2. Malaria is most important of the parasitic disease of humans
affecting more than 500 million people and causing 1 – 3 million
deaths in each year.
It is a protozoal disease caused by protozoa of the genus “
Plasmodium ” and is transmitted by the bite of infected female
Anopheles mosquito and is characterized by fever with rigors,
anemia and splenomegaly.
According to severity of illness, malaria can be broadly
classified into two types - Benign and Malignantt.
INTRODUCTION
3. Relatively milder disease
Generally caused by P. vivax
The chance of involvement of other organs (complications)
is much less.
Also referred to as Uncomplicated Malaria.
BENIGN MALARIA
4. Severe
Caused mainly by P. falciparum and rarely by P. vivax.
Poor prognosis (outcome)
Nowadays "severe malaria" or "complicated malaria" are used
more frequently to describe this type of malaria.
MALIGNANT MALARIA
5.
6. There are 4 major species of Plasmodium which infect man:
Plasmodium vivax
Causes benign malaria which though mild, has a tendency to
relapse.
Plasmodium falciparum
Causes malignant malaria which may result in death if untreated,
but once cured by drugs has no tendency to relapse.
Plasmodium ovale & Plasmodium malariae
Not so common and is mild, the infected individual develops
pyrexia every 4th day so, called benign quartan.
CAUSATIVE ORGANISM
7. Mode of Transmission
Malaria can be transmitted by the following ways:
By the bite if infected Anopheles mosquito.
By transfusion of infected blood.
From the mother to fetus by the passage of organisms across the
placenta.
8.
9.
10. The lack of sense of well being, headache, fatigue, abdominal
discomfort, myalgia, nausea, vomiting and orthostatic hypotension.
Fever, chills, rigors occur at regular intervals suggest infection with
P.vivax or P.ovale.
Childhood febrile convulsions.
Spleen enlargement, mild jaundice which usually resolves over 1–3
weeks.
Symptoms of severe P. falciparum malaria
Cerebral malaria
Convulsions, delirium, abnormal behavior and coma.
Hypoglycemia
Problematic in children and pregnant women. Results from failure of
hepatic gluconeogenesis & increase in consumption of glucose by host
and parasite.
CLINICAL FEATURES
11. Lactic acidosis
Anaerobic glycolysis occurs in tissue where parasitized erythrocytes
interfere with micro circulatory flow, lactate production by the parasite
combines with the failure of hepatic lactate clearance to cause lactic
acidosis.
Non – cardiogenic pulmonary edema
Renal impairment
Common in adults but rare in children caused due to parasitized
erythrocytes sequestration interfering with renal micro circulatory flow.
Malaria in pregnancy
P.falciparum malaria causes foetal death.
Also associated with low birth weight.
Infected mother remain asymptomatic despite parasitization of
placenta due to sequestration of infected RBC s in the placental
microcirculation.
12. Malaria in children
Convulsion, hypoglycemia, metabolic acidosis, severe anemia and
coma are common in severe malaria.
In general children tolerate the antimalarial drugs and respond
rapidly to the treatment.
Diagnosis
Clinical Diagnosis
Based on patients symptoms and on physical findings at examination
i.e fever, chills, sweats, myalgia, nausea and vomiting.
Microscopic examination
Malarial parasite can be identified by examining a drop of patient’s
blood under the microscope, spread out as a “ blood smear” on a
microscopic slide. The specimen is stained by Giemsa stain to give
parasite a distinctive appearance.
14. Class MOA Drugs
Tissue
Schizontocidal
agents
These act on primary (pre
erythrocytic) and latent tissue
forms (hypnozoites) in the liver
- Premaquine ( against both)
- Atovaquone & proguanil 9act on primary
form)
Blood
Schizontocidal
agents
These act on erythrocytic stage
of plasmodum and there by
terminate the clinical attack
Rapidly : Chloroquine, Artemisinin
derivatives, quinine, mefloquine,
atorvaquone, amodiaquine, lumefentrine
Slow acting agents: Proguanil,
pyrimethamine+sulphadoxine, doxycycline
(used always with rapid acting)
Gamatocidal
agents
These kills gamatocytes of
plasmodia in blood
Artemisinin and premaquine (active against
all species) Chloroquine and quinin (vivax)
they reduce transmission to mosquitoes
BASED ON STAGE OF PARASITE
15. Class MOA Drugs
Drugs used for casual
prophylaxis (pre-erythrocytic
stage of plasmodium in liver)
Proguanil( is effective mainly
for p. falsiparem) premaquine
(effective against all species
but not used due to its toxicity
Drugs for suppressive
prophylaxis
Suppress erythrocytic phase
thus clinical attack of malaria
is prevented
Chloroquine, mefloquine &
doxycycline
Drugs used for clinical cure These agents acts on
erythrocytic stages of malarial
parasite & terminate the
clinical attack
blood schizontal agents
BASED ON CLINICAL INDICATION FOR
USE (CLINICAL UTILITY)
16. Class MOA Drugs
Drugs used to prevent relapse These drugs act on the latent
tissue form ( Hipnozoites) of
P.vivax & P. ovale which
cause relapse
Premaquine
Premaquine with blood
schizontal agents (to prevent
relapse of hipnozoites)
Drugs used to prevent the
transmission of infection to
anopheles mosquito
Premaquine: has gamatocidal effect against all the 4 species of
plasmodia that infect man
Chloroquine & Quinine: are effective only against P.Vivax &
P. Malaria
17. Treatment
Drug M.O.A Dose Pharmaco -
kinetic
Profile
Side effects Interaction
Quinine &
Quinidine
Acts on
tropozoite blood
stage kills
gametocyte of
P.vivax, P.ovale
and P.malaria.
No action on
liver stage.
300 – 600 mg
as tablets.
Injection with
a dose of 300
– 600mg
Good oral &
IM
absorption.
t ½ is 6 hrs.
Tinnitus,
nausea,
vomiting,
hypoglycemia,
postural
hypotension,
cardiac
arrythmias
Actozolamide –
decrease renal
excretion of
these drugs.
Rifampicin,
Phenytoin,
Phenobarbiotne
– increase
hepatic
metabolism.
Digoxin –
quinidine
decreases the
clearance of
digoxin.
18. Drug M.O.A Dose
Pharmaco -
kinetic
Profile
Side effects Intreraction
Chloroquine
As for
quinine but
more rapid.
Phosphate &
Sulphate salts
as 250mg
tablets.
Injection : 200
– 300mg IM
or IV diluted
with 100ml of
glucose saine
Good oral
absorption,
very rapid IM
& SC
absorption.
t ½ is 1-2
months.
Hypotensive
shock, if
parenterally
arrhythma,
nausea,
retinoathy,
myopathy,
postural
hypotension
Mefloquine,
amiodarone –
Increase the risk
of arrhythmias.
Antacid –
interefere with
absorption.
Mefloquine
As for
quinine
250 mg as
tablets
Adequate oral
absorption,
no parenteral
preparation.
t ½ is 14 – 20
days
Nausea,
confusion,
sleeplessness,
encephalopath
y,
Neuropsychiat
ric reactions,
night mares.
Quinine,
Quinidine - β-
Blockers,
Calcium channel
blockers
use with
caution.
19. Drug M.O.A Dose Pharmaco -
kinetic
Profile
Side effects Intreraction
Tetracycline
Doxycycline
Affects the
apicoplast of
P.falciparum.
(apicoplast:
Gatekeepers)
T – 250mg od.
Doxy – 100mg
od.
Excellent
absorption. t
½ is 8 hrs
for Tetra &
18 hrs for
Doxy.
GI intolerance,
deposits in
growing bones
& teeth,
Photosensitivity,
intracranial
hypertension,
renal failure.
Halofantrine Schizonticide,
not active
against
gametocyte or
liver stage.
500mg 8 hrly Highly
variable
absorption, t
½ is 1 – 3
days.
Abdominal
pain, diarrhoea,
arrhythmias,
rashes, itching.
Primaquine Schizonticidal
Against
P.vivax but
not
P.falciparum
15mg daily for
14 days along
With
Chloroquine 1
g on 1st day &
500mg daily
for 2 days
Rapidly &
completely
absorbed,
metabolized
in liver.
t ½ is 3 6
hrs
Epigastric
distress, anemia,
leucopenia.
In G6PD
deficiency
causes
hemolysis.
20. Drug M.O.A Dose Pharmaco -
kinetic
Profile
Side effects Intreraction
Mepacrine Erythrocytic
schizonticidal
activity.
600mg / week
for
prophylaxis,
3g over 6 days
for cure.
Slowly
absorbed
form gut.
t ½ is 16 –
20 hrs.
Nausea,
Vomiting,
cramps &
vertigo.
Proguanil Erythrocytic
schizonticidal
activity against
P.falciparum
200mg daily
with
chloroquine
300mg till 6
weeks.
Highly
variable
absorption, t
½ is 1 – 3
days.
Abdominal
upset,
vomiting,
rashes,
hematuria, loss
of hair.
Pyrimetha
mine
Acts by
erythrocytic
activity but
doesn’t
eliminate the pre
erythrocytic
phase of
P.falciparum
500mg on the
1st day
followed by
25 mg daily
for 2 days
Absorption is
from gut but
slow .
t ½ is 4 days.
Nausea, rashes,
megaloblastic
anemia,
thrombocyotop
enia
In G6PD
deficiency
hepatic and
renal failure.
21. New Drugs
Drug Name M.O.A. Dose P’Kinetic
Profile
Side effects
Arteether
(Injection)
Potent & rapid
schizonticide
action
150 mg IM once for 3
successive days.
Absorption
is affected
by oral
route.
t ½ is 23 hrs.
Nausea, vomiting,
abdominal pain, loss
of apettite &
leucopenia
Artemether
(Injection)
- do -
80 mg IM on 1st day
followed by 80mg PO
daily for next 4 days.
- do - - do -
Artesunate
- do -
50 mg as tablets.
For cerebral malaria, 100
mg bd on the 1st day
followed by 50 bd mg for
next 4 days
- do - - do -
22. Take medications regularly.
Don’t allow the water to stagnate in your near by places.
Keep your surroundings clean.
Use nets while sleeping or use mosquito repellents.
PATIENT COUNSELING POINTS
