A report on Antimalarial medication

Antimalarial medications or simply antimalarials are a type of antiparasitic chemical agent, often naturally derived, that can be used to treat or to prevent malaria, in the latter case, most often aiming at two susceptible target groups, young children and pregnant women.

- Antimalarial medication

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Malaria parasite connecting to a red blood cell

Malaria

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Mosquito-borne infectious disease that affects humans and other animals.

Mosquito-borne infectious disease that affects humans and other animals.

Malaria parasite connecting to a red blood cell
Main symptoms of malaria
The life cycle of malaria parasites. Sporozoites are introduced by a mosquito bite. They migrate to the liver, where they multiply into thousands of merozoites. The merozoites infect red blood cells and replicate, infecting more and more red blood cells. Some parasites form gametocytes, which are taken up by a mosquito, continuing the life cycle.
Micrograph of a placenta from a stillbirth due to maternal malaria. H&E stain. Red blood cells are anuclear; blue/black staining in bright red structures (red blood cells) indicate foreign nuclei from the parasites.
Electron micrograph of a Plasmodium falciparum-infected red blood cell (center), illustrating adhesion protein "knobs"
The blood film is the gold standard for malaria diagnosis.
Ring-forms and gametocytes of Plasmodium falciparum in human blood
An Anopheles stephensi mosquito shortly after obtaining blood from a human (the droplet of blood is expelled as a surplus). This mosquito is a vector of malaria, and mosquito control is an effective way of reducing its incidence.
Man spraying kerosene oil in standing water, Panama Canal Zone, 1912
Walls where indoor residual spraying of DDT has been applied. The mosquitoes remain on the wall until they fall down dead on the floor.
A mosquito net in use.
An advertisement for quinine as a malaria treatment from 1927.
Deaths due to malaria per million persons in 2012
Past and current malaria prevalence in 2009
Ancient malaria oocysts preserved in Dominican amber
British doctor Ronald Ross received the Nobel Prize for Physiology or Medicine in 1902 for his work on malaria.
Chinese medical researcher Tu Youyou received the Nobel Prize for Physiology or Medicine in 2015 for her work on the antimalarial drug artemisinin.
Artemisia annua, source of the antimalarial drug artemisinin
U.S. Marines with malaria in a field hospital on Guadalcanal, October 1942
Members of the Malaria Commission of the League of Nations collecting larvae on the Danube delta, 1929
1962 Pakistani postage stamp promoting malaria eradication program
Malaria clinic in Tanzania
Child with malaria in Ethiopia
World War II poster
Disability-adjusted life year for malaria per 100,000 inhabitants in 2004 no data <10 0–100 100–500 500–1000 1000–1500 1500–2000 2000–2500 2500–2750 2750–3000 3000–3250 3250–3500 ≥3500

The recommended treatment for malaria is a combination of antimalarial medications that includes artemisinin.

Chloroquine

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Medication primarily used to prevent and treat malaria in areas where malaria remains sensitive to its effects.

Medication primarily used to prevent and treat malaria in areas where malaria remains sensitive to its effects.

Medical quinolines
Hemozoin formation in P. falciparum: many antimalarials are strong inhibitors of hemozoin crystal growth.
Resochin tablet package

In areas where resistance is present, other antimalarials, such as mefloquine or atovaquone, may be used instead.

Artesunate

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Medication used to treat malaria.

Medication used to treat malaria.

Often it is used as part of combination therapy, such as artesunate plus mefloquine.

Figure 1. Biosynthesis of Artemisinin

Artemisinin

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Artemisinin and its semisynthetic derivatives are a group of drugs used in the treatment of malaria due to Plasmodium falciparum.

Artemisinin and its semisynthetic derivatives are a group of drugs used in the treatment of malaria due to Plasmodium falciparum.

Figure 1. Biosynthesis of Artemisinin
Artemisia annua

Artemisinin-based combination therapies (ACTs) are now standard treatment worldwide for P. falciparum malaria as well as malaria due to other species of Plasmodium.

Plasmodium vivax

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Protozoal parasite and a human pathogen.

Protozoal parasite and a human pathogen.

Where an artemisinin-based combination therapy has been adopted as the first-line treatment for P. falciparum malaria, it may also be used for P. vivax malaria in combination with primaquine for radical cure.

Plasmodium

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Genus of unicellular eukaryotes that are obligate parasites of vertebrates and insects.

Genus of unicellular eukaryotes that are obligate parasites of vertebrates and insects.

Plasmodium is a eukaryote but with unusual features.
Life cycle of a species that infects humans
Ring forms of Plasmodium inside human red blood cells (Giemsa stain)
Sporozoites, one of several different forms of the parasite, from a mosquito
Oldest mosquito fossil with Plasmodium dominicana, 15-20 million year old
Many birds, from raptors to passerines like the red-whiskered bulbul (Pycnonotus jocosus), can carry malaria.
A clinic for treating human malaria in Tanzania
Over 3000 species of lizard, including the Carolina anole (Anolis carolinensis), carry some 90 kinds of malaria.
The mosquito Anopheles stephensi is among the blood-feeding insects that can be infected by a species of Plasmodium.

A number of drugs have been developed to treat Plasmodium infection; however, the parasites have evolved resistance to each drug developed.

Plasmodium falciparum

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Unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that causes malaria in humans.

Unicellular protozoan parasite of humans, and the deadliest species of Plasmodium that causes malaria in humans.

Laveran's drawing of various stages of P. falciparum as seen on fresh blood (1880).
Blood smear from a P. falciparum culture (K1 strain - asexual forms) - several red blood cells have ring stages inside them. Close to the center is a schizont and on the left a trophozoite.
Ring forms in red blood cells (Giemsa stain)
Life cycle of Plasmodium

According to WHO guidelines 2010, artemisinin-based combination therapies (ACTs) are the recommended first-line antimalarial treatments for uncomplicated malaria caused by P. falciparum.

Mefloquine

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Medication used to prevent or treat malaria.

Medication used to prevent or treat malaria.

Mefloquine (Lariam) 250mg tablets

It is not recommended for severe malaria infections, particularly infections from P. falciparum, which should be treated with intravenous antimalarials.

Plasmodium falciparum hemozoin crystals under polarised light.

Hemozoin

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Disposal product formed from the digestion of blood by some blood-feeding parasites.

Disposal product formed from the digestion of blood by some blood-feeding parasites.

Plasmodium falciparum hemozoin crystals under polarised light.
Human red blood cell infected by the malaria parasite Plasmodium falciparum, showing a residual body with brown hemozoin.
Transport vesicle delivering a heme detoxification protein (hdp) to a malaria food vacuole (fv) containing crystals of hemozoin (hz). Scale bar is 0.5 µm.
Isolated P.falciparum hemozoin
Structure of hemozoin, showing hydrogen bonds between hematin units as dotted lines, and coordinate bonds between iron atoms and carboxylate side chains as red lines
Electron micrograph of crystals of hemozoin isolated from the malaria parasite Plasmodium falciparum. Magnified 68,490 times. Hemozoin is produced by template mediated crystallization ("biocrystallization").
Drug heme interaction

Several currently used antimalarial drugs, such as chloroquine and mefloquine, are thought to kill malaria parasites by inhibiting haemozoin biocrystallization.

Amodiaquine

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Amodiaquine (ADQ) is a medication used to treat malaria, including Plasmodium falciparum malaria when uncomplicated.