A Life-Threatening Disease from a 2-Milligram Bug: Submicroscopic Malaria in India

By Loret Haas-Hanser

In a scientific, technological era it is difficult to imagine diseases infecting hundreds of millions of people per year- especially a disease that has been around since 1880. Malaria, although not a new disease, is still incredibly life-threatening if left untreated. Malaria, as defined by the World Health Organization, is a fatal parasitic disease transferred to humans by female mosquitos (WHO, 2020). Once bitten by an infected mosquito, symptoms may take over a week to appear and are hard to categorize specifically as Malaria. The initial symptoms of fever, headache and chills can quickly turn into severe anemia, respiratory breakdown, metabolic acidosis, multiple organ failure, and other horrific conditions. The most recent data from the Center for Disease Control suggests that in 2018, there were 228 million diagnoses and over 400,000 deaths due to malaria on a global scale (CDC, 2018). India is one of the many nations involved in a worldwide Malaria Elimination Act, with goals for completion being from 2017-2022 (van Eijk et al., 2019).

Despite an overall decrease in the past decade, Malaria in India remains a huge public health issue. Unfortunately, many cases of Malaria in India are often asymptomatic and are only observable on a submicroscopic level. Recently, a group of researchers conducted surveys and clinical studies at three epidemiologically different transmission sites throughout India. Essentially, Malaria is an extremely difficult disease to treat as many cases are asymptomatic, and can then suddenly take a serious turn. General antiparasitic treatments are successful once a malaria case has been identified, however, with many Indian malaria cases being asymptomatic, it is difficult to know when someone needs treatment before symptoms worsen. In India overall and specifically at these three transmission sites, Chennai, Nadiad, and Rourkela, individuals with Malaria typically are individuals impacted by protozoal parasites and pathogens P. Vivax and P. Falciparum. In the three sites researchers distributed extensive clinical questionnaires to be completed as well as completing molecular testing to understand infectious patterns of the disease (van Eijk et al., 2019).

Cross-sectional surveys were administered to a total of 6,645 participants. Following the survey a blood sample was taken and run through a rapid diagnostic test to analyze hemoglobin level, as well as the presence of the parasites and pathogens. The final step was a polymerase chain reaction (PCR) to analyze the specific sequences of DNA impacted by the Malaria disease. The researchers were able to conclude that there were some common risk factors such as rainy weather, gender, age and immune system susceptibility. They concluded that due to the asymptomatic and submicroscopic nature of the disease, it is incredibly necessary to administer surveys to entire populations in order to reduce transmission (van Eijk et al., 2019).

Malaria in three sites, 2012-2015, van Eijk et al., 2019

Every disease that impacts the health and functionality of humankind is alarming, no matter how small or detectible it may be. Malaria has been a disease stealing people’s lives and physical health for centuries. With many infections being asymptomatic and submicroscopic, the disease manipulates the immune system and can frequently even evade notice by individuals- making it extremely difficult to study and treat. Thankfully, with modern scientific techniques, scientists are making progress that is pushing them closer to their goal of decreasing and eventually eliminating malaria.


van Eijk, A. M., Sutton, P. L., Ramanathapuram, L., Sullivan, S. A., Kanagaraj, D., Priya, G. S. L., ... & Wassmer, S. C. (2019). The burden of submicroscopic and asymptomatic malaria in India revealed from epidemiology studies at three varied transmission sites in India. Scientific reports, 9(1), 1-11.

World Health Organization. Fact sheet about Malaria. (2020, February 14).

Center for Disease Control - Parasites - Malaria. (2019, December 11).

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