The Fever

by Sonia Shah

  While we debate, and argue, and haphazardly collect our strength to fight malaria, the parasite refines its plague upon us. Unlike us, Plasmodium does not reenact failed strategies and weak defenses, its historical memory shot. The evolution of its predation is progressive, methodical, probing.

  Plasmodium may have evolved a fifth species to prey upon humankind. In 2008, researchers found that more than a quarter of a sample of one thousand malaria patients in Malaysia harbored something altogether unexpected: Plasmodium knowlesi, a parasite previously believed to be confined to monkeys. As booming, tree-felling human populations increasingly intrude into monkey habitat, experts suspect, they’ve offered themselves as a new blood source for P. knowlesi to exploit. The parasite has already been found in humans in Thailand and China. Whether it will make its rounds into the rest of the malarious world remains unknown. For now, its victims must hope for quick diagnosis and prompt treatment. With the shortest life cycle of any malaria species, P. knowlesi can unleash tremendous masses of parasites rapidly.97

  Chloroquine-resistant falciparum parasites have arrived on the doorstep of the global economy. As drug traffickers and others ply the Caribbean’s cerulean waters on their way to the Panama Canal, they stop at the remote beaches that fringe the Panamanian coast, where Kuna communities live much as they have for centuries, untouched by road or rail. When an especially virulent strain of malaria broke out there in 2003, the Panamanian authorities couldn’t do much about it. The dissolution of the global eradication campaign and the political neglect of malaria that followed had seen spending on mosquito control in Panama drop from $1.20 per capita per year to just 19 cents.98

  In 2005, the coastal Kuna paddled their dugout canoes through miles of jungle until they arrived at Chepo, just outside Panama City, for a meeting of Kuna leaders. They strung their hammocks alongside their Kuna brethren who lived there. Every night, Chepo’s plentiful mosquitoes feasted on their blood, and then flitted over to the next hammock and bit the locals, too. In the morning, the Chepo Kuna, especially the young ones, who are eager to abandon the old ways, went off to their jobs in the pizza parlors of Panama City, where their warm bodies jostled with those of the tourists, from Michigan and New York and Essex and Rome, discharged from the cruise ships anchored in the canal.

  The entire economy, it is said, would have to break down in order for malaria to resettle in developed nations such as the United States. And yet mosquito-borne West Nile virus and Japanese encephalitis have spread unchecked. In 2002, California had a single case of West Nile virus; in 2003, there were three, according to the Centers for Disease Control. By 2004, there were 779 cases nationwide; in 2005, 873. In 2008, there were more than 1,300.99 The economy survives, despite it.

  The U.S. economy tolerates, too, those pockets of humid, neglected anarchy where Plasmodium builds its strongholds, such as the drowned cities of the South, deprived of electricity and order in the wake of the 2005 hurricanes. Malaria parasites continually shower upon the nation. Between 2005 and 2006 more than three thousand people in the United States fell ill with malaria picked up from West Africa, Asia, and elsewhere.100 Every now and again, the local mosquitoes start to transmit the parasites to people who’ve never broached a U.S. border. Between 1957 and 1994, American mosquitoes infected seventy-four people in the United States with malaria.101

  It wouldn’t take much for the malarial mosquitoes of Europe to start transmitting the parasite once again. Perhaps if Russia cut off Europe’s natural gas supply, as it did in the winter of 2006, rendering a blackout that might stall the water pumps. Or if a distracting health emergency occurred, like the 2003 heat wave that killed more than thirty thousand Europeans over the course of a single season.

  The local Anopheles vectors, in Europe as in North America, are as abundant as they ever were. And every couple of years, the mosquitoes pick up some parasites and start to bite the locals.102

  Their warm blood beckons.

  NOTES

  1. MALARIA AT OUR DOORSTEP

  1. www.stratfor.com/global_market_brief_panama_canal_expansion.

  2. Pan American Health Organization, “Malaria in Panama, 1998–2004: Time Series Epidemiological Data from 1998 to 2004.”

  3. Médecins Sans Frontières, “ACT NOW to Get Malaria Treatment That Works to Africa,” April 2003.

  4. G. Sabatinelli et al., “Malaria in the WHO European Region,” Euro Surveillance 6, no. 4 (April 2001): 61–65.

  5. World Health Organization, World Malaria Report 2005, available at www.rbm.who.int/wmr2005/html/exsummary_en.htm.

  6. Sabatinelli et al., “Malaria in the WHO European Region.”

  2. BIRTH OF A KILLER

  1. Interview with Themba Mzilahowa, medical entomologist, Blantyre, Malawi, February 20, 2007.

  2. Nicholas A. V. Beare et al., “Malarial Retinopathy: A Newly Established Diagnostic Sign in Severe Malaria,” American Journal of Tropical Medicine and Hygiene 75, no. 5 (2006): 790–97.

  3. Correspondence with Terrie Taylor, March 4, 2007.

  4. Interview with Terrie Taylor, February 19–21, 2007.

  5. Roy Porter, The Greatest Benefit to Mankind (New York: W. W. Norton, 1997), 25.

  6. Andrew Spielman and Michael D’Antonio, Mosquito: A Natural History of Our Most Persistent and Deadly Foe (New York: Hyperion, 2001), 44–45.

  7. Richard Carter and Kamini Mendis, “Evolutionary and Historical Aspects of the Burden of Malaria,” Clinical Microbiology Reviews 15, no. 4 (October 2002): 579.

  8. Carl Zimmer, Parasite Rex: Inside the Bizarre World of Nature’s Most Dangerous Creatures (New York: Touchstone, 2000), 17.

  9. Ibid., 17–18.

  10. David J. Marcogliese and Judith Price, “The Paradox of Parasites,” Global Bio-diversity 3 (1997): 7–15.

  11. “Herbicide Hope for Malaria,” BBC News, January 31, 2003.

  12. Graeme O’Neill, “Pathways to Destruction,” The Bulletin, February 12, 2003.

  13. Carter and Mendis, “Evolutionary and Historical Aspects of the Burden of Malaria,” 564–94.

  14. Lewis W. Hackett, Malaria in Europe: An Ecological Study (London: Oxford University Press, 1937), 201.

  15. Yuemei Dong et al., “ Anopheles gambiae Immune Responses to Human and Rodent Plasmodium Parasite Species,” PLoS Pathogens 2, no. 6 ( June 2006): e52.

  16. R. E. Sinden et al., “Mosquito-Malaria Interactions: A Reappraisal of the Concepts of Susceptibility and Refractoriness,” Insect Biochemistry and Molecular Biology 34 (2004): 625–29.

  17. David A. Warrell and Herbert M. Gilles, eds. Essential Malariology, 4th ed. (London: Hodder Arnold, 2002), 59.

  18. Angelika Sturm et al., “Manipulation of Host Hepatocytes by the Malaria Parasite for Delivery into Liver Sinusoids,” Science 313 (2006): 1287–90.

  19. Dominic P. Kwiatkowski, “How Malaria Has Affected the Human Genome and What Human Genetics Can Teach Us About Malaria,” American Journal of Human Genetics 77 (2005): 171–90.

  20. Spielman and D’Antonio, Mosquito, 15.

  21. Ibid., 15–16.

  22. Warrell and Gilles, eds. Essential Malariology, 12–13.

  23. Robert Sallares, Malaria and Rome: A History of Malaria in Ancient Italy (Oxford: Oxford University Press, 2002), 16.

  24. Robert A. Anderson et al., “The Effect of Plasmodium yoelii nigeriensis Infection on the Feeding Persistence of Anopheles stephensi Liston Throughout the Sporogonic Cycle,” Proceedings: Biological Sciences 266 (September 7, 1999): 1729–33.

  25. Jacob C. Koella et al., “The Malaria Parasite, Plasmodium falciparum, Increases the Frequency of Multiple Feeding of Its Mosquito Vector, Anopheles gambiae,” Proceedings of the Royal Society of London 265 (1998): 763–68.

  26. Anthony James, “Blocking Malaria Parasite Invasion of Mosquito Salivary Glands,” Journal of Experimental Biology 206 (2003): 3817–21.

  27. Heather Ferguson and Andrew F. Read, “Why Is the Effect of Malaria Parasites on Mosquito Survival Still Unresolved?”
Trends in Parasitology 18, no. 6 ( June 2002): 256–61.

  28. Renaud Lacroix et al., “Malaria Infection Increases Attractiveness of Humans to Mosquitoes,” PLoS Biology 3, no. 9 (September 2005): e298.

  29. Kevin Graham, “Rare Gene Pairing Lethal to Boy,” St. Petersburg Times, August 23, 2006; D. J. Weatherall and J. B. Clegg, “Inherited Haemoglobin Disorders: An Increasing Global Health Problem,” Bulletin of the World Health Organization 79, no. 8 (2001): 704.

  30. J. D. Smyth, Introduction to Animal Parasitology, 3rd ed. (Cambridge, UK: Cambridge University Press, 1994), 126–35.

  31. Sallares, Malaria and Rome, 12.

  32. Ibid.

  33. Warrell and Gilles, eds., Essential Malariology, 26–27.

  34. Ibid., 24–25.

  35. Carter and Mendis, “Evolutionary and Historical Aspects of the Burden of Malaria,” 564–94.

  36. Ibid.

  37. Sallares, Malaria and Rome, 151, citing Garnham 1966.

  38. Warrell and Gilles, eds., Essential Malariology, 24–25.

  39. Carter and Mendis, “Evolutionary and Historical Aspects of the Burden of Malaria,” 564–94.

  40. Ibid.

  41. Sir Malcolm Watson, African Highway: The Battle for Health in Central Africa (London: John Murray Publishers, 1953), 232.

  42. Nina L. Etkin, “The Co-evolution of People, Plants, and Parasites: Biological and Cultural Adaptations to Malaria,” Proceedings of the Nutrition Society 62 (2003): 311–17; James L. A. Webb, “Malaria and the Peopling of Early Tropical Africa,” Journal of World History 16, no. 3 (2005): 269–91.

  43. Francisco J. Ayala and Mario Coluzzi, “Chromosome Speciation: Humans, Drosophila, and Mosquitoes,” PNAS 102, suppl. 1 (May 3, 2005), 6535–42.

  44. Mario Coluzzi, “The Clay Feet of the Malaria Giant and Its African Roots: Hypotheses and Inferences About Origin, Spread, and Control of Plasmodium falciparum,” Parassitologia 41 (1999): 277–83.

  45. Ayala and Coluzzi, “Chromosome Speciation,” 6535–42.

  46. Sallares, Malaria and Rome, 25.

  47. Institute of Medicine, Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance (Washington, D.C.: National Academies Press, 2004), 144.

  48. Kwiatkowski, “How Malaria Has Affected the Human Genome and What Human Genetics Can Teach Us About Malaria,” 171–90.

  49. Carter and Mendis, “Evolutionary and Historical Aspects of the Burden of Malaria,” 564–94.

  50. Kwiatkowski, “How Malaria Has Affected the Human Genome,” 171–90.

  51. Weatherall and Clegg, “Inherited Haemoglobin Disorders,” 704–12.

  52. Siske S. Struik and Eleanor M. Riley, “Does Malaria Suffer from Lack of Memory?” Immunological Reviews 201 (2004): 268–90.

  53. Hackett, Malaria in Europe, 172.

  54. Interview with Dr. Simon Glover, QEH, Blantyre, Malawi, February 21, 2007; Beare et al., “Malarial Retinopathy,” 790–97.

  55. Kwiatkowski, “How Malaria Has Affected the Human Genome,” 171–90.

  56. Ibid.

  57. C. Dobano et al., “Expression of Merozoite Surface Protein Markers by Plasmodium falciparum–infected Erythrocytes in Peripheral Blood and Tissues of Children with Fatal Malaria,” Infection and Immunity 75, no. 2 (February 2007): 643–52.

  58. Warrell and Gilles, eds., Essential Malariology, 206.

  59. Estimate is of one million deaths from malaria every year, 700,000 to 900,000 of which occur among African children under the age of five.

  3. SWEPT IN MALARIA’S CURRENT

  1. “The Kingdom of Thirst,” New York Times, March 27, 1884.

  2. Address by Peter Asoka, Fourth MIM Pan-African Malaria Conference, November 2005, Yaoundé, Cameroon.

  3. James L. A. Webb, “Malaria and the Peopling of Early Tropical Africa,” Journal of World History 16, no. 3 (2005): 269–91.

  4. R. L. Miller et al., “Diagnosis of Plasmodium falciparum Infections in Mummies Using the Rapid Manual Para Sight-F Test,” Transactions of the Royal Society of Tropical Medicine and Hygiene 88 (1994): 31–32.

  5. Leonard Jan Bruce-Chwatt and Julian de Zulueta, The Rise and Fall of Malaria in Europe: A Historico-epidemiological Study (Oxford: Oxford University Press/Regional Office for Europe of the World Health Organization, 1980), 17.

  6. Robert S. Desowitz, The Malaria Capers: More Tales of Parasites and People, Research and Reality (New York: W. W. Norton, 1991), 150.

  7. Richard Carter and Kamini Mendis, “Evolutionary and Historical Aspects of the Burden of Malaria,” Clinical Microbiology Reviews 15, no. 4 (October 2002): 564–94, quoting from H. E. Sigerist, A History of Medicine, Volume 1: Primitive and Archaic Medicine (New York: Oxford University Press, 1951).

  8. Herbert S. Klein, The Atlantic Slave Trade (Cambridge, UK: Cambridge University Press, 1999), 68.

  9. Philip D. Curtin, Disease and Empire: The Health of European Troops in the Conquest of Africa (Cambridge, UK: Cambridge University Press, 1998), 21.

  10. Letter from David Livingstone to Dr. James Ormiston McWilliam, November 28, 1860, available at www.livingstoneonline.ucl.ac.uk, published in Transactions of the Epidemiological Society of London, 1860.

  11. Klein, The Atlantic Slave Trade, 59.

  12. Philip D. Curtin, “Epidemiology and the Slave Trade,” Political Science Quarterly 83, no. 2 ( June 1968): 190–216; Curtin, Disease and Empire, 1.

  13. Curtin, Disease and Empire, 3.

  14. Ann Vileisis, Discovering the Unknown Landscape: A History of America’s Wetlands (Washington, D.C.: Island Press), 4.

  15. Ibid., 16.

  16. W. V. King and G. H. Bradley, “Distribution of the Nearctic Species of Anopheles” and “Bionomics and Ecology of Nearctic Anopheles,” in Forest Ray Moulton, ed., A Symposium on Human Malaria with Special Reference to North America and the Caribbean Region (Washington, D.C.: American Association for the Advancement of Science, 1941), 71–87.

  17. Jon Kukla, “Kentish Agues and American Distempers: The Transmission of Malaria from England to Virginia in the Seventeenth Century,” Southern Studies 25, no. 2 (Summer 1986): 135–47.

  18. Quoted in Kukla, “Kentish Agues and American Distempers,” 135–47.

  19. See Thomas J. Wertenbaker, Virginia Under the Stuarts, 1607–1988 (Princeton, N.J.: Princeton University Press, 1914), 11; Darrett B. Rutman and Anita H. Rutman, “Of Agues and Fevers: Malaria in the Early Chesapeake,” The William and Mary Quarterly 33, no. 1 ( January 1976): 31–60; Alan Taylor, American Colonies: The Settling of North America (New York: Penguin, 2001), 130–31. Margaret Humphreys agrees with Wyndham Blanton and Carville Earle, who argue that the deadly fevers that afflicted the Jamestown colonists were probably typhoid, not malaria, because the colonists were not nonimmune to vivax, and there was no source of falciparum—Margaret Humphreys, Malaria: Poverty, Race, and Public Health in the United States (Baltimore: Johns Hopkins University Press, 2001), 24.

  20. Quoted in Rutman and Rutman, “Of Agues and Fevers,” 31–60.

  21. Taylor, American Colonies, 145.

  22. Ibid., 147.

  23. Kukla, “Kentish Agues and American Distempers,” 135–47.

  24. Mary J. Dobson, “Mortality Gradients and Disease Exchanges: Comparisons from Old England and Colonial America,” Social History of Medicine 2, no. 3 (December 1989): 259–97.

  25. Oliver Wendell Holmes, Boylston Prize Dissertations for the Years 1836 and 1837 (Boston: Charles C. Little and James Brown, 1838), 11–12.

  26. Dobson, “Mortality Gradients and Disease Exchanges,” 259–97.

  27. Klein, The Atlantic Slave Trade, 21, 27, 28, and Curtin, “Epidemiology and the Slave Trade,” 190–216.

  28. Klein, The Atlantic Slave Trade, 2.

  29. Curtin, “Epidemiology and the Slave Trade,” 190–216.

  30. Klein, The Atlantic Slave Trade, 10.

  31. Ibid., 72, 120–26.

  32. Ibid., 91.

  33. Ibid., 77, 122, 125, 152.

  34.
Alexander Falconbridge, An Account of the Slave Trade on the Coast of Africa (London: J. Phillips, 1788), 11, 51.

  35. Klein, The Atlantic Slave Trade, 81, 125.

  36. St. Julien Ravenel Childs, Malaria and Colonization in the Carolina Low Country 1526–1696 (Baltimore: Johns Hopkins University Press, 1940), 28.

  37. Quoted in Karen Ordahl Kupperman, “Fear of Hot Climates in the Anglo-American Colonial Experience,” William and Mary Quarterly 41, no. 2 (April 1984): 213–40.

  38. James Stevens Simmons, Malaria in Panama (Baltimore: Johns Hopkins University Press, 1939), 6.

  39. Ibid., 4.

  40. John Prebble, The Darién Disaster: A Scots Colony in the New World, 1698–1700 (New York: Holt, Rinehart and Winston, 1968), 76.

  41. Simmons, Malaria in Panama, 6.

  42. Ibid., 6–7.

  43. Ibid., 4.

  44. Ignacio J. Gallup-Diaz, The Door of the Seas and Key to the Universe (New York: Columbia University Press, 2000).

  45. Taylor, American Colonies, 217.

  46. Ravenel Childs, Malaria and Colonization, 245.

  47. Ibid., 231.

  48. Ibid., 221.

  49. Peter H. Wood, Black Majority: Negroes in Colonial South Carolina from 1670 Through the Stono Rebellion (New York: Alfred A. Knopf, 1975), 67.

  50. Ibid.

  51. Fiammetta Rocco, The Miraculous Fever-Tree: Malaria and the Quest for a Cure That Changed the World (New York: HarperCollins, 2003), 171–74.

  52. H. Roy Merrens and George D. Terry, “Dying in Paradise: Malaria, Mortality, and the Perceptual Environment in Colonial South Carolina,” Journal of Southern History 50, no. 4 (November 1984): 542.

  53. Jill Dubisch, “Low Country Fevers: Cultural Adaptations to Malaria in An tebellum South Carolina,” Social Science and Medicine 21, no. 6 (1985): 641–49.