Dr. Johanna Daily’s interest in global health started in her first year of medical school where she studied what was then called tropical medicine. And her passion has only grown. Dr. Daily, who is a professor in the department of medicine (infectious diseases) and in the department of microbiology & immunology, has been laser focused on malaria, which has been her life’s work.
Dr. Daily’s excitement about the advances to date and what’s on the horizon is contagious (so to speak). We recently spoke with her about her experiences and what motivates her.
What sparked your interest in the field of infectious disease and why global health and malaria in particular?
I was interested in diseases of poverty and curious about the world so in medical school I took an elective at Kenyatta Hospital in Nairobi. It was an externship on the pediatric ward and I saw a lot of children with malaria. This was my first real-life exposure to tropical medicine and it propelled me on my career path.
During residency, I did internal medicine but spent a month at the London School of Tropical Medicine where I observed a lot of people doing research and I had this revelation that I could explore a disease of interest and apply a scientific approach to improve outcomes.
I selected a fellowship studying malaria with a very well-known malaria research group and spent a lot of time in the lab learning how to grow the parasite and looking at gene function. This led to my interest in severe malaria where people fall into a coma – known as cerebral malaria.
Cerebral malaria has perplexed doctors because no one understands what actually causes the coma and why some people with malaria fall into a coma and others don’t.
What kind of research have you done? What are you most excited about?
I have worked on malaria drug resistance and malaria immunology as well as looking at malaria in the Bronx where there are some 60,000 African immigrants. One of the things we ask ourselves is are we good at diagnosing it here in the U.S.? There are a lot of factors at play for doctors who don’t commonly see malaria cases and in a patient population that may present in ways that mimic common conditions like the flu or a stomach bug. In fact, Montefiore sees about 10-20 cases of malaria annually, usually during the summer when African immigrants go visit friends and relatives in their home countries. One of our medical students who did a year of master’s in clinical research with me studied patients who were admitted with malaria in the Montefiore Health System. He found that children were often misdiagnosed (43% of the time) before they were finally diagnosed at Montefiore and admitted. So, a key area is educating our patients about how to prevent malaria and how to access care, as well as educate our frontline providers who, unlike me, are not thinking about malaria 24/7.
Presently, my focus is on what causes coma in malaria. We believe that it has something to do with a molecule found in our blood – called pipecolic acid. The malaria parasite can generate high levels of pipecolic acid. There are some old studies in unrelated diseases showing that pipecolic acid normally crosses into the brain and could cause an unconscious state.
We found that the levels of pipecolic acid in the blood of children in Malawi who had cerebral coma were abnormally elevated compared to children with malaria who did not have coma. So now we are going to examine their cerebral spinal fluid to measure pipecolic acid. We also have an animal model of cerebral malaria where we can actually measure the level of pipecolic acid in brain tissue, try to knock its production out of the parasite, and see if the coma doesn’t occur in the animal model. Dr. Aristea Galanopoulou (a professor in the Saul R. Korey Department of Neurology - pediatric neurology - and in the Dominick P. Purpura Department of Neuroscience) and I are collaborating to determine whether pipecolic acid is causing an unconscious state, and if so, how.
Dr. Daily recently received a five-year grant from the National Institute of Allergy and Infectious Diseases to support this research.
How quickly after someone gets bitten by a malaria carrying mosquito do symptoms start?
There are five types of malaria that infect humans. The one that is most prevalent and fatal and often drug resistant, typically presents in U.S. travelers within 30 days of returning to the U.S. This is the P falciparum species. We have found that chemoprophylaxis is needed to reduce the incidence of malaria in U.S. residents. [Related: “Know Before You Go: For U.S. Visitors to Malaria-Endemic Countries, Prophylactic Measures Targeting Country-Specific Malaria Strains is Wise,” an interview with Dr. Daily that appears in the August 19, 2022, issue of Progress Note.]
It has been such an exciting experience working in infectious disease. To be working in the field when AIDS went from being a death sentence to a manageable disease was truly breathtaking. I witnessed patients dying and then suddenly the protease inhibitors were decreasing mortality by 50% and AIDS became a manageable disease. And most recently, with COVID-19, we all saw how scientists came together and in one year developed a vaccine that has saved so many lives.
In terms of malaria, there is excitement about vaccines, and, overall, a renewed enthusiasm about malaria control and eradication. It’s all going to hinge on having a potent vaccine, which has been difficult to make because of the antigenic variation of the parasite. But I think there are some breakthroughs coming down the line, which is so exciting.
Globally, rates of malaria transmission have dropped over the past 20-30 years. There are only eight high transmission countries and if we can help eradicate transmission in those countries and throughout the globe in the next couple of years, I would be happy to be out of a job.
Posted on: Friday, November 18, 2022