Researchers in Malaysia have identified key laboratory and clinical features of an emerging new form of malaria infection. The research, funded by the Wellcome Trust, confirms the potentially deadly nature of the disease.
Malaria kills more than a million people each year. It is caused by malaria parasites, which are injected into the bloodstream by infected mosquitoes. Of the four species of malaria that commonly cause disease in humans, Plasmodium falciparum, found most commonly in Africa, is the most deadly. P. malariae, found in tropical and sub-tropical regions across the globe, has symptoms that are usually less serious.
Recently, researchers at the University Malaysia Sarawak, led by Professors Balbir Singh and Janet Cox-Singh, showed that P. knowlesi, a malaria parasite previously thought to mainly infect only monkeys - in particular long-tailed and pig-tailed macaques found in the rainforests of Southeast Asia - was widespread amongst humans in Malaysia. Subsequent reports in neighbouring Southeast Asian countries have led to the recognition of P. knowlesi as the fifth cause of malaria in humans.
Now, in a study published in the journal Clinical Infectious Diseases, Professors Singh and Cox-Singh, together with colleagues from University Malaysia Sarawak, Kapit Hospital and the University of Western Australia, have published the first detailed prospective study of the clinical and laboratory features of human P. knowlesi infections.
"P. knowlesi malaria can easily be confused with P. malariae since these two parasites look similar by microscopy, but the latter causes a benign form of malaria," says Professor Singh. "In fact, because the P. knowlesi parasites reproduce every twenty four hours in the blood, the disease can be potentially fatal, so early diagnosis and appropriate treatment is essential. Understanding the most common features of the disease will be important in helping make this diagnosis and in planning appropriate clinical management."
The researchers initially recruited over 150 patients admitted to Kapit Hospital in Sarawak, Malaysian Borneo, between July 2006 and January 2008 who had tested positive with a blood film slide for Plasmodium species. Using molecular detection methods, P. knowlesi was found to be by far the most common infection amongst these patients, accounting for over two-thirds of all cases.