Monday, November 7, 2011

A tale of two malaria patients

It is already cold in Palamu. Nights are quite cold enough to warrant the use of quilts. But, the climate is quite unusual for malaria. Maybe, after all the posts against malaria, the malarial parasite and the mosquitoes are getting back at me. There have enough reasons for me to suspect things other than malaria.. There was a well documented case where I was sure that it was imported leptospirosis from Kerala. There has already been an epidemic of viral encephalitis in the neighbouring districts. Of course fevers in NJH has always been baffling me and I still strongly believe that we have more causative agents other than just malaria or typhoid.

Coming back to malaria we’ve already had about 5 cases of Plasmodium Falciparum and another 4 cases of Flasmodium Vivax over the last week. However, yesterday, I had 2 little children who came in with confirmed blood smears of Plasmodium Falciparum. Read their stories.


The first to come in was PS who came in late in the morning. The history was very peculiar. PS was doing quite well in the morning and was playing with his friends, when he suddenly collapsed and became unconscious. The history initially looked like he had a head injury. On examination, DK was quite stuporous, crying incessantly and quite significantly appeared to be hemiplegic on the right side of the body. The right side of the body was in a state of spasm with flexion of both the upper limb and lower limb.


All the possible causes of a young stroke raced through my mind. But the blood tests brought about a surprise. He had falciparum teeming in his blood and he started to run a very high grade fever. Since there was a hemiplegia involved, I started to condition the parents to take the patient to Ranchi for a CT scan. But, the family was very poor.


I started him on the classical treatment for Cerebral Malaria. I was surprised when I saw him in the night. His hemiplegia was resolved and he was crying for food.

However, the next patient was not very lucky. SB, a 5 year old boy from one of the nearby villages was visiting relatives elsewhere where he had fallen sick since the last 5 days.
One of the village quacks were providing treatment. Today early morning he had become unconscious. The parents realized the gravity of the situation and rushed him to his home village nearby.

Unfortunately, the first place they went to was again one of the local quacks. By nightfall, they realized that SB was quite sick. SB came to NJH at around midnight. On examination, it was obvious that SB was quite sick and only a miracle could save him. The blood investigations only confirmed the inevitable. Hemoglobin was a pathetic 5 gm% and 75% of his Red Blood Cells contained the falciparum parasite. His platelet count was 17,000/cu mm.

The parents wanted to know if taking to Ranchi would be of any benefit. I told them of the pros and cons. Ultimately, they took the decision to take to Ranchi. I wrote off the referral letter. However, I started to harangue them for some blood to transfuse. But, the response from the parents was very cold.

The labour room was also quite busy. I was busy attending to other patients too. Somewhere in my mind I lost track of the child considering into fact that the parents have already taken the option of referral. Unfortunately, what I did not realize was that the parents were waiting till daybreak before they took SB to Ranchi.

The next thing I know is Dr Nandamani informing me at 7:30 next day morning that SB died. There was nothing we could do. Later I realized that I had written the chart for SB and the treatment was started.

Maybe if had some blood, SB would have survived. But again with a platelet count of 17,000, I’m not very sure.

SB could have been saved had we got a blood smear done and started him on Chloroquine quite early. PS’s presentation still perplexes me. I saw him today morning. He has improved quite a lot. 

Ultimately, whatever said about newer emerging and newer emerging diseases, malaria continues remain as a scourge in the public health scenario of places such as ours.


  1. hai jeevan ...i read the whole stuff,,amazing!! you are really doing a wonderful job..hatss of to u mann...this is real mission work...i am proud of u words to express...i am dumb these days of degeberating value for true mission work..u r a best example that real MISSION exists...god bless..
    Dr siby kurian philip MD,pediatrician,st thomas mission hospital,kattanam,allepy dist

  2. Could you please look into this:-
    Researchers at the University of Washington have discovered a method of treating malaria with magnetic fields that could prove revolutionary in controlling the disease the World Health Organization calls one of the world’s most complex and serious human health concerns.

    Henry Lai, UW research professor of bioengineering, says the malaria parasite Plasmodium appears to lose vigor and can die when exposed to oscillating magnetic fields, which Lai thinks may cause tiny iron-containing particles inside the parasite to move in ways that damage the organism.

    “If further studies confirm our findings and their application in animals and people, this would be an inexpensive and simple way to treat a disease that affects 500 million people every year, almost all in third-world countries,” Lai said. According to the World Health Organization, as many as 2.7 million people die of malaria every year. Approximately 1 million of those are children.

    In the past two decades, the emergence of drug-resistant malaria parasites has created enormous problems in controlling the disease. Lai says his method could bypass those concerns because it is unlikely Plasmodium could develop a resistance to magnetic fields.

    Malaria is spread by female Anopheles mosquitoes. The organism first invades the liver, then re-emerges into the bloodstream and attacks red blood cells. This is what causes malaria’s hallmark symptoms: fever, uncontrolled shivering, aches in the joints and headaches. Infected blood cells can block blood vessels to the brain, causing seizures and death. Other vital organs are also at risk.

    Lai’s research appears to take advantage of how the parasites feed. Malaria parasites “eat” the hemoglobin in red blood cells of the host. They break down the globin portion of the hemoglobin molecule, but the iron portion, or the heme, is left intact because the parasite lacks the enzyme needed to degrade it. This causes a problem for the parasite because free heme molecules can cause a chain reaction of oxidation of unsaturated fatty acids, leading to membrane damage in the parasite. The malaria organism renders the free heme molecules non-toxic by binding them into long stacks – like “tiny bar magnets,” according to Lai.

    He and three other researchers have exposed Plasmodium falciparum, the deadliest of the four malaria parasite species, to a weak alternating, or oscillating, magnetic field. Data sets showed that exposed samples ended up with 33 to 70 percent fewer parasites than unexposed samples. Measurements of hypoxanthine, a precursor for nucleic acid synthesis used by the parasite, indicated that metabolic activities had also significantly slowed in exposed samples. Such reductions would be enough to manage malaria, Lai said.

    The oscillating magnetic field may affect the parasites in two ways, according to Lai. In organisms still in the process of binding free heme molecules into stacks, the alternating field likely “shakes” the stacked heme molecules, preventing further stacking. That would allow harmful heme free reign within the parasite. If the parasite is further along in its life cycle and has already bound the heme into stacks, the oscillating field could cause the stacks to spin, causing damage and death of the parasite.

    Although initially promising, Lai says more research is needed.

    “We need to make certain that it won’t harm the host,” Lai said. “My guess is that it won’t. It’s a very weak magnetic field, just a little stronger than the earth’s. The difference is that it is oscillating.”

    If the method is proven effective and safe, Lai envisions rooms equipped with magnetic coils to produce the oscillating field.

    “It would be very easy. People could come to the room and sit and read or whatever while they’re being treated,” he said. “Or you could set it up in the back of a big transport truck, then drive from village to village to treat people.”