Malaria therapy

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Classification according to ICD-10
B53.8 Other parasitologically confirmed malaria
ICD-10 online (WHO version 2019)

The malaria therapy is a historical treatment that at different diseases was used. The patient was intentionally infected with a relatively harmless form of malaria . Plasmodia , the unicellular pathogen causing malaria, were transmitted to patients by injection or by provoking mosquito bites in order to cure their disease through the attacks of malaria.

Whereas the malaria therapy intentionally triggered Malaria is also Impfmalaria , artificial , therapeutic or induced malaria called, to distinguish it from an unintentional or "natural" acquired malaria.

The malaria therapy was before the antibiotic era the only effective therapy for progressive paralysis , a late-stage syphilis . The use of other diseases is controversial and experimental . Recently, malaria therapy has been proposed for the treatment of borreliosis and HIV disease, and z. T. used on a trial basis. Because it has a lower chance of success than other treatment options or has more dangerous side effects that are more stressful for the patient and the effectiveness of any disease has not yet been proven in a controlled study , malaria therapy is considered obsolete. The US-American health authority "Center for Disease Control" is calling for malaria therapies to be reported to the authorities in patients .

discovery

In 1917, during the First World War , Julius Wagner-Jauregg , director of the Lower Austrian State Healing and Nursing Institution for the Nervous and Mentally Ill in Vienna , took up his proposal , which was already thirty years old, and vaccinated nine patients with progressive paralysis with blood of a malaria sufferer. He observed an effect that was considerably more favorable than with all previously used therapy methods, and worked out a procedure combined with arsphenamine , which was soon widely recognized and for the discovery of which he was awarded the Nobel Prize in Medicine in 1927 . If malaria therapy was applied when the first symptoms of paralysis appeared, a complete remission could be observed in over 80% of the treated patients .

methodology

Plasmodia are used, which trigger malaria tertiana . Two different methods of transmission are used: vaccination of infectious blood or bite from a mosquito that carries plasmodia.

Cultivation of pathogens

The malaria therapy should be carried out technically easiest if some patients are being treated at a hospital at any time and at the same time as " culture media used" for the used agent strain. During the typical bouts of fever, blood containing plasmodia in the merozoite stage is taken from the patients in order to vaccinate and re-infect other patients. In order to keep the risk of spreading other pathogens as low as possible, blood from otherwise healthy people suffering from malaria is preferably used, if it is available.

Stinging Anopheles -Mücke

Ornate is the breeding of Anopheles - mosquitoes , their infection and the transmission of Plasmodium in the sporozoite stage created by mosquito bite . In order to control the dose of the transmitted pathogens, it is necessary to determine the concentration of sporozoites in the mosquito's salivary gland. At the English Horton Malaria Laboratory in Epsom , Surrey , 13,000 paralysis patients were treated with malaria between 1926 and 1960, and a total of over 100,000 mosquitoes were bred.

Preserved blood containing the pathogens can be used less reliably, and no useful method has been developed to maintain sufficient virulence of the plasmodia during transport or storage. Therefore, mainly a few large centers practiced malaria therapy .

therapy

Erythrocytes with plasmodia

When the malaria pathogens are transmitted through blood , 5 to 10  ml of blood are administered intramuscularly or intravenously . After five to ten attacks of fever, which usually occur every 48 hours and last more than twelve hours, malaria therapy with quinine , chloroquine, or another anti-malarial agent that kills the pathogens living in the blood is stopped. For high fever or long-lasting bouts of fever can with a dose that is sufficiently reduces the amount parasites docked be.

The main contraindications are heart and circulatory diseases due to the physical strain caused by a fever of over 40 degrees Celsius and blood and spleen diseases , especially anemia , due to the destruction of a large number of red blood cells by the plasmodia. Complications to watch out for include potassium deficiency , hypoglycemia, and acute kidney failure, and a ruptured spleen . After months or years, malaria can flare up again because pathogens in the liver can remain in a dormant state ( hypnozoites ) resistant to anti-malarial agents .

Because there is no suitable method of killing pathogens in the blood without reducing the virulence of the plasmodia, the simultaneous transmission of other diseases is a risk with malaria therapy . This also applies to transmission by mosquitoes.

If Anopheles mosquitoes, which can transmit malaria, occur naturally in the vicinity of the hospital, mosquito nets and mosquito nets in the rooms of treated patients must prevent the uncontrolled spread of malaria.

Mechanism of action

Plasmodia activate the immune system so intensely that there are presumably enough immunocompetent cells and immunologically active cytokines such as interleukins and tumor necrosis factor to combat a disease that could have existed opportunistically up to that point. Wagner-Jauregg already suspected that the effect was not due to the change in body temperature alone ( therapeutic hyperthermia ). According to more recent studies, the effect on diseased nerve tissue in progressive paralysis may also be based on a direct stimulation of the regeneration of neurons by cytokines.

The activation of the body's own defenses is also clearly referred to as "re-tuning". Representatives of alternative medicine , who therapeutically like to rely on self-healing powers , see malaria therapy as a "biological" method of increasing the immune system.

Experimental use

Transferring pathogens such as malaria to humans for research purposes is ethically questionable, even if the goal is to find curative treatments for incurable diseases. Occasional improvements in serious illnesses are attributed to infections with a high fever , but comparative epidemiological studies also attribute infections such as malaria to a protective function against certain illnesses. However, given the risks and side effects of malaria therapy, these motivations are generally not considered sufficient. Therapy attempts were therefore often made in times of war , when human life was less valued, and preferably on inmates of prisons , concentration camps, or psychiatric hospitals . At least until the mid-1960s, malaria therapy was used at the Hoff Clinic in Vienna, including on children in homes.

schizophrenia Gerhard Rose , head of the tropical medicine department at the Robert Koch Institute in Berlin and the Malaria Research Institute in Pfafferode near Mühlhausen , carried out experiments on patients in psychiatric hospitals with malaria pathogens, including pathogens, in search of a therapy for schizophrenia during the National Socialist dictatorship more dangerous tropica malaria . The documents were secured by US authorities at the end of the war in 1945. Rose was sentenced to life imprisonment at the Nuremberg Doctors ' Trial in 1947 .
tuberculosis Claus Schilling , tropical medicine specialist , carried out experiments with malaria pathogens on prisoners and prisoners of war in the Dachau concentration camp from 1942 to 1945, including to treat severe infectious diseases, namely tuberculosis. In the first Dachau trial he was therefore sentenced to death and executed in 1946. Records of the experiments had been destroyed before the camp was liberated.
cancer Werner Zabel , head of a private clinic in Berchtesgaden , tried malaria therapy between 1950 and 1970 on 19 cancer patients. The tests were discontinued due to technical difficulties and the associated dangers. An evaluation was not published, " in an inexplicable way the logs with the courses and results got lost. " [ Weblink : Windstosser ]
Thrombangiitis obliterans F. Corelli treated thrombangiitis obliterans (Winiwarter-Bürger's disease) with malaria in Italy . He published about it in Italian journals until 1973.
Lyme disease At the beginning of the 1990s, a warning was issued in the USA against receiving treatment for Lyme disease with malaria in Mexico .
HIV Henry Heimlich , Chen Xiao Ping and a research team in Guangzhou published the results of pilot studies in 1997 and 2003 on malaria therapy for HIV patients. For violating the rules for medical experiments, participating US researchers were investigated by their university.

Other parasite therapies

Individual evidence

  1. ↑ Historians roll up the post-war history of the "Klinik Hoff". The March 7, 2012 standard .

literature

  • Julius Wagner-Jauregg : On the effect of febrile illnesses on psychoses in: Year books for psychiatry , Vol. VII Vienna 1887
  • Julius Wagner-Jauregg: About the effect of febrile illnesses on psychoses Psychiatrisch-Neurologische Wochenschrift 20/1918 pp. 132-134 and 251-255
  • Julius Wagner-Jauregg: Prevention and treatment of progressive paralysis by vaccine malaria in: Handbuch der experimentalherapie supplementary volume Munich 1931
  • Werner Zabel : The malaria therapy in carcinoma and the technique of the malaria blood conservation in: The additional therapy of tumor diseases , Karl F. Haug Verlag Heidelberg 1970 ISBN 3-7760-26-6
  • Wolfgang U. Eckart, H. Vondra: Malaria and World War II German malaria experiments 1939-45 Parassitologia Rom 42/2000 pp. 53-58 PMID 11234332 .

Web links