“The awkward fact with which US policy wrestles is that
description
Transcript of “The awkward fact with which US policy wrestles is that
![Page 1: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/1.jpg)
“The awkward fact with which US policy wrestles is that
People flee the world’s Haitis for a combination of motives.
All are deserving of some compassion but how much?”
Newsweek, Dec. 4 1991
“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed, to me”
Inscribed at base of Statue of Liberty, by Emma Lazarus
![Page 2: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/2.jpg)
Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)
As you knowin the developing world treatable
infectious diseases remain big killers
![Page 3: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/3.jpg)
Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)
Now it’s time to look at number 3:Malaria
![Page 4: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/4.jpg)
Leading causes of death in Sub-Saharan Africa, South Asia, and Southeast Asia for persons age 0-44 (World Health Organization)
That’s right: 300 million new cases per year
making it the most prevalent serious infectious disease!
![Page 5: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/5.jpg)
–2.1 billion people live in MALARIOUS areas2.1 billion people live in MALARIOUS areas
![Page 6: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/6.jpg)
–Like HIV and TB, malaria is Like HIV and TB, malaria is
–unequally distributed, even in the tropicsunequally distributed, even in the tropics
![Page 7: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/7.jpg)
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
–In areas of Africa with high transmission In areas of Africa with high transmission –there are 2700 deaths per day = 2 per minutethere are 2700 deaths per day = 2 per minute
![Page 8: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/8.jpg)
It’s especially hard on kids
![Page 9: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/9.jpg)
It’s especially hard on kids
75% of the deaths are among African children75% of the deaths are among African children
![Page 10: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/10.jpg)
www.uhhg.org/mcrh/resources/video/malariappt.pdf
![Page 11: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/11.jpg)
What Is malaria? A mosquito-borne infectious disease caused by A mosquito-borne infectious disease caused by
Protozoan parasites of the genus Protozoan parasites of the genus PlasmodiumPlasmodium
![Page 12: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/12.jpg)
What Is malaria? Transmitted only by Anopheles Mosquitoes Transmitted only by Anopheles Mosquitoes (>60 species!)(>60 species!)
Seattle Biomedical Research Institute
![Page 13: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/13.jpg)
What Is malaria?
The Disease can be Acute or ChronicThe Disease can be Acute or Chronic
![Page 14: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/14.jpg)
Acute Symptoms Classical features include cyclic symptoms
– Cold stage: chills and shaking
– Hot stage: fever, headache, vomiting, seizures in children
– Sweating stage: weakness
– Feel well for period of time, then cycle repeats itself
www.uhhg.org/mcrh/resources/video/malariappt.pdf
![Page 15: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/15.jpg)
In fact it is several different diseases
![Page 16: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/16.jpg)
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
![Page 17: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/17.jpg)
Each disease has a distinct course
![Page 18: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/18.jpg)
Each disease has a distinct course
“Tertian Malaria”
(P.falciparum, P.ovale and P.vivax)
fever occurs every third day.
“Quartan Malaria”
(P. malariae)
fever occurs every fourth day.
www.uhhg.org/mcrh/resources/video/malariappt.pdf
![Page 19: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/19.jpg)
Each disease has a distinct course
P.ovale and P.vivax
can cause chronic malaria,
reappearing after months or years
due to latent parasites in liver
www.uhhg.org/mcrh/resources/video/malariappt.pdf
![Page 20: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/20.jpg)
Each disease also has a distinct geographical distribution
www.uhhg.org/mcrh/resources/video/malariappt.pdf
![Page 21: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/21.jpg)
Each disease also has a distinct geographical distribution
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
![Page 22: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/22.jpg)
Each disease also has a distinct geographical distribution
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
![Page 23: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/23.jpg)
![Page 24: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/24.jpg)
Malaria damages the bodyin a number of ways
Red blood cell destruction -> anemiaRed blood cell destruction -> anemia
Waves of parasites bursting red blood cellsWaves of parasites bursting red blood cells
Lead to classic cycles of fever and chillsLead to classic cycles of fever and chills
![Page 25: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/25.jpg)
Malaria damages the bodyin a number of ways
Changes adhesive properties of infectedChanges adhesive properties of infected
Red blood cells -> blocking blood vessels Red blood cells -> blocking blood vessels leading to Tissue hypoxialeading to Tissue hypoxia
![Page 26: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/26.jpg)
Malaria damages the bodyin a number of ways
If this happens in brain it is cerebral malariaIf this happens in brain it is cerebral malaria
which is often fatalwhich is often fatal
Blocking bloodBlocking blood
vessels can alsovessels can also
cause kidney failurecause kidney failure
![Page 27: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/27.jpg)
Malaria damages the bodyin a number of ways
In severe cases 20% of patients can die,In severe cases 20% of patients can die,
even with the best careeven with the best care
![Page 28: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/28.jpg)
Gold standard: Multiple thick and thin smears
DIAGNOSIS
![Page 29: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/29.jpg)
![Page 30: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/30.jpg)
![Page 31: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/31.jpg)
www.uhhg.org/mcrh/resources/video/malariappt.pdf
1300 cases in US per year1300 cases in US per year Essentially all “imported”Essentially all “imported” Also transfusion related malariaAlso transfusion related malaria
Malaria is not currently a serious threat in the US
![Page 32: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/32.jpg)
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
Although….
![Page 33: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/33.jpg)
Malaria is not currently a serious threat in the US
![Page 34: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/34.jpg)
However, this was not always the case
![Page 35: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/35.jpg)
Not that long ago….
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
![Page 36: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/36.jpg)
![Page 37: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/37.jpg)
It could come back!
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
![Page 38: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/38.jpg)
Let step back and lookat the parasites that cause malaria
![Page 39: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/39.jpg)
A French army doctor in A French army doctor in AlgeriaAlgeria observed observed parasites inside parasites inside red blood cellsred blood cells of malaria of malaria patients and proposed patients and proposed for the first time that a for the first time that a protozoan caused protozoan caused diseasedisease
www.uhhg.org/mcrh/resources/video/malariappt.pdf
It was discovered more than 100 years ago
Charles Louis Alphonse Laveran
![Page 40: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/40.jpg)
French army doctor in French army doctor in AlgeriaAlgeria observed observed parasites inside parasites inside red blood cellsred blood cells of malaria of malaria patients and proposed patients and proposed for the first time that a for the first time that a protozoan caused protozoan caused diseasedisease
www.uhhg.org/mcrh/resources/video/malariappt.pdf
Charles Louis Alphonse Laveran
1907 1907 Nobel Prize for Physiology
or Medicine!!
![Page 41: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/41.jpg)
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
So just who
is this
Plasmodium?
![Page 42: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/42.jpg)
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
It’s not a
bacterium or
virus but a
eukaryote
like us
![Page 43: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/43.jpg)
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
However,
unlike us
it lives a
solitary life
as a single
cell
![Page 44: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/44.jpg)
Let’s go back to the family tree
![Page 45: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/45.jpg)
http://drnelson.utmem.edu/Woods.Hole/slide5.png
Let’s go back to the family tree
![Page 46: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/46.jpg)
http://drnelson.utmem.edu/Woods.Hole/slide5.png
Let’s go back to the family tree
You and me
![Page 47: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/47.jpg)
http://drnelson.utmem.edu/Woods.Hole/slide5.png
You and memushrooms
![Page 48: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/48.jpg)
http://drnelson.utmem.edu/Woods.Hole/slide5.png
You and memushrooms
plants
![Page 49: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/49.jpg)
http://drnelson.utmem.edu/Woods.Hole/slide5.png
We are family….You and me
mushrooms
plants
Plasmodium
![Page 50: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/50.jpg)
http://drnelson.utmem.edu/Woods.Hole/slide5.png
They are on the same region of
the eukaryote tree as plants
You and me
plants
Plasmodium
![Page 51: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/51.jpg)
Consistent with this,
we now know Plasmodium
and its relatives have a
remnant of the chloroplast
called the apicoplast
which may help it digest
heme and other things
It harvests from red blood cells
![Page 52: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/52.jpg)
Consistent with this,
we now know Plasmodium
and its relatives have a
remnant of the chloroplast
called the apicoplast
which may help it digest
heme and other things
It harvests from red blood cellsWe don’t have this sort of organelle
How might we use that fact??!
![Page 53: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/53.jpg)
Plasmodium and its relatives
also have a specialized
Structure at one end of the cell
Involved in invading other cells
![Page 54: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/54.jpg)
www.columbia.edu/itc/hs/medical/pathophys/parasitology/2006/PAR-05Color .pdf
![Page 55: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/55.jpg)
Plasmodium’s closer relatives
Include parasites causing
Babesiosis, Toxoplasmosis,
And Cryptosporidiosis
![Page 56: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/56.jpg)
Purves et al., Life: The Science of Biology, 4th Edition
Plasmodium has a wildly complex life cycle
2
3
4
5
1
6
![Page 57: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/57.jpg)
Purves et al., Life: The Science of Biology, 4th Edition
And that’s just in the mosquito!
2
3
4
5
1
6
![Page 58: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/58.jpg)
Purves et al., Life: The Science of Biology, 4th Edition
7
8
The wildly complex life cycle continued
![Page 59: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/59.jpg)
Purves et al., Life: The Science of Biology, 4th Edition
9
Had enough yet??
![Page 60: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/60.jpg)
Purves et al., Life: The Science of Biology, 4th Edition
Now we get to the troublesome stage
Cycles of replication inside red blood cells
Lead to cycles of fever and chills
And aggregated blood cells block blood vessels
10
![Page 61: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/61.jpg)
Purves et al., Life: The Science of Biology, 4th Edition
We also need to get back to the next mosquito to complete the cycle
11
![Page 62: “The awkward fact with which US policy wrestles is that](https://reader035.fdocuments.in/reader035/viewer/2022062322/56814bfc550346895db8f912/html5/thumbnails/62.jpg)
Here’s Glaxo-
SmithKline’s
Cliff Notes
version