Malaria emerges from a disequilibrium of the system 'human-plasmodium-mosquito' (HPM) Key words: malaria -control -coadaptation -coevolution -infectron -vaccine -antimalarial drugs -mosquitoinsecticide -equilibrium
MALARIA, A CHANGING CONCEPTThe association of humans with plasmodia is probably as old as Humanity. However, our perceptions about the infection have been drastically changed throughout the time. In ancient times, and for a long while, malaria and several other infectious diseases were considered as due to God's punishment for human sins. During the Middle Age, the idea that the environment could affect human health by means of miasms associated with swamps was also applied to malaria. During the period of Renaissance, the Italian physician Girolamo Fracastoro introduced the concept of contagion, which was replaced by that of infectious agents three centuries later. Therefore, by the end of the XIX century malaria was considered as an infectious disease caused by plasmodia and transmitted by mosquitoes. The better understanding of the pathological aspects of the host-parasite relationships accomplished during the next century allowed to consider the major clinical-pathological manifestations of malaria as caused by an uncontrolled activation of the immune system by plasmodia, death sometimes occurring in the presence of minimal parasitemia or even in the absence of circulating parasites. Since the endothelium is the most affected structure in brain, kidney, and lung involvement, and the cells and molecules of the immune system are the major responsible for that, severe malaria could be considered as an immune endotheliopathy.A novel view is emerging at the dawn of the XXI century: malaria as the result of disequilibrium of the system 'human-plasmodium-mosquito' (HMP). If this system is maintained in equilibrium, malaria does not ensue, and the result is asymptomatic plasmodium infection. A vast body of evidence supports this assumption and, as shown in this essay, all phenomena concerning the relationships among the components of the system HMP involve coadaptation. The recognition of these coadaptive linkages, leading to equilibrium of the system and evolution of its components, compels to a reinterpretation of the immunology, therapeutics and vaccinology of malaria, and may contribute to change the tenets of malaria control strategies.