The Pathophysiology of Malaria

The resurgence of malaria in the past two decades has stimulated a considerable amount of scientific and medical research. Understanding of pathophysiological mechanisms in malaria has advanced considerably in areas, such as the pathogenesis of metabolic dysfunction, the molecular processes involved in cytoadherence, and the causes of anaemia. However, in other areas progress has been slow. Much of the recent research has been conducted either with animal models or with cultured P. fakiparum parasites. The relevance of the observations, and the hypotheses they generate, to disease in man still needs to be established in many cases. The roles of cytoadherence, rosetting, and cytokine release have come to the fore, whereas the parts played by immune damage, intravascular coagulation, and increased vascular permeability have receded. Clinical investigation has taken some of the mystery out of malaria, but still relatively little is known for certain. The next challenge is to translate these advances in understanding of pathophysiology into improved treatments.