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For Some, Surviving Malaria Could Be 'a Worse Outcome Than Dying'

August 21, 2000|From Baltimore Sun

After the "Long Rains" raked the ragged fields along Kenya's coast, the fever returned to claim its melancholy harvest.

Ria Sulubu lay in a hospital ward in the town of Kilifi last summer, his soft brown skin shining against the white sheet. The 3-year-old panted. A desk lamp warmed him. His tiny fists clenched and unclenched, his eyes darting fitfully. Others in the cramped ward coughed or moaned.

In some villages in sub-Saharan Africa, malaria kills one out of five children before their fifth birthday. Unlike many other infectious diseases, malaria confers only limited immunity. Small children can contract malaria 30 or 40 times. Even if the disease doesn't kill them, it can cause severe brain damage or make them vulnerable to other infections.

Ria suffered from a severe complication called cerebral malaria. For 10 days, seizures jolted his brain. His medical chart for June 25 records more than a dozen episodes, and if doctors couldn't stop them, Ria would die.

Two weeks earlier, Ria had been bitten by a female mosquito, seeking the nourishment of human blood before she laid her eggs. The insect's saliva carried Plasmodium falciparum, one of four species of the malaria parasite and the one responsible for almost all the deaths.

Eyelash-shaped parasites slipped through Ria's skin and into his blood. Within minutes, each parasite wiggled into a liver cell and adopted a beady shape, like a fish egg. They poked out a chemical net to snare nutrients from the blood. Over the next 10 days, the parasites changed form, gorged and created tens of thousands of offspring. Leaving the liver, they invaded red blood cells, shifted shape again to fool the body's defenses, and multiplied. Every 48 hours, new parasites burst in unison from their host blood cells and swarmed into fresh cells.

With each eruption, the parasites created showers of cellular debris. That provoked Ria's immune system to pump out chemicals called cytokines, causing shattering chills, fevers and pain. His body's thermostat rose from 98.6 degrees Fahrenheit to over 105. His body ordered his muscles to shiver, generating heat through friction. It is the defining symptom of a malaria infection. A roller coaster of chills and fevers followed. Every two days, the parasites increased tenfold. In a week, Ria's blood was loaded with tens of millions of them.

Ria's fever soared, and he became listless and weak. His mother, Fatuma, carried him to a private health clinic and paid about $3.60--a day's pay for her husband--for what probably was chloroquine.

Twenty years ago, the drug would have helped. Because local strains are increasingly resistant to chloroquine, it didn't help Ria. (Several drugs are still effective and might have cured him, but they are more expensive and often not available in rural areas.)

By the next day, he didn't have enough healthy blood cells left to deliver oxygen through his body. The boy gasped for breath. Soon, some of his organs began to fail. The parasites began to clog the capillaries in Ria's brain, and he fell into a coma.

Fatuma bundled the boy up and carried him several miles to the highway, where she caught a bus to Kilifi. A doctor sent him to the hospital's intensive care unit, a building with eight metal frame beds, a hole in the floor for a toilet, and little else. It was one of the worst malaria seasons in memory. So many children were sick, they crowded three to a bed.

There, seizures jolted Ria, shocking the delicate circuitry of his brain. Twice, doctors tried to halt the seizures by injecting him with Valium, with no effect. Finally, the doctor injected Ria with her most powerful remedy, phenobarbital. The drug might have killed him, but the seizures could destroy his brain. After 65 recorded seizures, Ria's siege ended.

Fatuma was murmuring to her son a few days later when Ria turned to listen. He was coming out of his coma. But, she realized, he couldn't sit up or talk. And the seizures had left him blind.

Fatuma's prominent cheekbones glistened with perspiration, her eyes sagged with fatigue. She had spent a week by Ria's bed. "Now I want to take him home," she said.

Dr. James Berkley, a young British-born physician, said: "Given the level of severity, he will not recover," he said quietly. "That's about as bad as malaria gets. In some ways, it's a worse outcome than dying."

Fatuma washed Ria and slung him in a cloth on her back. Ria stared blankly. How, his mother was asked, will she cope once she gets him home? Fatuma's exhausted face hardened. Finally, she whispered: "The baby is OK now." And she turned to leave.

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