CDC

2. Malaria
 It is a major health problem and cause of
morbidity and premature death.
 It is increasing due to drugs resistance and
failure of vector control
 Malaria is endemic in 91 countries. 40% of the
world’s population at risk
 Each year: 300-500 million new cases 90% in
Africa

3. Plasmodium species:
 P.falciparum
 P.vivax.
 P.malaria
 P.ovale.

4. Transmission:
 1. By the bite of an infected mosquito.
 2. By transfusion of infected blood.
 3. Contaminated needles with infected blood.
 4.Congenitally, Transplacental

5. Life cycle of plasmodium:
 Infected female anopheles mosquito inoculate sporozoites when it
takes blood meal.
 In human host:
 sporozoites infect liver cells & multiply by schizogony
(Exoerythrocytic) some sporozoites of P.vivax & P.ovale become
dormant hypnozoites in liver to be activated after several months.
Liver schizont rupture releasing merozoites that attack RBCs,
become trophozoites and multiply by schizogony, with
P.falciparum in capillaries of body organ. Schizont rupture,
merozoites infect new RBCs.
 Some merozoite develop into male & female gametocytes.

6.  In the mosquito:
 ♀ and ♂ gametocytes fuse to form Zygote → Oocyst in stomach
walls full of sporozoites, that rupture to reach the salivary glands.

8. Clinical features and pathology:
The characteristic feature of malaria is fever
caused by the release of toxins
typical malaria is seen in non-immune individuals This
includes:
 children in any area.
 Adults in hypoendemic areas.
 Any visitors from anon-malarious region.

9.  Incubation period:
 The normal incubation period is 10–21 days,
but can be longer.
 Symptoms may occur later in those who have
taken anti -malaria medication as prevention
 The condition usually starts with vague
symptoms such as malaise ,nausea, loss of
appetite ,vomiting , diarrhea , and pain
 The most common symptom is fever

10. Classical stages of fever of malaria
1. The cold stage:
In which the patient feels cold ,start to shiver
From head to foot, passes into rigors ,and his
Temperature rises to around 40 degrees.
This stage lasts about 15 minute to one hour.

11. 2. The hot stage:
The patient feels intense heat , the temperature
remain at the level of cold stage or may rise to
hyperpyrexia. nausea, vomiting, headache are
Common. the patient may go into delirium.
This stage lasts (1-4) hours.

12. The hot stage

13. 3. The sweating stage :
Profuse sweating, temperature fall ,and the patient begin to
feel comfortable then he goes into deep sleep. This stage
lasts (1-4) hours. These stage are most often
recognized in p.vivax infection.
In rare cases the patient may be afebrile in presence of
a very severe p.falciparum infection.

14. The sweating stage

15. p.Vivax and p.ovale infection
 The paroxysm is repeated 48 hours later.
 The illness is relatively mild.
 Liver& spleen enlarged gradually and may be
tender.
 Hypnozoites in the liver can cause relapse for
many years after infection.
 Anaemia develops slowly.

16. p.Malariae infection
 This is associated with mild symptoms.
 The paroxysm(convulsion ) is repeated every
72 hours.
 It tends to run a more chronic course.

17. p.Falciparum infection
 This causes, in many cases, a self-limiting
illness similar to the other types of malaria.
 But it is more dangerous than other form of
malaria.
 It may also causes serious complications.

18. Signs:
1. Pale (anemia,).
2. 2. Splenomegaly.
3. Mild enlargement of liver.
4. jaundice

19. Complication of falciparum malaria:
 1. Cerebral malaria:
 The commonest cause of coma & death.
 RBCs are sequestrated In brain capillaries with hemorrhage.
 2. Black water fever: rapid & massiveIntravascular haemolysis of
parasitized and non parasitized RBCs→ Hb anemia,
 Hb urea and ↓Hb.
 It is complicated by: ↑ fever, vomit, Jaundice, renal failure →
death.

20. Lab ∆ :-
 1. By detecting and identifying malaria
parasites microscopically in blood films for
malaria (BFFM).
 2. Concentration of venous blood by
centrifugation .
 3. Using rapid malaria antigen or enzyme test
e.g ICT (immune chromatography test),

21. Blood films:
 Stained Giemsa or field stain.
 Thick film: 30 times more sensitive than thin
film.
 Thin film to confirm the species and see the
changes in RBcs, degree of parasitaemia,
response to treatment.

22. Management:
 Aims:
 i. To support life.
 ii. To cure the illness.
 iii. To prevent relapse.

24. Supportive treatment:
 Rehydration, dextrose, antipyretic.

25. specific treatment :
 i. Quinoline-related compounds:-
 quinine, mefioquins, halofantrine, primoquine.
 ii. Antifol: Pyremethamine, proguanil, trimethoprim
 iii. Artemisinin: Artemether.
 iv. Antibacterial : Tetracycline , doxycycline

26. Side effect of drugs
1. QUININE :
GIT( nausea , vomiting)
Arrhythmias tinnitus – temporal hearing loss
Black water fever
Hypoglycemia
PYRIMETHAMINE :
rash
bone marrow depression
hypersensitivity reaction
PRIMAQUINE :
haemolysis especially in pt .with G6PD
GIT disturbance

27. Control:
 Early diagnosis & prompt treatment.
 Vector control. Used spray and mosquito net
 Dryness of wet area
 Prevention or early detection of epidemic.
 Used prophylaxes in endemic
 Health education.
 Applied research promotion.

28. Vector control.

29. Nursing Processes
 Assessment
 Has there been fever? How high has the
patient's temperature been? What is the
fever pattern? Is the temperature
constant, or does it rise and fall? Has
fever been associated with chills? Has the
patient taken medication to relieve fever?
 Does the patient have diarrhea, vomiting,
headache or abdominal pain?

30. Nursing Diagnoses
 Risk for ineffective thermoregulation (fever)
related to the presence of infection
 Risk for fluid volume deficit RT loss of fluid
through diarrhea, vomiting and sweating
 Risk alteration nutrition less of body requirement
RT GIT disturbance
 Risk for infection transmission

31. Nursing Diagnoses
 Deficient knowledge about the disease,
cause of infection, treatment, and
prevention measures

32. Planning and Goals
 Control of fever and related discomforts
 Maintain normal body fluid
 Maintain adequate nutrition
 Prevention of spread of infection,
 Increased knowledge about the infection and
its treatment,