immunoassays used throughout the world. Recently a similar test was FDA-cleared for use in the United States. The Binax (Binax, Inc., Portland, Maine) is an immunochromatographic test in the same format as the Binax tests for respiratory syncytial virus and Streptococcus pneumoniae antigen in urine. A comparison of the malaria test to microscopy and the gold standard polymerase chain reaction showed the Binax to be 94% sensitive for the detection of P. falciparum malaria but only 84% for non-P. falciparum infections. Another evaluation of the Binax performed at the patient's bedside revealed a slightly less desirable 88% sensitivity for P. falciparum diagnosis. U.S. laboratories are advised to use the rapid test as an adjunct to current tests and not as a replacement. Better diagnostic tests are needed along with better prevention strategies. One creative approach to prevention deserves better publicity. Malaria is spread by the bite of the female Anopheles mosquito. Mosquito abatement has been the basis of preventive efforts throughout much of the world.…


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