A Foreign Fiend (Part 1)
Under two distinct guises, a foreign fiend continues to challenge clinicians in Manila. Our world is changing, and the scope of Malaria is too. Earlier this week, I saw it with my own eyes.
At some discreet hospital in Manila, where I shadowed a pair of gutsy Physicians as they went about their daily business in solving some of the more weird and wonderful cases in Medicine, my mental understanding from journals and books became a very practical reality. It was here where I saw malaria parasites from blood samples, under a microscope, that until 15 years ago would have been relatively unheard of (if not at all) in Filipino patients.
The world is changing, and despite huge advancements in Malaria prevention and treatment, with greater distribution and use of bed nets and access to artemesinin derivates (for example), scientists and clinicians are still faced with novel challenges.
Artemesinin – our so called “magic bullet” against the most severe human strain in Plasmodium falciparum – is not uncommonly ineffective throughout countries of the Mekong region. Antimicrobial resistance is way past the idea of “scary prospect”.
Also, in rare instances, overseas workers in other endemic countries return to the Philippines with this severe strain, adding to the countries malaria burden which is already laden with P falciparum and P vivax. There may be subtleties to these infections – complicating the clinical picture further. I saw one such patient returning from sub-Saharan Africa – sitting through their follow-up consultation during an afebrile window but in the full knowledge a resurgence of fever was about to commence.
There is another “fifth” Plasmodium parasite able to cause malaria and with a fatality rate of 3%. This parasite, Plasmodium knowlesi, came to the attention of doctors and scientists in the 1930s, but it came until the early 2000s before we understood the parasite to be a widespread emerging zoonoses in South-East Asia, with Wild Macaques as the natural reservoir. There are many such cases in the central region of the Philippines, with some patients presenting with infection in the capital. I was all ears when listening to my supervising Physician of their experiences with with this emerging pathogen.
And what has driven the emergence? Much evidence points towards vast ecological change with deforestation, with an associated increase in the human population. Of course – the full picture is still unfolding.
I will be back at the hospital in just a few days, eager to follow up on the more perplexing malaria cases, alongside the many other weird and wonderful narratives of patients and their afflictions.