B io Factsheet

www.curriculum-press.co.uk Number 206

Malaria
This Factsheet summarises:
Definitions
• The cause and means of transmission of malaria.
Vector: An organism responsible for the transmission or spread
• The worldwide distribution and importance of malaria.
of a pathogen. In the case of malaria, the female mosquito is the
• The social, economic and biological factors significant in the
vector as it transmits the Plasmodium parasite from human to
prevention and control of malaria.
human.
Malaria is an infectious disease that threatens over one third of the Host: An organism inside which the reproduction of another
world’s population. Up to 124 million people in Africa alone live in organism occurs. Humans act as a host for the malarial parasite.
areas at risk of seasonal epidemics. This year, malaria is expected to
kill one million individuals, 90% of them under age five, and the vast Asexual reproduction: Reproduction with just one parent
majority living in Africa. organism. Offspring are genetically identical, and are produced
rapidly and in large numbers.
What causes malaria?
Malaria is caused by 4 different species of the protoctist parasite Sexual reproduction: Requires the fertilization of a male and
Plasmodium. It is spread from human to human by female Anopheles female gamete to form a zygote. Offspring contain a combination
mosquitoes as they feed on blood to obtain the protein they need of the genes of both gametes.
to produce their eggs.
Transmission of Malaria
1. Mosquito bites usually occur in the early evening. As the infected mosquito feeds, it injects saliva containing an anticoagulant to
prevent the blood from clotting.
2. Malarial parasites known as sporozoites are injected along with the saliva and enter the human bloodstream where they migrate to the
liver. The mosquito is therefore said to act as a vector of the malarial parasite.
3. In the liver cells the sporozoites multiply asexually, very rapidly increasing in number.
4. The liver cells burst open releasing many merozoites, which then invade the red blood cells.
5. These merozoites reproduce asexually again inside the red blood cells, causing the red blood cells to burst, releasing more merozoites
which cause the characteristic fever and other symptoms of the disease.
6. Some of these merozoites develop into gametocytes (the male and female forms of the parasite) which are ingested by the female
mosquito during feeding, and so complete the cycle of transmission between human and mosquito.
7. Once inside the female mosquito’s gut, the male and female gametocytes fuse to form sporozoites which migrate to the salivary glands
ready to be injected into a new human host at the next blood meal.
The diagram below summarizes the life cycle of the malarial parasite and is typical of many exam questions.

Uninfected female mosquito feeds in

Infected female mosquito feeds in the
the early evening and takes in mature
early evening and injetcs malarial
sex cells with the blood
parasites into the blood stream

skin surface
mature sex cells
malarial parasites
After 28 hours sex cells have matured
blood system
of human

liver cell Immature sex cells

malarial parasite Every 48 hours, infected red blood
cells burst, releasing more parasites
Malarial parasite rapidly enters liver cell and and immature sex cells
red blood cells
changes form. New form ruptures liver cell, escapes
into blood stream and infects red blood cells

1
206 Malaria
Exam Hint: - Examiners often ask candidates to distinguish
between the stage of sexual reproduction in the female
mosquito, and the asexual stages in the liver and red blood
cells of the human host, and to outline the advantages of
each. Asexual reproduction is much more rapid and produces
large numbers of offspring in a short space of time.
Typical Exam Questions
1. Explain the importance of the female mosquito in the life
cycle of the malarial parasite.
2. Explain why an infected person may feel feverish every
two days in the early stages of malaria.
3. Describe and explain how Plasmodium is adapted to its
way of life.
Answers
1. Female acts as a vector/ transmits the parasite to humans;
Fertilization of male and female gametocytes occurs in the
female mosquito/ where sexual stage of life cycle occurs;
2. Infected red blood cells burst every 48 hours releasing more
parasites into the bloodstream;
3. Has no locomotory structures because it is transported via
the blood stream in humans and uses two hosts to transfer
it from one stage to the next;
Does not need an attachment mechanism as penetrates
human host using mosquito vector;
Has no need for a mechanism for regulating its water content
because it lives inside cells;
Avoids attack by host immune system by living inside host
cells;
Complex life cycle with several stages aids immune evasion;
Sexual reproduction phase of life cycle allows for antigenic
variation;
Asexual reproduction phase of life cycle allows production
of large numbers of offspring;
Where do Students go wrong?
• Many candidates’ knowledge of the malarial parasite’s life cycle
is insufficient
• Some candidates do not show that they understand the need
for rapid, asexual reproduction to produce sufficient numbers
of parasites to ensure transmission to another host
• Few candidates mention the importance of the anticoagulant
• Some candidates are unsure of the sequence of stages within
the human
Exam Question
The maps below show the pattern of annual rainfall in Africa and the incidence of malaria.
Incidence of malaria Annual rainfall
No malaria
Low incidence
Medium incidence
High incidence
2
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Controlling the Spread of Malaria
At present, there is no vaccine for malaria, so prevention and control
measures mainly focus on disrupting the breeding cycle of the
mosquito in order to reduce the risk of mosquito bites. The female
mosquito lays her eggs in the water where the larvae and pupae
develop.
• Draining swamps, marshes and other exposed areas of water
removes potential breeding places for mosquitoes.
• Spreading oil over the surfaces of bodies of water suffocates
the mosquito larvae and pupae by preventing them from coming
to the surface to obtain oxygen.
• Sprays containing the bacterium Bacillus thuringiensis can be
used which kills mosquito larvae but is not toxic to other species.
• Biological control by stocking permanent bodies of water with
fish which feed on mosquito larvae.
• Sleeping beneath mosquito nets which have been soaked in
insecticides, and the use of insect repellents on the skin.
• Keeping skin covered at dusk when mosquitoes are most likely
to bite.
• Sleeping with a dog or a pig! Local wisdom in New Guinea
advises that mosquitoes much prefer animal blood to human
blood.
Many of these measures, however, are not always successful.
Mosquitoes will breed in the tiniest bodies of water, such as puddles,
making it difficult to treat or eliminate breeding places entirely. Other
measures, such as mosquito nets and insecticides are expensive
and logistically difficult to implement in remote areas. Civil war and
unrest, along with poor infrastructure, prevents access to many
endemic regions.
Mosquitoes cross national boundaries and so control programs
must be co-coordinated between nations in order to be successful.
The more recent problems of insecticide-resistant mosquitoes and
drug-resistant strains of Plasmodium also hinder prevention and
control.
Describe and explain the relationship
between annual rainfall in Africa and the
incidence of malaria.
grounds;
/cm Rainfall causes puddles/pools/more breeding
Under 25 water;
25-50 Malaria is spread by mosquitoes that breed in
50-100
rainfall;
100-150
Correlation between the incidence of malaria and
Over 150
Answer
206 Malaria Bio Factsheet
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Anti-Malarial Drugs and Resistance

In addition to the above measures, anti-malarial drugs such as quinine have been in use for many years. Modern anti-malarial drugs are
often used as prophylaxis by tourists traveling to regions where malaria is endemic, to prevent infection occurring. These drugs can
also be used to improve the condition of individuals who are already infected, reducing the number of parasites within their bodies and
hence reducing the likelihood of the disease being passed on to others.
Anti-malarial drugs, however, have drawbacks:
• They are too expensive to be used in many developing countries where malaria is endemic.
• Malarial parasites have developed resistance to the drugs, especially chloroquine. At present, there are some regions where no anti-
malarial drugs are effective due to the problem of resistance.

Insecticides, Resistance and the DDT Story Malaria and Sickle Cell Anaemia
In the 1950s, the World Health Organisation co-coordinated a Sickle cell anaemia is a lethal condition in which the presence of the
worldwide program for the eradication of malaria. The program failed mutant allele HbS in place of the normal allele HbA results in an
for two main reasons: amino acid substitution at a critical position in the haemoglobin
1. The emergence of drug-resistant strains of Plasmodium. molecule. This causes the red blood cells to have a characteristic
2. The emergence of insecticide-resistant strains of Anopheles sickle shape, which leads to blockage of capillaries and severe
mosquitoes. anaemia. The frequency of the HbS allele is correlated with the
distribution of malaria, being particularly prevalent in West Africa.
In addition, the program itself became very unpopular with local This is because heterozygotes who are said to show sickle cell
communities. When constantly re-infected with malaria, individuals ‘trait’, have sufficient amounts of normal haemoglobin to prevent
acquire resistance to infection that is lost if they are no longer in severe anaemia, however, the small percentage of sickled red blood
contact with the disease. The temporary eradication of malaria in cells confers an increased resistance to malaria giving them a
some areas during the program caused locals to lose their immunity selective advantage over ‘normal’ individuals as they less likely to
with many deaths and much suffering when the disease returned. die from malaria in childhood.
Vaccination The diagram below shows the distribution of malaria and the sickle
Given the problems of drug resistance, the approach most likely to cell allele and is typical of many exam questions.
be successful in controlling malaria is the development of a vaccine.
However, the production of a vaccine against malaria has so far
proved difficult for a number of reasons:
• Plasmodium is a protoctists parasite, therefore much larger and
much more complex than viruses and bacteria. It has many surface
antigens which differ between the several species of parasite
that can cause malaria.
• In order to survive inside the human host, Plasmodium evades
the immune response by quickly entering and remaining
“hidden” inside either red blood cells or liver cells for much of
its time (antigen concealment).
• Once inside host cells, antigens from the parasite are displayed
on the cell surface to aid immune detection. Plasmodium can Sickle cell allele
mutate and vary these antigens so that the immune system no
Malaria
longer recognizes them (antigenic drift).
• Different stages in the life cycle display different proteins, and
so a vaccine would ideally target multiple stages in order to be
effective.
Typical exam Question
Typical Exam Question
Explain why the sickle cell allele occurs at such high
Outline the difficulties associated with controlling the spread
frequencies in some areas.
of malaria.
10. Lack of education over preventing mosquito bites. Answer
9. Poor primary health care makes detection and treatment difficult.
1. Individuals homozygous for sickle cell allele die from sickle
8. No vaccine.
cell anaemia.
immune system to operate.
7. Different stages of the life cycle in the body make it difficult for 2. Individuals homozygous for normal allele are likely to die
immune system to detect. from malaria in childhood.
concealment within red blood cells and liver cells make it difficult for 3. Sickle cell allele frequent in malarial areas.
6. Large number of surface antigens/ antigenic variation and antigenic 4. Heterozygotes have a selective advantage because they are
5. Resistance of Plasmodium to anti-malarial drugs such as chloroquine. resistant to malaria.
infrastructure and lack of funds. 5. So are more likely to survive and pass on sickle cell allele.
4. Mosquito control programs have been disrupted by war, poor
3. Mosquitoes can quickly travel long distances making control difficult.
in very small bodies of water. Acknowledgements:
2. Difficulty in controlling breeding of mosquitoes as they can lay eggs This Factsheet was researched and written by Katrina Fox.
Curriculum Press, Bank House, 105 King Street, Wellington, Shropshire, TF1 1NU.
1. Resistance of mosquitoes to insecticides such as DDT. Bio Factsheets may be copied free of charge by teaching staff or students, provided that their school is a registered
subscriber. No part of these Factsheets may be reproduced, stored in a retrieval system, or transmitted, in any other
Answer form or by any other means, without the prior permission of the publisher. ISSN 1351-5136