Immunology, Pathophysiology, and Treatment of Malaria

Despite increasing research and control efforts over the past 20 years, malaria remains one of the worlds most significant health problems. As the disease flourishes and drug resistance spreads, the search for vaccines and effective drugs for therapy and prophylaxis becomes ever more important. Recent advances in our understanding of the ultrastructure and biology of Plasmodia will aid that quest. For vaccines, work continues on identifying the immune mechanisms and parasite target responsible for protective immunity and developing methods of constructing the subunit vaccines that will provide such immunity. One promising vaccine, SPF66, is being evaluated in several field trials. Mefloquine, the drug most commonly used for prophylaxis in area with chloroquine-resistant Plasmodium falciparum, remains effective in most areas, except in parts of southeast Asia where high-grade multidrug resistance is prevalent. In prophylactic doses, it has proved to be as safe as chloroquine. For therapy, halofantrine is highly effective in areas with drug resistance. Artemisinin compounds are effective in treating severe malaria caused by multidrug-resistant P. falciparum.