May 9, 2013
Karl Seydel (above right), assistant professor of osteopathic medical specialties, is part of the MSU team working in Malawi to better understand and treat childhood malaria.
“She was fine yesterday,” the mother repeats in a state of shock and disbelief, as she watches her comatose daughter continue to convulse on the bed in the hospital admissions area. She had rushed to the hospital at first light this morning after the child deteriorated quickly overnight. The child was absolutely fine yesterday – attended school, played with friends in the afternoon and ate a good dinner. The parents were awoken in the night by her convulsions and brought her to Queen Elizabeth Central Hospital in Blantyre, Malawi. There is very little question in the parents’ or the clinicians’ minds about what’s causing this rapid, life-threatening illness: It must be malaria.
Malaria is caused by a parasite transmitted by mosquitoes and capable of invading human red blood cells. Estimates are the disease has killed more people than any other in history. Even with rapid, effective antimalarial treatment, the death rate for cerebral malaria – the most deadly form of this disease – remains about 15 percent. This results in more than 700,000 deaths annually, mostly in children under the age of five who live in sub-Saharan Africa.
What is incredible, and unacceptable, is the lack of knowledge regarding how malaria develops. Malaria has coexisted with humans for thousands of years – and yet we still don’t understand many of the most basic mechanisms of disease. The parasite is a wily foe, taking refuge in the red blood cell, a cell type that is essentially hidden from the immune system. It can morph quickly, rapidly developing resistance to a variety of antimalarial drugs. Disease presentation is also highly variable, with some children able to cope with the presence of parasites with very few symptoms, while others develop rapid, progressive disease.
The basic questions surrounding the disease are what drew malaria researchers from MSU to Malawi more than 25 years ago. What actually kills these children? Why do some children seem resistant to the disease? How can we tell which kids are going to get sick? Are more parasites always worse?
Much progress has been made during this time. MSU researchers have carried out the world’s largest series of autopsies on children who died from cerebral malaria. They also have been instrumental in defining a malaria-specific pathology that occurs in the eyes of children with cerebral malaria. In 2008 MSU helped bring to Malawi the country’s first MRI machine, which has led to new insights into how malaria damages the brain. MSU researchers have also worked on improved diagnostics, and have recently used the presence of a parasite protein to define which children will progress to severe disease, hoping to improve the ability of clinicians to triage and refer patients to the appropriate level of care.
Despite these advances, every year when the rains and the mosquitoes appear, the pediatric research ward fills with children in various stages of recovery from this devastating disease.
Recently, a four-year-old-boy who was slowly regaining consciousness was crying inconsolably for an entire afternoon. The mother and nurses discovered that he was gesturing towards an MSU Sparty doll that perches protectively near the ceiling of the ward, looking out upon all the beds. The child quieted immediately upon presentation of Sparty and slept with him for the next two days. I suspect that the medicine and nursing care might have had something to do with his full recovery, but I am not sure we can completely rule out the healing power of Sparty.