Malaria 1234

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  • The life cycle of all species that infect humans is basically the same. There is an exogenous asexual phase in the mosquito called sporogony during which the parasite multiplies. There is also an endogenous asexual phase that takes place in the vertebrate or human host that is called schizogeny. This phase includes the parasite development that takes place in the red blood cell, called the erythrocytic cycle and the phase tthat takes place in the parencymal cells in the liver, called the exo-erythrocytic phase. The exo-erthrocytic phase is also called the tissue phase. The schizogeny that takes place here can occur without delay during the primary infection or can be delayed in the case of relapses of malaria. I will focus on the development of the parasite in the human host.
  • Malaria 1234

    1. 1. © 2012 Right Doctor MALARIAMALARI Prepared By Department of Community Medicine Shaheed Monsur Ali Medical College 2014
    2. 2. © 2012 Right Doctor Malaria   Malaria is a protozoal disease caused by  infection with parasites of the genus  Plasmodium and transmitted to man by  certain species of infected female  Anopheline mosquito. Malaria   Malaria is a protozoal disease caused by  infection with parasites of the genus  Plasmodium and transmitted to man by  certain species of infected female  Anopheline mosquito.
    3. 3. © 2012 Right Doctor Bangladesh situation: In Bangladesh 1 crore 13 lakh population are at risk of malaria in 13 districts. 80% of the infections occur at Rangamati, Bandarban and Khagrachhari districts of Chittagong Hill tracts. Affected population was 26,851 and total number of deaths due to malaria was 15 at 2013. Bangladesh situation: In Bangladesh 1 crore 13 lakh population are at risk of malaria in 13 districts. 80% of the infections occur at Rangamati, Bandarban and Khagrachhari districts of Chittagong Hill tracts. Affected population was 26,851 and total number of deaths due to malaria was 15 at 2013.
    4. 4. © 2012 Right Doctor Epidemiology of malaria:Epidemiology of malaria: As regards malaria problem, Bangladesh can be broadly divided into three distinct epidemiological zones/areas: 1.High risk area: this includes forested hilly areas, forest fringe areas and foothill areas and covers C.H. Districts (Rangamati, Khagrachhari, Bandarban and Chittagong), Cox’s Bazar district, greater Sylhet (parts), and frontier areas of greater Mymensingh district. This area is characterized by presence of stable malaria and high immune status among indigenous population. As regards malaria problem, Bangladesh can be broadly divided into three distinct epidemiological zones/areas: 1.High risk area: this includes forested hilly areas, forest fringe areas and foothill areas and covers C.H. Districts (Rangamati, Khagrachhari, Bandarban and Chittagong), Cox’s Bazar district, greater Sylhet (parts), and frontier areas of greater Mymensingh district. This area is characterized by presence of stable malaria and high immune status among indigenous population.
    5. 5. © 2012 Right Doctor 2. Epidemic prone area: This area includes 20 upazilas and 43 unions under 9 districts namely Sylhet, Sunamgonj, Habigonj, Moulvibazar, Netrokona, Mymensingh, Sherpur, Jamalpur and Kurigram. 3. Low risk areas: These comprise vast plain cultivable areas. 2. Epidemic prone area: This area includes 20 upazilas and 43 unions under 9 districts namely Sylhet, Sunamgonj, Habigonj, Moulvibazar, Netrokona, Mymensingh, Sherpur, Jamalpur and Kurigram. 3. Low risk areas: These comprise vast plain cultivable areas.
    6. 6. © 2012 Right Doctor Agent: Human malaria is caused  by one of the four species  of Plasmodium- P.vivax,  P.ovale, P.falciparum and  P.malariae; the causative  agents of vivax (benign  tertian) malaria, ovale  (ovale tertian) malaria,  falciparum (malignant  tertian) malaria and  malariae (quartan)  malaria respectively. Agent: Human malaria is caused  by one of the four species  of Plasmodium- P.vivax,  P.ovale, P.falciparum and  P.malariae; the causative  agents of vivax (benign  tertian) malaria, ovale  (ovale tertian) malaria,  falciparum (malignant  tertian) malaria and  malariae (quartan)  malaria respectively.
    7. 7. © 2012 Right Doctor Exo- erythrocytic (hepatic) cycle Sporozoites Mosquito Salivary Gland Malaria Life Cycle Life Cycle Gametocytes Oocyst Erythrocytic Cycle Zygote Schizogony Sporogony Hypnozoites (for P. vivax and P. ovale)
    8. 8. © 2012 Right Doctor
    9. 9. © 2012 Right Doctor Life cycle of malaria parasite:Life cycle of malaria parasite: The life cycle of malaria parasite is completed in two hosts- the vector mosquitoes (the definitive host) in which the sexual cycle takes place and the human host (the intermediate host) in which asexual cycle occurs. The life cycle of malaria parasite is completed in two hosts- the vector mosquitoes (the definitive host) in which the sexual cycle takes place and the human host (the intermediate host) in which asexual cycle occurs. When the female mosquito takes an infective blood meal it ingests both asexual and sexual forms of the parasite. Asexual forms are digested in the mosquito’s stomach but the mature sexual forms gametocytes survive. The male and female gametocytes undergo further development and form micro (male) and female (macro) gametes. A male gamet fertilizes a female gamet and the resultant structure (zygote, which later on develops into ookinete) penetrates the stomach wall. When the female mosquito takes an infective blood meal it ingests both asexual and sexual forms of the parasite. Asexual forms are digested in the mosquito’s stomach but the mature sexual forms gametocytes survive. The male and female gametocytes undergo further development and form micro (male) and female (macro) gametes. A male gamet fertilizes a female gamet and the resultant structure (zygote, which later on develops into ookinete) penetrates the stomach wall.
    10. 10. © 2012 Right Doctor Ookinete Oocyst in 7-14 days Sporozoites (the infective form) Ookinete Oocyst in 7-14 days Sporozoites (the infective form)
    11. 11. © 2012 Right Doctor • The oocyst rupture and the sporozoites are released into the body cavity of the mosquito and eventually appear in its salivary gland. When it bites a human, sporozoites are injected together with saliva and circulate in the blood stream for less than an hour, by which time some of them invade liver cells in which develop pre-erythrocytic forms. • The oocyst rupture and the sporozoites are released into the body cavity of the mosquito and eventually appear in its salivary gland. When it bites a human, sporozoites are injected together with saliva and circulate in the blood stream for less than an hour, by which time some of them invade liver cells in which develop pre-erythrocytic forms. After 6-15 days these rupture and release thousands of merozoites. Some of these are phagocytosed, others enter erythrocytes, and the erythrocytic phase begins. They pass through the stages of trophozoite and schizont. It ends by liberation of merozoites, which infect fresh red blood cells. Some erythrocytic forms do not divide but become male and female gametocytes. These are the sexual forms and infective to mosquito. After 6-15 days these rupture and release thousands of merozoites. Some of these are phagocytosed, others enter erythrocytes, and the erythrocytic phase begins. They pass through the stages of trophozoite and schizont. It ends by liberation of merozoites, which infect fresh red blood cells. Some erythrocytic forms do not divide but become male and female gametocytes. These are the sexual forms and infective to mosquito.
    12. 12. © 2012 Right Doctor Host factors: Human is the intermediate host Mosquito is the definitive host. Human host: Immunity in malaria are of two types- natural or innate immunity and acquired immunity. Host factors: Human is the intermediate host Mosquito is the definitive host. Human host: Immunity in malaria are of two types- natural or innate immunity and acquired immunity.
    13. 13. © 2012 Right Doctor Vector mosquito: In Bangladesh following species are important vectors of malaria: Vector mosquito: In Bangladesh following species are important vectors of malaria: A. philippinensis A. dirus A. sundaicus A. aconitus A. maculatus A. philippinensis A. dirus A. sundaicus A. aconitus A. maculatus Other species causing malaria in SEARO countries are- A.culcifacies, A. stephensi, A.aconitus, A. fluviatilis. Other species causing malaria in SEARO countries are- A.culcifacies, A. stephensi, A.aconitus, A. fluviatilis.
    14. 14. © 2012 Right Doctor Environmental factors: The best conditions for the development of Plasmodia in the Anopheles and the transmission of the infection are when the mean temperature is within a range of 20-30°C, while the mean relative humidity is at least 60%. Environmental factors: The best conditions for the development of Plasmodia in the Anopheles and the transmission of the infection are when the mean temperature is within a range of 20-30°C, while the mean relative humidity is at least 60%.
    15. 15. © 2012 Right Doctor Diagnosis of malaria: The diagnosis of malaria is based on a) Clinical features and b) laboratory investigations. Diagnosis of malaria: The diagnosis of malaria is based on a) Clinical features and b) laboratory investigations.
    16. 16. © 2012 Right Doctor Clinical features: The natural H/O malaria is characterized by incubation period, prepatent period, primary attack (composed of paroxysms), latent period (parasitic latency) and recurrences (long term relapses) Clinical features: The natural H/O malaria is characterized by incubation period, prepatent period, primary attack (composed of paroxysms), latent period (parasitic latency) and recurrences (long term relapses) The typical attack has 3 distinct stages: 1.cold stage ( 1 hour or so), 2. hot stage (<1 to 6 hours), 3. sweating stage ( 1 hour or so) The typical attack has 3 distinct stages: 1.cold stage ( 1 hour or so), 2. hot stage (<1 to 6 hours), 3. sweating stage ( 1 hour or so)
    17. 17. © 2012 Right Doctor Malaria pyrexia: •Types- intermittent, remittent and subcontinuous •Periodicity-quotidian, tertian, quartan •Regularity-every 48 or 72 hours is very characteristic of malaria; it may come at the same time of the day. Malaria pyrexia: •Types- intermittent, remittent and subcontinuous •Periodicity-quotidian, tertian, quartan •Regularity-every 48 or 72 hours is very characteristic of malaria; it may come at the same time of the day. Other features- i) Anaemia- Hemolytic anaemia in falciparum malaria, ii) Dehydration, iii) Spleen enlargement, iv) Liver enlargement. Other features- i) Anaemia- Hemolytic anaemia in falciparum malaria, ii) Dehydration, iii) Spleen enlargement, iv) Liver enlargement.
    18. 18. © 2012 Right Doctor Laboratory diagnosis: In P. falciparum infection, parasites are usually present in the blood for a few hours after an attack/paroxysm and then become negative, whereas P.vivax and P. malariae infections always yield positive blood films. Thick films are ideal for scanty parasitaemia, whereas thin films are ideal for species identification. Laboratory diagnosis: In P. falciparum infection, parasites are usually present in the blood for a few hours after an attack/paroxysm and then become negative, whereas P.vivax and P. malariae infections always yield positive blood films. Thick films are ideal for scanty parasitaemia, whereas thin films are ideal for species identification.
    19. 19. © 2012 Right Doctor Malaria prevention and control: 1. Personal protection measures: •Destruction of the vector mosquito on the spot: by space spraying. •Protection against mosquito bites: I.Screening of houses II.Use of repellents III.Bed net untreated IV.Insecticide impregnated bed net –these are being distributed by the Bangladesh malaria control programme in high risk areas. •Individual chemoprophylaxis Malaria prevention and control: 1. Personal protection measures: •Destruction of the vector mosquito on the spot: by space spraying. •Protection against mosquito bites: I.Screening of houses II.Use of repellents III.Bed net untreated IV.Insecticide impregnated bed net –these are being distributed by the Bangladesh malaria control programme in high risk areas. •Individual chemoprophylaxis
    20. 20. © 2012 Right Doctor 2. Vector control measures: •Environmental management •Biological methods •Genetic control •Chemical control 2. Vector control measures: •Environmental management •Biological methods •Genetic control •Chemical control
    21. 21. © 2012 Right Doctor 3. Anti-parasite measures: Treatment of malaria (in high risk areas): Presumptive treatment of all suspected malaria cases: •Day 1: Tab. Chloroquine- 10 mg/kg body wt(600mg adult dose); Tab. Primaquine- 0.75 mg/kg body wt(45 mg adult dose) •Day 2: Tab. Chloroquine -10 mg/kg body wt (600mg adult dose) •Day 3: Tab. Chloroquine-5 mg/kg body wt (300mg adult dose) 3. Anti-parasite measures: Treatment of malaria (in high risk areas): Presumptive treatment of all suspected malaria cases: •Day 1: Tab. Chloroquine- 10 mg/kg body wt(600mg adult dose); Tab. Primaquine- 0.75 mg/kg body wt(45 mg adult dose) •Day 2: Tab. Chloroquine -10 mg/kg body wt (600mg adult dose) •Day 3: Tab. Chloroquine-5 mg/kg body wt (300mg adult dose)
    22. 22. © 2012 Right Doctor •Radical treatment after microscopic confirmation of species: P. vivax- Tab. Primaquine- 0.25 mg/kg body wt (15 mg adult dose) daily for 5 days P. falciparum-No further treatment required. •In Chloroquine resistance P. falciparum cases: Single dose of 25 mg/ kg bw tab. Sulfalene/Sulfadoxine and 1.25 mg/ kg bw Pyrimethamine combination (3 tablets adult dose); thereafter Tab. Primaquine- 0.75 mg/kg body wt. •Radical treatment after microscopic confirmation of species: P. vivax- Tab. Primaquine- 0.25 mg/kg body wt (15 mg adult dose) daily for 5 days P. falciparum-No further treatment required. •In Chloroquine resistance P. falciparum cases: Single dose of 25 mg/ kg bw tab. Sulfalene/Sulfadoxine and 1.25 mg/ kg bw Pyrimethamine combination (3 tablets adult dose); thereafter Tab. Primaquine- 0.75 mg/kg body wt.
    23. 23. © 2012 Right Doctor Treatment of malaria (in low risk areas): Presumptive treatment of all suspected malaria cases: Day 1: Tab. Chloroquine- 10 mg/kg body wt(600mg adult dose Radical treatment after microscopic confirmation of species: P. vivax- Tab. Chloroquine- 10 mg/kg body wt single dose and Tab. Primaquine- 0.25 mg/kg body wt (15 mg adult dose) daily for 5 days P. falciparum- Tab. Chloroquine- 10 mg/kg body wt and Tab. Primaquine- 0.75 mg/kg body wt single dose. Treatment of malaria (in low risk areas): Presumptive treatment of all suspected malaria cases: Day 1: Tab. Chloroquine- 10 mg/kg body wt(600mg adult dose Radical treatment after microscopic confirmation of species: P. vivax- Tab. Chloroquine- 10 mg/kg body wt single dose and Tab. Primaquine- 0.25 mg/kg body wt (15 mg adult dose) daily for 5 days P. falciparum- Tab. Chloroquine- 10 mg/kg body wt and Tab. Primaquine- 0.75 mg/kg body wt single dose.
    24. 24. © 2012 Right Doctor Chemoprophylaxis: • Groups of persons to be considered for prophylaxis: Non-immune visitors to malarious areas: A. Chloroquine 300 mg base weekly (adult): the first dose to be given one week before leaving for endemic area; to be continued for 4-6 weeks after leaving the endemic area. B. In low to moderate Chloroquine resistance: Chloroquine 300 mg weekly or Chloroquine 300 mg weekly plus proguanil 200mg daily. C.In high Chloroquine resistance areas: SP (sulfadoxin/sulfalene- pyrimethamine) one tablet weekly plus Chloroquine 300 mg weekly. Chemoprophylaxis: • Groups of persons to be considered for prophylaxis: Non-immune visitors to malarious areas: A. Chloroquine 300 mg base weekly (adult): the first dose to be given one week before leaving for endemic area; to be continued for 4-6 weeks after leaving the endemic area. B. In low to moderate Chloroquine resistance: Chloroquine 300 mg weekly or Chloroquine 300 mg weekly plus proguanil 200mg daily. C.In high Chloroquine resistance areas: SP (sulfadoxin/sulfalene- pyrimethamine) one tablet weekly plus Chloroquine 300 mg weekly.
    25. 25. © 2012 Right Doctor Malaria Control/Eradication in Bangladesh:Malaria Control/Eradication in Bangladesh:
    26. 26. © 2012 Right Doctor Presented By: Dr. Dep. Of Community Medicine

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