Affects >2400 million people, over 40% of the world's population, in more than 100 countries.
Every year 300 million to 500 million people suffer from this disease (90% of them in sub-Saharan Africa, two thirds of the remaining cases occur in six countries- India, Brazil, Sri Lanka, Vietnam, Colombia and Solomon Islands)
About 1.5 million to 3 million people die of malaria every year (85% of these occur in Africa)
One child dies of malaria somewhere in Africa every 20 sec, and one malarial death occurs every 12 sec somewhere in the world.
Estimated annual expenditure on malaria research, prevention and treatment: US$84 million/year
Malaria Kills more people than AIDS
Malaria kills in one year what AIDS kills in 15 years
For every death due to HIV/AIDS there are about 50 deaths due to malaria
To add to the problem is the increasing drug resistance to the established drug.
Continues to be most important cause of fever and morbidity in the world.
Name is derived from Italian word
Mal’ aria or bad air
Malaria Human Malaria is caused by one of protozoan parasites: Plasmodium falciparum Plasmodium vivax Plasmodium ovale Plasmodium malariae Plasmodium knowlesi- forested regions of South East Asia Malaria is transmitted through the bite of an infected female Anopheles mosquito
Life cycle of malarial parasite
Malaria Diagnosis & Treatment
Defined as symptomatic malaria without signs of severity or evidence ( clinical or laboratory )of vital organ dysfunctional
Suspected mostly on the basis of fever or a history of fever
Other signs and symptoms include :
Muscle and joint aches
Manifestations of severe malaria include:
Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities
Severe anemia due to hemolysis
Abnormalities in blood coagulation and thrombocytopenia
Cardiovascular collapse and shock
Parasitological diagnosis of Malaria
Prompt parasitological confirmation by microscopy or alternatively by RDTs is recommended in all patients suspected of malaria before treatment is started.
Treatment solely on the basis of clinical suspicion may be considered in areas of high transmission where parasitological diagnosis is not available or is likely to delay treatment, particularly in high risk groups such as:
WHO-Current and Future directions “ Drug management of malaria” “ Malaria endemic countries which are experiencing high levels of resistance to currently used anti-malarial drugs as monotherapy are advised to switch over to combination therapy ”
Treatment of Uncomplicated P.Falciparum Infection
The treatment of choice for uncomplicated falciparum malaria is a combination of two or more antimalarial medicines with different mechanisms of action.
ACTs are the recommended treatments for uncomplicated falciparum malaria.
The artemisinin derivative components of the combination must be given for at least three days for an optimum effect.
ACTs Currently recommended by the WHO : Artemether-lumefantrine Artesunate + Amodiaquin Artesunate + Mefloquine, Artesunate + sulfadoxine–pyrimethamine. Dihydrortemisinin + piperaquine Artemesinin –based combination therapies should be used in preference to sulfadoxine-pyrimethamine (sp) + amodiaquine (aq)
2 nd line antimalarial treatment
Alternative ACT known to be effective in the region
Artesunate+tetracycline/doxycycline/clindamycin, any of these combinations should be given for 7 days
any of these combinations should be given for 7 days
Treatment of Severe P.Falciparum
Severe malaria is a medical emergency . after rapid clinical assessment and confirmation of the diagnosis, full doses of parenteral antimalarial treatment should be started without delay with any effective antimalarial first available.
For adults, artesunate 2.4 mg/kg body weight iv or im given on admission (time = 0), then at 12 h and 24 h, then once a day is the recommended treatment. Quinine is an acceptable alternative if parenteral artesunate is not available: quinine 20 mg salt/kg body weight on admission (iv infusion or divided im injection), then 10 mg/kg body weight every 8 h; infusion rate should not exceed 5 mg salt/kg body weight per hour.
Artemesinine or Quinine for severe falciparum ?? WHO view point :
“ Artesunate is the treatment of choice for adults with severe malaria in view of a recent multicentric trial in which mortality in the Artesunate group was reduced by 34.7% as compared to Quinine group”.*
*SEAQUAMAT , Lancet , 2005
Also known as qinghaosu, has been used in China for the treatment of fever for over a thousand years
Potent and rapidly acting blood schizontocide and is active against all Plasmodium species
Unusually broad activity against asexual parasites, killing all stages from young rings to schizonts. In P. falciparum malaria also kills the gametocytes which are otherwise only sensitive to primaquine.
-severe-- vomiting, abd pain, diarrhea, severe vertigo
2) Hypersensitivity reactions
- urticaria, bronchospasm, thrombocytopenia, hemolytic anemia to life threatening hemolytic uremic syndrome
3) ECG abnormalities
-prolongation of QT interval
IM injections –acidic and can cause pain, focal necrosis, abscess formation common cause of sciatic nerve injury.
Rapid IV injection- hypotension and cardiac arrest
Must be given only by infusion, never injection
Overdose-oculotoxicity and cardiotoxicity
Treatment of P. vivax and P.ovale Infection
Chloroquine 25 mg base/kg body weight divided over 3 days, combined with primaquine 0.25 mg base/kg body weight, taken with food once daily for 14 days is the treatment of choice for chloroquine-sensitive infections. in oceania and south-east asia, the dose of primaquine should be 0.5 mg/kg body weight.
ACTs combined with primaquine for chloroquine-resistant vivax malaria.
Treatment of P. vivax and P.ovale Infection
In mild-to-moderate G6pd deficiency , primaquine 0.75 mg base/kg body weight should be given once a week for 8 weeks. in severe G6pd deficiency, primaquine is contraindicated and should not be used.
Where ACT (exception as+sp) has been adopted as the first-line treatment for P. falciparum malaria, it may also be used for P. vivax malaria in combination with primaquine for radical cure. artesunate plus sulfadoxine-pyrimethamine is not effective against P. vivax in many places.