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Current time:0:00Total duration:8:30

Video transcript

so once malaria has been confirmed by lab or biochemical diagnosis treatment kind of has to start right away to give the person the best chance of survival right with as few complications as possible so let's say we're going to use anti malarial drugs to treat the disease right so to make sure we're using the right drugs we'll need to know a few things so we need to know what type of Plasmodium is causing the infection because some subtypes will just respond to drugs that others might not we'll need to know how the patient's doing right is this an uncomplicated malaria right with you know flu II symptoms fevers and chills that kind of stuff or is this severe malaria with systemic life-threatening symptoms we'll need to know what we're dealing with we'll also need to know if these parasites that are causing the infection we need to know if they're resistant to any of our treatments maybe the infection was picked up in you know a part of the world known to have treatment resistant malaria so there's a couple things we need to know right off the bat before we start treatment so let's say our patient over here he has uncomplicated malaria and let's remind ourselves that uncomplicated is still very serious it can still be fatal and our patient over here let's say he has severe malaria notice that this guy uncomplicated guys just hanging out at home right he's still really exhausted and fluey feeling but he's at home but severe malaria guy over here he's in a hospital bed and he's got an IV in and he's being monitored he's being totally looked after by the hospital staff and that's because for uncomplicated guy over here he can take his anti malarial drugs in pill form he can just take them at home but severe guy remember he's having systemic symptoms maybe his blood pressure is dangerously lower maybe he's severely anemic or maybe he has brain symptoms cerebral malaria where he's having seizures or maybe his brain just isn't controlling his breathing properly or maybe he's gone into a coma so he's in hospital because in addition to getting anti-malarials which he'll get through this IV line here he won't get them in pill form like this guy over here he'll need constant medical care to make sure that he survives and with his few permanent occasions as possible so let's talk about the types of medicines that can cure a malaria infection so remember that there's essentially two stages of infection with malaria there's a liver phase where sporozoites infect your liver cells and multiply into thousands of marrows o lights and then there's a red blood cell phase where these little marrow sites break out of your liver cells and infect your red blood cells and once they're inside your red blood cells they turn into what are called trophy sites they hang out for a while and then they multiply into thousands more marrow sites again so we have medications that can destroy these parasites at any of these stages which is good so for uncomplicated malaria the person usually gets treated with combination therapy which means that they take a few different drugs to treat their malaria so they take usually two to three drugs because if you just use one drug to treat a malaria infection Mol pretty quickly the parasites are going to figure out how to become resistant right how to avoid being killed by that one drug and in fact this is already a huge problem there's already a lot of drug resistance that's cropped up in different parts of the world so that's why it's super important to use combination therapies to make sure that no potentially mutated parasites survive after treatment otherwise one day we just won't have any drugs left at work so the recommended combination for for treating uncomplicated malaria is called a CT artemisinin combination therapy and artemisinin here is actually the name of a plant that we get this main drug in this combo from the drug is called artisan 8 and we get it from the Artemis inand plant so artisan 8 does a few things it creates a really toxic environment in the parasites that can kill them and it interferes with some pretty important proteins on the Plasmodium surface that allow them to get their nutrients so that makes it hard for them to stay alive - and the reason that a CT is built around this artists innate drug here is because artisan 8 is really really effective against all of the types of Plasmodium and because there's not really much resistance to it right now which is great so the standard combo is artisan 8 plus some other drug with a different mechanism of action so for example one that's commonly used as mefloquine meth Lachlan here which disrupts the acid-base balance in the parasite and that's often lethal to the parasite or sometimes you'll get a combo of two synergistic drugs sulfa dachshund and para methylene which stops the malaria from being able to replicate its DNA properly which means it just can't really reproduce very well in our bodies these are just examples there's other possibilities as well though so what I just told you all this AC T stuff that's the standard treatment of uncomplicated malaria caused specifically by Plasmodium falciparum AC T is really good at clearing a false if room infection from the bloodstream Plasmodium vivax on the other hand that has to be treated in a different way so for the blood stage you could still use a CT just like with falciparum or often a drug called chloroquine is used but there's a fair amount of resistance to chloroquine amongst malaria parasites nowadays mostly in Southeast Asia but how does chloroquine work well malaria parasites feed on blood they actually like the hemoglobin component of red blood cells that's why they have such a blast in our bloodstream but when they're busy digesting the hemoglobin from a red blood cell they release the heme part of the hemoglobin molecule right so it's just kind of floating around because they don't want to eat it they just eat the globin part and free heme floating around here is actually toxic to both of them the parasites and to the red blood cell that they're hanging around in so because they want to stick around in the red cell for a while and you know of course because they want to live the parasites convert the scheme into crystals of hemas Owen which is not toxic to the cell or to them so chloroquine and actually methylene does this as well these drugs prevent the parasites from converting the toxic heme into non-toxic Chema's Owen crystals right so all of the resulting heme it builds up and it just makes the environment really toxic and then the parasites end up dying which is great so that's a blood stage with Plasmodium vivax but vivax is interesting though it likes to hang out in the liver as well in a dormant phase unlike falciparum falciparum sort of gets on with it super severe infection pretty quickly whereas vivax right while it can still be really severe it takes it a bit slower so it likes to transform into what are called Hypno's iights and then these Hypno's i'ts taking naps in the liver cells for extended periods of time so it's kind of like having a chronic malaria infection with the vivax so you have to kill the liver parasites and you can do that with primaquine which is actually effective against all types of malaria but we especially like it for how it deals with the vivax hypno sites anyway the primaquine works by blocking oxidative metabolism in these hypnotizes in the liver so it stops them from being able to make enough energy to survive so they die now those are just the basic ideas of how you treat uncomplicated false sipper them and vivax you can see that there's quite a few different things to think about but if someone has severe malaria right this guy over here there's pretty much one thing that you always do you stick in an IV an intravenous line right and you give the person artisan a to remember that main drug in the a CT combo therapy and they can't take it in pill form they need it to go straight into their bloodstream because there's not really any time to fiddle around with pills and all that so besides the IV are too soon eight the person will need supportive treatment remember in severe malaria the person might be having seizures or they might be in a coma or they might not be able to breathe on their own so they're going to need a respiratory support and they'll probably also be really dehydrated so they'll need fluids and electrolytes as well so what sort of prognosis can you expect with malaria treatment well if you get proper treatment then usually you can expect a full recovery especially with uncomplicated malaria and this is all usually true with severe malaria - but it's important to keep in mind that severe malaria can progress really quickly and it can also be a bit unpredictable so even with treatment and intensive care it still often leads to death