Combination therapy and artemisinin here is actually the name of a plant that we get this main drug, in this combo from the drug, one 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 for 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, 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 but that’s the standard treatment of uncomplicated malaria caused specifically by Plasmodium falciparum. 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, 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. It’s 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, they 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, 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, 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 are 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. So the primaquine works by blocking oxidative metabolism in this, it 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 malaria and vivax, you can see that there’s quite a few different things to think about but if someone has severe malaria, 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, remember that main drug in the 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 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.

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