WEBVTT - Ep 8 ABRACADABRA - Go Away Malaria! 0:00:07.320 --> 0:00:11.920 Hello, Hey, Yay, how's it going. 0:00:12.560 --> 0:00:13.320 It's going well. 0:00:13.720 --> 0:00:17.680 I just made it back home and I frantically prepared 0:00:18.400 --> 0:00:19.320 a gin and tonic. 0:00:19.920 --> 0:00:22.880 Gin and tonic with lemon will accept it. 0:00:24.520 --> 0:00:27.000 So for this episode, we decided to sit down with 0:00:27.080 --> 0:00:30.560 our good friend Uma to ask him about his personal 0:00:30.600 --> 0:00:32.160 experiences with malaria. 0:00:33.400 --> 0:00:36.560 I'm Umatsamji. I grew up in Nairobi, Kenya. 0:00:37.000 --> 0:00:40.720 Right now, I'm a graduate student at the University of Florida, Gainesville. 0:00:41.159 --> 0:00:44.360 And I met. 0:00:44.240 --> 0:00:48.160 Aaron and Erin in Gembo, Panama while we were doing 0:00:48.200 --> 0:00:53.800 field work at this tropical research station. I remember I 0:00:53.840 --> 0:00:57.480 had just come from a camping trip in western Kenya, 0:00:57.640 --> 0:01:00.240 and now I've been back in Nairobi, where you know, 0:01:00.320 --> 0:01:02.680 I lived and my parents lived for about two weeks. 0:01:03.080 --> 0:01:07.280 One day, I I was just feeling really lethargic and tired, 0:01:07.720 --> 0:01:10.880 and I had this lower back pain that was really memorable, 0:01:11.000 --> 0:01:12.320 like this pain in my lower back. 0:01:12.760 --> 0:01:15.560 And I went to bed and in the. 0:01:15.520 --> 0:01:18.759 Morning, you know, I was confused. I had a fever. 0:01:19.280 --> 0:01:22.319 I was really sick. My body hurt a lot. So 0:01:22.600 --> 0:01:27.000 I remember just having like really weird, wacky dreams, you know, 0:01:27.040 --> 0:01:29.960 and having these high fevers and and so I went 0:01:30.160 --> 0:01:32.600 my parents took me to the to the doctors and 0:01:32.640 --> 0:01:35.720 I got a blood test. Living in the tropics, there's 0:01:35.800 --> 0:01:39.199 a lot of different things that you could get. Of course, 0:01:39.240 --> 0:01:42.400 they did the maloria test and they didn't find malaria. 0:01:42.560 --> 0:01:46.440 But I had these very cyclical fevers. I would get 0:01:46.800 --> 0:01:49.560 really really cold, and suddenly i'd be really really hot again. 0:01:50.240 --> 0:01:53.160 And I remember when I was when I had the fever. 0:01:53.200 --> 0:01:55.440 When I was feeling really cold, I would be shivering 0:01:55.480 --> 0:01:57.960 so much that my like my muscles would contract so 0:01:58.040 --> 0:02:00.480 much that they'd be hurting. And I went for another 0:02:00.520 --> 0:02:03.800 blood test because my mom was suspicious that this actually 0:02:03.880 --> 0:02:09.200 might be malaria. And still there was no positive malaria diagnosis. 0:02:09.600 --> 0:02:12.480 But then my mom took me to the hospital at 0:02:12.480 --> 0:02:15.320 two am, and I didn't know what was happening. I 0:02:15.360 --> 0:02:17.360 didn't know why, you know, why, we were going to 0:02:17.360 --> 0:02:20.480 the hospital in the middle of the night, and I 0:02:20.480 --> 0:02:24.400 got a blood test done at that time and they 0:02:24.440 --> 0:02:27.680 diagnosed me with malaria. And I didn't learn until later 0:02:28.080 --> 0:02:31.640 that it's really common for malaria not to be in 0:02:31.680 --> 0:02:34.760 your purple bloodstream until the middle of the night. 0:02:35.560 --> 0:02:39.680 So, yeah, that was kind of an interesting experience. I 0:02:39.680 --> 0:02:43.440 feel like malaria was such a big part of life 0:02:43.639 --> 0:02:44.640 growing up in Kenya. 0:02:44.720 --> 0:02:47.280 It was I feel like it was the kind of 0:02:47.320 --> 0:02:50.600 the disease that whenever somebody had a fever or any 0:02:50.639 --> 0:02:54.160 sort of sickness, you'd always wonder like, is it malaria, 0:02:54.280 --> 0:02:57.280 because it could be. You know, it's really common there. 0:02:58.040 --> 0:03:01.160 So when you're really young, you learn about the anopolies mosquito. 0:03:01.240 --> 0:03:04.480 So like I remember in primary school growing up, we 0:03:04.600 --> 0:03:07.280 learned about anopolies and what it looked like when it 0:03:07.400 --> 0:03:07.960 was resting. 0:03:08.000 --> 0:03:10.960 It has this very unique posture when it's resting, and. 0:03:10.880 --> 0:03:14.080 You can recognize it immediately, and it's something that you know, 0:03:14.840 --> 0:03:18.760 everybody learns in school when from a really young age. 0:03:19.400 --> 0:03:22.000 When I was really young, you know how as the 0:03:22.080 --> 0:03:25.840 stereotype every like young kid hates to have the chore 0:03:25.840 --> 0:03:28.280 of doing their beds, just like any kids. 0:03:28.320 --> 0:03:30.919 I hated doing my bed but there was something else 0:03:30.919 --> 0:03:32.800 I had to do. I had to, you know, fold 0:03:32.880 --> 0:03:34.520 up and roll up my mosquito. 0:03:34.160 --> 0:03:37.960 Net every day, and every night I had to unroll 0:03:38.040 --> 0:03:41.040 it and you know, tuck it around my bed so 0:03:41.080 --> 0:03:42.160 I could go to sleep for the night. 0:03:42.520 --> 0:03:44.840 And you know, I hated doing it. It's a chore 0:03:45.160 --> 0:03:46.320 and it's this extra. 0:03:46.160 --> 0:03:47.760 Thing you have to do and I would do it 0:03:47.800 --> 0:03:52.080 badly sometimes And I remember lots of times my parents 0:03:52.120 --> 0:03:54.080 waking me up and I, you know, I had gone 0:03:54.120 --> 0:03:57.120 to sleep a rebellious. 0:03:56.320 --> 0:04:01.600 Teenager not putting my mosquito net on. I was the worst. Yeah, 0:04:01.760 --> 0:04:06.760 and you know I'll be like, okay, fine, I'll do it. 0:04:08.000 --> 0:04:15.279 That is the most beautiful introduction. Absolutely, it was like textbook. 0:04:17.320 --> 0:04:21.960 So thank you for going through that period. Yeah, so 0:04:22.080 --> 0:04:26.440 that was incredible, amazing. Thank you so much, Uhmat for 0:04:26.560 --> 0:04:29.480 sharing your story about malaria and wow. 0:04:44.960 --> 0:04:49.000 Hi and welcome to episode eight. Holy crap, holy crap 0:04:49.160 --> 0:04:51.960 of this podcast will kill you. I'm Aaron Welsh and 0:04:52.040 --> 0:04:53.160 I'm Aaron Alman Updyke. 0:04:53.600 --> 0:04:54.680 Thanks for joining us. 0:04:54.800 --> 0:04:56.239 We're very excited. 0:05:05.360 --> 0:05:09.719 This week. We're talking about malaria, yep, which is a 0:05:09.720 --> 0:05:13.000 big one. But we're gonna have a good time today. 0:05:13.200 --> 0:05:15.960 It's gonna be really fun. I'm thrilled about it. 0:05:16.000 --> 0:05:17.320 Malaria is fascinating. 0:05:17.400 --> 0:05:21.560 It's a really it's actually one of the first diseases 0:05:21.720 --> 0:05:24.599 that made me want to study disease. 0:05:24.760 --> 0:05:25.719 So I'm really excited that. 0:05:25.839 --> 0:05:28.720 Yeah, malaria is just a semiasis. Oh, they're like very 0:05:28.720 --> 0:05:29.440 close to my heart. 0:05:31.000 --> 0:05:31.719 That's so cool. 0:05:31.800 --> 0:05:33.560 Yeah, all right, I'm excited about it. 0:05:33.720 --> 0:05:34.880 Learn something new about you, all. 0:05:34.880 --> 0:05:38.840 Right, But before we jump in, we have a correction, 0:05:39.200 --> 0:05:42.640 yes to make. We always say if we get something wrong, 0:05:42.680 --> 0:05:44.760 please let us know, and this is proof that we're 0:05:44.760 --> 0:05:47.400 not lying. All of this is outside of our area 0:05:47.440 --> 0:05:48.160 of expertise. 0:05:48.240 --> 0:05:49.520 We expect to get things wrong. 0:05:49.800 --> 0:05:53.400 So in the very first episode, eight whole weeks ago 0:05:53.440 --> 0:05:57.159 at this point, oh, I know, right, we talked about 0:05:57.240 --> 0:06:02.760 influenza and I mistakenly said that influenza was a retrovirus. 0:06:03.240 --> 0:06:07.599 That is incorrect. Thank you Dustin for letting us know that. 0:06:07.960 --> 0:06:08.560 Yeah, thank you. 0:06:08.839 --> 0:06:12.760 But anyways, that's our correction. Influenza is an RNA virus, 0:06:12.839 --> 0:06:16.120 but it is not a retrovirus. So if you have 0:06:16.160 --> 0:06:18.320 a correction for us, you can go ahead and send 0:06:18.320 --> 0:06:20.760 that to this podcast Will Kill You at gmail dot com, 0:06:20.920 --> 0:06:22.719 or you can message us on any of our social 0:06:22.760 --> 0:06:26.039 media profiles as well. Yeah, that is all all right. 0:06:27.040 --> 0:06:30.960 That means that we're onto Quarantini's. Ooh, what are we 0:06:31.040 --> 0:06:31.920 drinking this week? 0:06:32.640 --> 0:06:34.719 This week is the Fever Reliever? 0:06:36.760 --> 0:06:39.080 Wonderful? And what is in the Fever Reliever? 0:06:39.440 --> 0:06:43.440 Well, since we're talking about malaria today, we're drinking basically 0:06:43.480 --> 0:06:46.000 a gin and tonic. Okay, And when I say basically, 0:06:46.040 --> 0:06:48.560 I mean it's a gin and tonic people with a line. 0:06:48.920 --> 0:06:52.360 Yes, all right, And we're going to get into why 0:06:52.400 --> 0:06:54.960 that has anything to do with malaria later on in 0:06:54.960 --> 0:06:56.760 the episode. Make sure you stay tuned. 0:06:56.880 --> 0:06:58.840 Tonic water has quinine in it. 0:06:59.560 --> 0:07:02.760 Yeah, it won't be any sort of effective dose. 0:07:02.600 --> 0:07:06.960 But no, no, no, just enough to be delicious chills 0:07:07.240 --> 0:07:11.400 chazz jaws, yes with a British accent. For many raisons 0:07:11.640 --> 0:07:14.000 chaos delicious. 0:07:13.680 --> 0:07:16.400 Gin and tonics were when I was living in Panama, 0:07:16.480 --> 0:07:17.600 they were my drink. 0:07:18.680 --> 0:07:20.120 Too bad that you weren't living in an area of 0:07:20.160 --> 0:07:22.000 Panama where malaria was a real risk factor. 0:07:22.120 --> 0:07:27.040 I don't think that's too bad, self medicare I'm pretty 0:07:27.080 --> 0:07:28.720 I'm pretty okay, you're happy with that fact. 0:07:29.680 --> 0:07:29.960 Cool. 0:07:40.720 --> 0:07:44.400 So, now that we've got our quarantines underway, we're going 0:07:44.400 --> 0:07:48.960 to delve right into the biology. Aaron, tell me about malaria. 0:07:49.040 --> 0:07:54.000 I will try my best. Malaria is a big one. 0:07:54.280 --> 0:07:57.200 And one of the things that makes malaria so interesting 0:07:57.600 --> 0:07:59.960 is the fact that it has a really complex life sitle, 0:08:00.760 --> 0:08:03.600 which means it's going to be complex to talk about today. 0:08:03.920 --> 0:08:05.880 But we're going to simplify it as much as possible. 0:08:06.040 --> 0:08:09.640 Yes, So malaria is caused by a parasite. This is 0:08:09.680 --> 0:08:11.960 the first disease that we're talking about on the show 0:08:12.000 --> 0:08:13.280 that's caused by a parasite. 0:08:13.360 --> 0:08:16.040 Can you explain to me the difference between a parasite 0:08:16.080 --> 0:08:16.840 and a pathogen. 0:08:17.440 --> 0:08:20.400 Yes, So we usually use the word pathogen to refer 0:08:20.480 --> 0:08:26.920 to viral and bacterial diseases, Okay. A parasite is usually 0:08:27.320 --> 0:08:32.520 referred to only for what are called protozoans or like 0:08:32.679 --> 0:08:34.120 parasitic worms and things. 0:08:34.200 --> 0:08:36.960 Okay, and protozoonins are not bacteria. 0:08:36.559 --> 0:08:40.080 Right, So protozoa it's not a great term, but it 0:08:40.240 --> 0:08:43.800 essentially means it's still a single celled organism, but it's 0:08:44.080 --> 0:08:47.240 much larger than a bacteria or a virus, and it's 0:08:47.320 --> 0:08:50.360 more closely related to plants and animals than it is to. 0:08:50.320 --> 0:08:53.079 Bacteria, so a little more complex, exactly. 0:08:53.320 --> 0:08:59.679 Yeah, so malaria is a protozoa all right. There are 0:08:59.720 --> 0:09:03.640 several different species of parasite that cause malaria. The one 0:09:03.640 --> 0:09:06.120 that causes the worst disease in humans and is the 0:09:06.120 --> 0:09:10.280 most widespread is called Plasmodium falciprum. This is the species 0:09:10.320 --> 0:09:13.240 that's the most common throughout most of Africa, and it 0:09:13.320 --> 0:09:16.320 replicates really quickly, so it causes a very severe form 0:09:16.360 --> 0:09:21.199 of disease. The other species are Plasmodium vivax, which is 0:09:21.240 --> 0:09:24.360 the most common species in Asia, and it, along with 0:09:24.440 --> 0:09:29.160 another species called Plasmodium o vale, have these dormant stages 0:09:29.559 --> 0:09:31.920 that kind of hang out in your liver for a 0:09:31.960 --> 0:09:35.000 long period of time where they're not really causing any 0:09:35.040 --> 0:09:39.679 active infection, not really causing any real symptoms, but they 0:09:39.679 --> 0:09:41.920 can just hang out there and then re emerge later 0:09:41.960 --> 0:09:44.119 in your life, like months or years later. 0:09:44.000 --> 0:09:48.400 Which is important also in the distribution for the mosquito 0:09:48.520 --> 0:09:52.080 and the seasonality of this, because something like falciprum has 0:09:52.160 --> 0:09:55.600 to occur where the species occurs year round, right, the 0:09:55.600 --> 0:09:59.240 pusquito species occurs year round, whereas something like vivacs can 0:09:59.320 --> 0:10:01.400 exist in a place that has more seasonality to it 0:10:01.440 --> 0:10:02.560 in terms of cold. 0:10:02.720 --> 0:10:08.280 Yeah, definitely. And then finally there's Plasmodium malaria, which is 0:10:08.320 --> 0:10:12.000 found pretty much worldwide and causes the most chronic infection 0:10:12.120 --> 0:10:15.720 if untreated. I should also note that there are other 0:10:15.760 --> 0:10:19.440 species of malaria that infect other mammals as well as birds. 0:10:20.200 --> 0:10:23.319 Avian malaria is actually really important and is a major 0:10:23.360 --> 0:10:26.200 cause of decline of native bird populations in Hawaii and 0:10:26.280 --> 0:10:29.120 other places. But unfortunately we don't have the time to 0:10:29.120 --> 0:10:32.000 talk about those today. Maybe we could have a future 0:10:32.000 --> 0:10:35.760 episode on avian malaria. Yeah, anyways, let's talk about the 0:10:35.760 --> 0:10:37.080 life cycle, shall we. 0:10:37.160 --> 0:10:37.760 Let's do it. 0:10:38.360 --> 0:10:42.840 So malaria infection starts when an infected female mosquito. Put 0:10:42.880 --> 0:10:45.920 my entomologists hat on here, because it's only female mosquitos 0:10:45.960 --> 0:10:48.839 that bite you and suck your blood. Male mosquitoes just 0:10:49.559 --> 0:10:54.199 drink nectar. They're just little beat bops. Okay, So, an 0:10:54.200 --> 0:10:58.200 infected female mosquito takes a blood meal, meaning sticks her 0:10:58.240 --> 0:11:00.960 snout into you and sucks your blood. And as she 0:11:01.080 --> 0:11:04.040 does this, the parasites which are in her salivary glands 0:11:04.040 --> 0:11:08.280 are injected into your bloodstream. These parasites, which look kind 0:11:08.320 --> 0:11:11.520 of like little spores, they're just little balls at this point, 0:11:12.040 --> 0:11:14.760 once in your blood, will infect your red blood cells, 0:11:15.160 --> 0:11:17.600 or in some cases, they'll travel through your bloodstream to 0:11:17.640 --> 0:11:21.480 your liver and infect your liver cells directly. Then, once 0:11:21.600 --> 0:11:24.800 inside of your cells, the parasites begin to replicate. They 0:11:24.840 --> 0:11:29.240 replicate and replicate and eventually explode out of your blood cells, 0:11:29.760 --> 0:11:33.240 and they'll fly freely through your bloodstream again. Uh oh, 0:11:33.280 --> 0:11:35.400 And this is what's actually causing the symptoms that we 0:11:35.440 --> 0:11:38.679 see in malaria is when these thousands of millions of 0:11:38.720 --> 0:11:42.520 parasites explode open your red blood cells and then travel 0:11:42.559 --> 0:11:45.840 through your blood to find new cells to infect. So 0:11:45.960 --> 0:11:49.400 now these parasites are free floating in your bloodstream and 0:11:49.440 --> 0:11:51.840 they can be picked up by another mosquito as it 0:11:51.880 --> 0:11:56.000 feeds on you. Then within the mosquito, the parasites have 0:11:56.080 --> 0:12:01.840 to travel through the mosquito's gut, survive through the stomach, replicate, reproduce. 0:12:02.600 --> 0:12:05.319 Then they have to exit the gut, which isn't easy 0:12:05.360 --> 0:12:08.559 to do because they're basically punching through the gut wall 0:12:08.640 --> 0:12:11.840 of this mosquito. Then they have to travel to the 0:12:11.880 --> 0:12:14.520 salivary glands where they can then get ready to start 0:12:14.520 --> 0:12:15.600 the cycle all over again. 0:12:16.280 --> 0:12:21.200 All this tells me is that I'm amazed that this 0:12:21.400 --> 0:12:24.079 is a real thing. Like, it's so cool the way 0:12:24.120 --> 0:12:28.360 it's so complex. How long it took for this to evolve, right, 0:12:28.800 --> 0:12:30.720 such a complex life cycle, it's such. 0:12:30.600 --> 0:12:33.640 This is what I love about vector borne diseases is 0:12:33.720 --> 0:12:37.640 how much more complex this becomes because you have this 0:12:37.840 --> 0:12:40.720 entire other organism and there is a part of this 0:12:40.920 --> 0:12:43.840 life cycle of this parasite that takes place only in 0:12:43.920 --> 0:12:47.040 the mosquito and is dependent on that mosquito. All players 0:12:47.080 --> 0:12:51.280 have to be there, exactly Cool. Yeah, so transmission to 0:12:51.320 --> 0:12:54.040 malaria isn't direct person a person. It happens just from 0:12:54.040 --> 0:12:59.400 the bite of this infected mosquito. Specifically, it's an anophies mosquito. 0:12:59.720 --> 0:13:02.680 There are several hundred species, but only about thirty or 0:13:02.720 --> 0:13:05.840 forty that are important in terms of human malaria transmission. 0:13:06.960 --> 0:13:10.720 And there's some evidence that once a mosquito is infected 0:13:10.960 --> 0:13:14.960 with malaria, like once these parasites are in the salivary 0:13:15.000 --> 0:13:19.080 glands and ready to infect a human, mosquitoes are more 0:13:19.120 --> 0:13:23.240 attracted to host, more persistent in their attempts to feed, 0:13:23.559 --> 0:13:27.360 and they feed on more hosts per feeding attempt, which 0:13:27.440 --> 0:13:30.440 is crazy because it's basically the malaria parasite going hey, 0:13:30.440 --> 0:13:32.400 I'm here, I'm ready to go. Better take a meal. 0:13:32.520 --> 0:13:34.199 Better take a meal, Better take a meal. 0:13:34.360 --> 0:13:37.199 That's super cool. It's host manipulation by a parasite. 0:13:37.320 --> 0:13:38.240 Yeah, it's crazy. 0:13:38.960 --> 0:13:41.880 That's one of my favorite themes, I guess, or like 0:13:41.960 --> 0:13:44.959 favorite things. And yeah, like the zombie fungus maybe we'll 0:13:44.960 --> 0:13:46.880 do an episode on cortyceps. 0:13:46.920 --> 0:13:50.800 Definitely, no question, we have to Okay, sorry to interrupt, No, 0:13:50.920 --> 0:13:54.080 you're fine. One thing I think that's really interesting about this, 0:13:54.160 --> 0:13:56.280 and I'll talk more about it later on, is just 0:13:56.360 --> 0:14:00.320 that in terms of thinking about prevention of malaria, On 0:14:00.360 --> 0:14:03.200 the one hand, it makes it a lot harder to 0:14:03.440 --> 0:14:06.960 deal with prevention when you have an entire other species 0:14:06.960 --> 0:14:10.920 that you're trying to deal with, But it also means 0:14:10.960 --> 0:14:13.960 that there's a lot of stages of the malaria parasite 0:14:13.960 --> 0:14:16.040 that you could potentially target that are outside of the 0:14:16.120 --> 0:14:18.400 human which I think is really interesting. So I'll talk 0:14:18.480 --> 0:14:20.440 more about that when we talk about the status of 0:14:20.920 --> 0:14:24.320 malaria in the world today. What else about malaria? So, 0:14:24.360 --> 0:14:27.080 the incubation period, which again is the time from when 0:14:27.160 --> 0:14:29.800 you're infected to when you show symptoms in this case, 0:14:29.840 --> 0:14:32.960 from when you're bit by a mosquito and until you 0:14:33.000 --> 0:14:35.400 have your first round of symptoms, is between seven and 0:14:35.520 --> 0:14:39.600 thirty days. And this large range depends on the species 0:14:39.600 --> 0:14:43.400 of parasite that you're infected with. Okay, so Plasmodium fauciperum, 0:14:43.440 --> 0:14:46.040 the one that's sort of the worst, has the shortest 0:14:46.040 --> 0:14:49.920 incubation period, while plasmodium malaria has the longest. 0:14:50.000 --> 0:14:52.480 That would make sense because you said falciprum replicate so 0:14:52.560 --> 0:14:53.600 quickly exactly. 0:14:54.600 --> 0:14:56.760 So in some cases, because you can have this really 0:14:56.800 --> 0:15:00.760 long incubation period, diagnosis and treatment can be somewhat harder, 0:15:00.960 --> 0:15:04.440 especially for example, if you're traveling, or you become infected 0:15:04.440 --> 0:15:07.080 while you're traveling and you come back to a country 0:15:07.080 --> 0:15:09.720 where malaria maybe isn't very common, it can be really 0:15:09.720 --> 0:15:12.160 difficult to diagnose because it might be several weeks or 0:15:12.240 --> 0:15:15.040 months until you actually have any symptoms. 0:15:15.640 --> 0:15:20.840 That makes sense, Yeah, so malaria's inside you. You've been 0:15:20.840 --> 0:15:24.680 bitten by a mosquito that has injected a bunch of parasites. 0:15:25.560 --> 0:15:26.680 What's my body gonna do? 0:15:27.520 --> 0:15:31.360 Well, First, there's something that's called classic malaria, which has 0:15:31.480 --> 0:15:35.080 a cold stage with shivering, feeling very cold, a hot 0:15:35.120 --> 0:15:38.920 stage where you have fever, headaches, vomiting, young children can 0:15:38.960 --> 0:15:41.760 have seizures, and then a sweating stage where you just 0:15:42.200 --> 0:15:45.840 sweat a lot. But I don't know why they call 0:15:45.880 --> 0:15:49.479 it classic malaria, because apparently this is a very rare presentation, 0:15:49.640 --> 0:15:52.080 like it doesn't usually happen this way. Really, Yeah, I 0:15:52.080 --> 0:15:54.320 don't know if maybe this is so maybe people have 0:15:54.400 --> 0:15:56.520 written about malaria in this way a lot, and that's 0:15:56.520 --> 0:16:00.720 why it's called classic. But realistically what happens is all 0:16:00.760 --> 0:16:04.400 at once, you have fever, chills, sweats, headaches, nausea, vomiting, 0:16:04.440 --> 0:16:10.880 body aches. You feel like absolute human garbage, human garbage. 0:16:12.320 --> 0:16:16.720 And this happens in cycles. A classic attack lasts for 0:16:16.880 --> 0:16:20.320 between six and ten hours and happens every two to 0:16:20.400 --> 0:16:25.239 three days, depending on the parasite species. So Plasmodium falciperum 0:16:25.440 --> 0:16:29.320 replicates every two days, as does vivax and ovale, whereas 0:16:29.360 --> 0:16:32.320 malaria replicates every three days. So that means that in 0:16:32.360 --> 0:16:36.080 your cells, they're basically taking two days to have a 0:16:36.120 --> 0:16:39.000 full cycle of replication and then they're bursting out of 0:16:39.040 --> 0:16:42.160 your cells, okay, And so that is how you end 0:16:42.240 --> 0:16:45.680 up with these fever and headaches, is all of these 0:16:45.800 --> 0:16:48.400 parasites all at once are bursting out of your cells 0:16:48.400 --> 0:16:49.280 and into your bloodstream. 0:16:49.360 --> 0:16:51.280 So each time you have this intense spike and all 0:16:51.320 --> 0:16:55.400 these symptoms, it's in response to the parasite reproducing exactly. 0:16:55.760 --> 0:16:57.600 And that is also when you're going to be most 0:16:57.680 --> 0:17:01.960 effective for mosquitoes, because that's when these stages that are 0:17:01.960 --> 0:17:04.520 effective to the mosquito are free floating in your bloodstream 0:17:04.560 --> 0:17:04.880 as well. 0:17:04.960 --> 0:17:05.920 Okay, that makes sense. 0:17:06.440 --> 0:17:10.119 Yeah, so that's most of what you need to know. 0:17:10.200 --> 0:17:13.480 I think about malaria biology. One thing that makes it 0:17:13.560 --> 0:17:16.720 difficult to control also is that diagnosis is really difficult. 0:17:17.480 --> 0:17:21.399 So typically it's done by microscopy. So you need a 0:17:21.440 --> 0:17:24.520 person who's very highly trained to actually take a smear 0:17:24.600 --> 0:17:27.719 of your blood on a microscope slide and look through it. 0:17:28.359 --> 0:17:32.199 And it's effective. But you have to have people that 0:17:32.240 --> 0:17:34.480 are very well trained and even very well trained people 0:17:34.760 --> 0:17:37.200 because you have these cycles. If you just take blood 0:17:37.240 --> 0:17:39.520 at the wrong time, you might not see them, or 0:17:39.560 --> 0:17:41.960 you might see things that look like malaria but aren't 0:17:41.960 --> 0:17:47.520 actually malaria. So basically microscopy is imperfect. There are other 0:17:47.680 --> 0:17:50.760 molecular methods that you can use for detection of malaria, 0:17:50.840 --> 0:17:55.040 but they're also not perfect, and in many cases they're 0:17:55.400 --> 0:17:59.360 expensive and sometimes cost prohibitive. But yeah, I think that's 0:17:59.400 --> 0:18:02.840 it for malaria biology. Okay, so do you want to 0:18:02.880 --> 0:18:04.040 hear about the history of malaria. 0:18:04.080 --> 0:18:22.600 Oh, I'm really excited about it. 0:18:22.600 --> 0:18:28.200 It's spans eons, eons, oh millions and millions of years. 0:18:28.280 --> 0:18:30.679 What that's got to be that's the first time We've 0:18:30.720 --> 0:18:32.840 talked about millions of years on this episode. 0:18:33.320 --> 0:18:38.920 Probably is malaria's history is Yeah, it's enormous, and we're 0:18:38.920 --> 0:18:39.760 going to get through it all. 0:18:40.280 --> 0:18:42.679 Yes, in the next ten minutes. 0:18:42.880 --> 0:18:46.760 No, uh, well, first we're going to go back to 0:18:46.760 --> 0:18:51.159 the Dinosaursky and malaria's evolutionary origins. Then I'm going to 0:18:51.240 --> 0:18:56.720 talk malaria before treatments were discovered, then Panama Canal time, yes, 0:18:56.920 --> 0:19:00.159 just a little bit, and the failed eradication campaigns the 0:19:00.160 --> 0:19:01.000 twentieth century. 0:19:01.520 --> 0:19:03.399 I'm thrilled, let's do this. Gave it to me. 0:19:04.280 --> 0:19:10.240 Malaria is an ancient, ancient disease, definitely prehistoric. Some researchers 0:19:10.400 --> 0:19:13.720 think that the parasite evolved from a free living plant species. 0:19:13.840 --> 0:19:17.320 A plant species, yeah, like algae or something. Yeah. So 0:19:17.480 --> 0:19:19.800 it has a bunch of genetic fragments that are similar 0:19:19.880 --> 0:19:21.719 to those used to make chlorophyll. 0:19:22.080 --> 0:19:22.159 What. 0:19:22.680 --> 0:19:24.600 Yeah, that's so cool. I never knew that. 0:19:24.840 --> 0:19:26.280 It's very it's very strange. 0:19:26.359 --> 0:19:29.600 I just assume that everything is like an animal because 0:19:29.640 --> 0:19:33.440 I'm oh, what does Matt call it? I have plant blindness? 0:19:33.720 --> 0:19:36.040 Yeah, you do, I think we both do. Yeah, a 0:19:36.040 --> 0:19:40.080 lot of disease ecologists have plant blindness. Definitely, Okay, anyway, 0:19:40.119 --> 0:19:44.520 so in prehistoric times, I'm talking like time of the dinosaurs, prehistoric, 0:19:45.280 --> 0:19:48.800 the ancestor of malaria made the jump from plant species 0:19:48.840 --> 0:19:52.480 to parasite. Scientists have found the DNA of a malaria 0:19:52.520 --> 0:19:56.080 species in a biting midge, which is an insect preserved 0:19:56.080 --> 0:19:58.240 an amber from one hundred million years ago. 0:19:59.119 --> 0:19:59.520 Stop. 0:20:00.119 --> 0:20:04.160 Yeah, that's thrilling, like Jurassic Park style. 0:20:04.440 --> 0:20:07.560 That's really Jurassic Yeah. Oh yeah, that's so cool. 0:20:08.160 --> 0:20:12.320 So long, long, long before malaria became a parasite of humans, 0:20:12.320 --> 0:20:16.080 it was probably a parasite of dinosaurs, which makes sense 0:20:16.200 --> 0:20:19.200 considering that there are malaria parasites in so many different 0:20:19.200 --> 0:20:23.080 groups of animals today, including birds and reptiles. Okay, but 0:20:23.200 --> 0:20:26.000 we know that modern malaria is transmitted by mosquitoes, not 0:20:26.080 --> 0:20:30.399 biting midges. So when did that happen? Probably around thirty 0:20:30.440 --> 0:20:34.040 million years ago. Eventually it became a parasite of humans 0:20:34.080 --> 0:20:38.080 maybe eight million years ago, wow, or ancestors of humans 0:20:39.200 --> 0:20:41.760 maybe fifteen thousand years ago. I mean, there's a lot 0:20:41.760 --> 0:20:42.240 of debate. 0:20:42.800 --> 0:20:46.359 Everyone in the U and I study plus or. 0:20:46.359 --> 0:20:50.000 Minus eight million years. In any case, once it was 0:20:50.080 --> 0:20:53.800 in humans, it never really left ever since malaria emerged 0:20:53.880 --> 0:20:58.240 as a human parasite. It has infected and killed billions. 0:20:58.800 --> 0:21:01.000 That's with a bee. That's what a be of people 0:21:01.040 --> 0:21:04.600 throughout history. Oh man, it doesn't really have the same 0:21:05.040 --> 0:21:08.760 wham like epidemic storyline that some of these other diseases 0:21:08.760 --> 0:21:09.760 that we've talked about have. 0:21:09.920 --> 0:21:11.600 Dinosaurs are a pretty big wham though. 0:21:11.760 --> 0:21:14.520 Oh yeah, absolutely, But like you know, in terms of 0:21:14.560 --> 0:21:17.679 a pandemic or an epidemic. But the numbers are still 0:21:17.760 --> 0:21:21.680 absolutely staggering, both an ancient and in modern times. Are 0:21:21.680 --> 0:21:27.680 you ready for the body count? Malaria probably killed half 0:21:28.600 --> 0:21:33.680 fifty percent of all of the humans who have ever lived. 0:21:35.200 --> 0:21:39.360 What about one hundred and eight billion people have existed 0:21:39.400 --> 0:21:43.720 at some point or another throughout history. That means that 0:21:43.760 --> 0:21:47.160 malaria has probably killed about fifty four billion of them. 0:21:47.560 --> 0:21:50.520 What on earth? Does that? Even? 0:21:51.920 --> 0:21:52.639 You can't even? 0:21:53.160 --> 0:21:55.080 I can't. I literally. 0:21:59.240 --> 0:22:02.479 Okay, no, we were millennials before, you know now. But 0:22:02.840 --> 0:22:06.800 also that number seemed really outrageous. Also, it's just too 0:22:07.560 --> 0:22:09.520 it's too much, it's you can't wrap your brain around it. 0:22:09.560 --> 0:22:11.720 All those things. Yeah, but I was like, all right, 0:22:11.800 --> 0:22:14.399 that seems wait, let's hold on a second. Let's take 0:22:14.400 --> 0:22:14.879 a step back. 0:22:15.520 --> 0:22:16.840 Exaggerating I saw. 0:22:16.640 --> 0:22:18.000 That and I was like, I really want to put 0:22:18.000 --> 0:22:19.880 that in the podcast. And I was like, I don't know. 0:22:20.200 --> 0:22:22.520 That seems a little bit bogus. I looked into it, 0:22:23.240 --> 0:22:27.119 and it may be on the upper end of things, 0:22:27.119 --> 0:22:31.760 but it seems certainly possible. There's obviously, yeah, there's well, 0:22:32.080 --> 0:22:34.040 I don't know if you can make a confidence interval 0:22:34.040 --> 0:22:37.679 with this type of you know, back of the cuff calculation, 0:22:38.200 --> 0:22:43.240 but it is possible. Wow, it's insane. 0:22:43.320 --> 0:22:46.639