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Drug Resistance in Malaria Eugene Mark Department of Biochemistry University of Ghana

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Drug Resistance in Malaria Eugene Mark Department of Biochemistry University of Ghana http://www.inosr.net/inosr-scientific-research/ INOSR Scientific Research 4(1): 1-12, 2018. Eugene ©INOSR PUBLICATIONS International Network Organization for Scientific Research ISSN: 2705-1706 Drug Resistance in Malaria Eugene Mark Department of Biochemistry University of Ghana ABSTRACT Drug resistant malaria is primarily caused Established and strong drug pressure by Plasmodium falciparum, a species combined with low antiparasitic immunity highly prevalent in tropical. It causes probably explains the multidrug-resistance severe fever or anaemia that leads to more encountered in the forests of South-east than a million deaths each year. The Asia and South America. In Africa, emergence of chloroquine resistance has frequent genetic recombination in been associated with a dramatic increase Plasmodium originate from a high level of in malaria mortality among inhabitants of malaria transmission, and falciparum some endemic regions. The mechanisms of chloroquine-resistant prevalence seems to resistance for amino-alcohols (quinine, stabilize at the same level as chloroquine- mefloquine and halofantrine) are still sensitive malaria. Nevertheless, resistance unclear. Epidemiological studies have levels may differ according to place and established that the frequency of time. In vivo and in vitro tests do not chloroquine resistant mutants varies provide an adequate accurate map of among isolated parasite populations, while resistance. Biochemical tools at a low cost resistance to antifolates is highly prevalent are urgently needed for prospective in most malarial endemic countries. monitoring of resistance. Keywords: Drug, Resistance, Malaria. INTRODUCTION Malaria is a mosquito-borne infectious reproduce [3]. Five species of Plasmodium disease that affects humans and other can infect and be spread by humans. Most animals. Malaria causes symptoms that deaths are caused by P. falciparum typically include fever, tiredness, because P. vivax, P. ovale, and P. malariae vomiting, and headaches [1]. In severe generally cause a milder form of malaria. cases it can cause yellow skin, seizures, The species P. knowlesi rarely causes coma, or death. Symptoms usually begin disease in humans. Malaria is typically ten to fifteen days after being bitten by an diagnosed by the microscopic infected mosquito. If not properly treated, examination of blood using blood films, people may have recurrences of the or with antigen-based rapid diagnostic disease months later. In those who have tests [4]. Methods that use the polymerase recently survived an infection, reinfection chain reaction to detect the parasite's usually causes milder symptoms. This DNA have been developed, but are not partial resistance disappears over months widely used in areas where malaria is to years if the person has no continuing common due to their cost and complexity exposure to malaria [2]. [5]. It is caused by single-celled The risk of disease can be reduced by microorganisms of the Plasmodium group. preventing mosquito bites through the The disease is most commonly spread by use of mosquito nets and insect an infected female Anopheles mosquito. repellents, or with mosquito control The mosquito bite introduces the measures such as spraying insecticides parasites from the mosquito's saliva into and draining standing water. Several a person's blood. The parasites travel to medications are available to prevent the liver where they mature and malaria in travellers to areas where the 1 http://www.inosr.net/inosr-scientific-research/ INOSR Scientific Research 4(1): 1-12, 2018. disease is common. Occasional doses of making it economically unfeasible in the combination medication some areas [10]. sulfadoxine/pyrimethamine are Prevention of malaria may be more cost- recommended in infants and after the effective than treatment of the disease in first trimester of pregnancy in areas with the long run, but the initial costs required high rates of malaria [6]. Despite a need, are out of reach of many of the world's no effective vaccine exists, although poorest people. There is a wide difference efforts to develop one are ongoing. The in the costs of control (i.e. maintenance of recommended treatment for malaria is a low endemicity) and elimination programs combination of antimalarial medications between countries. In areas where malaria that includes an artemisinin. The second is common, children under five years old medication may be either mefloquine, often have anemia, which is sometimes lumefantrine, or due to malaria. Giving children with sulfadoxine/pyrimethamine. Quinine anemia in these areas preventive along with doxycycline may be used if an antimalarial medication improves red artemisinin is not available [7]. It is blood cell levels slightly but does not recommended that in areas where the affect the risk of death or need for disease is common, malaria is confirmed hospitalization [11]. if possible before treatment is started due Prevention of malaria includes: to concerns of increasing drug resistance. Preventing infection, by avoiding Resistance among the parasites has bites by parasite-carrying developed to several antimalarial mosquitoes, or medications; for example, chloroquine- Preventing disease, by using resistant P. falciparum has spread to most antimalarial drugs malarial areas, and resistance to prophylactically. The drugs do not artemisinin has become a problem in prevent initial infection through a some parts of Southeast Asia. The disease mosquito bite, but they prevent is widespread in the tropical and the development of malaria subtropical regions that exist in a broad parasites in the blood, which are band around the equator. Malaria is the forms that cause disease. This commonly associated with poverty and type of prevention is also called has a major negative effect on economic “suppression. development [8]. Prevention of disease by Prevention of Malaria administration of antimalarial Methods used to prevent malaria include drugs to particularly vulnerable medications, mosquito elimination and population groups such as the prevention of bites. There is no pregnant women and infants. vaccine for malaria. The presence of Personal protection measures such malaria in an area requires a combination as insecticide-treated bed nets of high human population density, high Preventive treatment with anopheles mosquito population density antimalarial drugs of vulnerable and high rates of transmission from groups such as pregnant women, humans to mosquitoes and from who receive intermittent mosquitoes to humans. If any of these is preventive treatment lowered sufficiently, the parasite Provision of equipment and eventually disappears from that area, as supplies (e.g., microscopes, drugs, happened in North America, Europe, and bed nets) to allow the health parts of the Middle East [9]. However, workers and the communities to unless the parasite is eliminated from the carry out the interventions. whole world, it could re-establish if Drug-resistant malaria parasites conditions revert to a combination that hinder case management by favors the parasite's reproduction. decreasing the efficacy of Furthermore, the cost per person of antimalarial drugs and by eliminating anopheles mosquitoes rises requiring the use of alternate with decreasing population density, 2 http://www.inosr.net/inosr-scientific-research/ INOSR Scientific Research 4(1): 1-12, 2018. drugs that are often more costly, of liver forms with primaquine [13]. less safe and less easy to Treatment with tafenoquine prevents administer. relapses after confirmed P. vivax malaria Insecticide resistance decreases severe and complicated malaria are the efficacy of interventions that almost always caused by infection with P. rely on insecticides such as falciparum. The other species usually insecticide-treated bed nets and cause only febrile disease. insecticide spraying. Severe and complicated malaria are Inadequate health infrastructures medical emergencies since mortality rates in poor countries are unable to are high (10% to 50%). Cerebral malaria is conduct the recommended the form of severe and complicated interventions. malaria with the worst neurological The people most exposed to symptoms. Recommended treatment for malaria are often poor and lack severe malaria is the intravenous use of education. They often do not know antimalarial drugs. For severe malaria, how to prevent or treat malaria. parenteral artesunate was superior to Even when they do know, they quinine in both children and adults. In often do not have the financial another systematic review, artemisinin means to purchase the necessary derivatives (artemether and arteether) products, such as drugs or bed were as efficacious as quinine in the nets. treatment of cerebral malaria in children Treatment Of Malaria [14]. Treatment of severe malaria involves Malaria is treated with antimalarial supportive measures that are best done in medications; the ones used depends on a critical care unit. This includes the the type and severity of the disease. While management of high fevers and the medications against fever are commonly seizures that may result from it. It also used, their effects on outcomes are not includes monitoring for poor breathing clear. Simple or uncomplicated malaria effort, low blood sugar, and low blood may be treated with oral medications. The potassium [15]. most effective treatment for P. falciparum How is malaria treated? infection is the use of artemisinins in Drugs that kill the parasite that causes combination with
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