Malaria is caused by Plasmodium parasites and transmitted via the bites of infected Anopheles mosquitoes. The parasite has a complex life cycle, alternating between human and mosquito hosts. In humans, malaria causes flu-like symptoms and periodic fevers, which can become severe and even fatal depending on the Plasmodium species. Diagnosis is made by microscopic examination of blood films, and treatment involves antimalarial drugs. Preventive measures focus on mosquito control and chemoprophylaxis for those in high risk areas.

2. Malaria
Mal - air

3. Causative organism
Malaria caused by plasmodium
species :
P.vivax----benign tertian M.
P.ovale-----benign tertian M.
P.Malariebenign quartan M.
p.FalciparumMalignant subtertian M.

4. Life cycle

5. Habitat: RBCs & liver cells of man
Hosts :
D.host: Female anopheles mosquito
I.host : Man.
R.host : chimpanzee in Africa.

6. Mode of infection
1-Biological transmission by
Female anopheles mosquito.
2-Blood transmission.
3-The use of contaminated syringes.
4-congenital through placenta.

7. Any other route of transmission
other than mosquito bite …does
not lead to chronic malaria or
relapse and will cause only
clinical attack of malaria as there
is no liver stage
No exo-erythrocytic schizogony

9. IMMUNITY
After many attacks protection of human
body against re infection with the same
plasmodium occur but patient remain
susceptible to infection with other
species with plasmodium ( no cross
immunity between different species) .

11. CLINICAL PICTURE
I.P: 6-40 days.
It’s the pre-erythrocyte cycle:
P.F : 6 days
P.M:11 days
P.V & OVAL :in between
General symptoms: flu like .
bone ache.
chills.

12. Clinical picture
There are no recognized symptoms associated with
liver phase of malaria or rupture of tissue schizont.
Development of blood phase is necessary for
malarial illness as red cell rupture is associated
with release of malaria toxins

13. CLINICAL PICTURE
Malarial paroxysm due to:
synchronous rupture of large number of blood
schizonts (at least 200/ml) .
The classical paroxysm has sudden onset and show three
stages:
Cold stage ( 1-2 hr ) : sever coldness, rigors,
because ( his temperature rises sharply )
Hot stage ( 3-4 hr ) : sensation of great heat (39 –
41),headache , thirst , hot-dry-flushed skin and rapid full
pulse
Sweat stage (1-4 hr ) : profuse sweating , descend of fever
and relieve of symptom .

14. CLINICAL PICTURE
After sweating stage the patient is exhausted
and falls sleep .
If patient not treated the paroxysm will
repeated every :
4 days (quartan ) in P.malaria.
3 days (tertian) in P.ovale & P.vivax.
1-2 days (subtertian ) in P.falciparum.

15. CLINICAL PICTURE
The paroxysm occurs for few weeks with
decreasing intensity then stop due to elimination
of erythrocyte stage.
In P.M & P.F a low grade parasitaemia that can
not cause paroxysm may persist for along period
up to 20 years leading to recurudescence if the
patient become immuno suppresed
(recrudescence).

16. CLINICAL PICTURE
Repeated paroxysm will lead to :
Anemia
Jaundice
Hepatosplenomegaly

17. Always consider malaria in the traveler from a
developing country who presents with:
- Influenza-like syndrome. Or
- Attacks of fever. Or
- Jaundice. Or
- Confusion or coma.
CLINICAL PICTURE

19. complications
They are more common in P.F due to :
1-shot pre-erythrocyt stage 6 days.
2-large number of merozoites in liver
schizont (40,000).
3-these merozoites attack RBC’s of all
ages.

20. complications
1. severe hemolytic anemia.
2. Huge splenomegaly.
3. Splenic rupture in acute cases which
may occur spontaneous or following
minor truma.
4. Nephrotic syndrome in P.M due to
immune complex deposition. There is
no response to anti malarial drug or
steroids.

21. complications
5. Complications of P.F (malignant malaria):
it occurs due to adhesion phenomena due to
adhesion of infected RBCs that contain
trophozoites and schizonts together and to
capillary endothelium leading to:
Vascular obstruction.
Ischaemia and anoxia

22. complications
both of them leading to destruction of the
surrounding tissue giving clinical manifestation
according to affected organs as :
a. cerebral malaria : severe headache,
hyperpyrexia
paralysis
convulsions
death

23. complications
b. GIT : gastric hemorrhage, vomiting
cholera like diarrhea and dysentery
c. Algig malaria .shock ,collapse and
perepheral circulatory center due to generalized vascular
thrombosis
d. pulmonary edema
e. Retinal heamorrage
f. abortion
j. renal faliure
h. hypoglycaemia due to impaired hepatic
glucuneogenesis

24. complications
I. Black water fever:
Produce by acute massive intravascular hemolysis
which result from either :
1- high level of parasitaaemia >100000
organism per ml.
2- insufficient treatment with quinine which
renders the infected RBCs antigenic leading to
autoimmune reaction against these RBC.
3- primaquine to patient with G6PD deficency.

26. DIAGNOSIS
Clinical picture :
malarial paroxysms
history of visiting endemic area
Laboratory :
Direct : examination of thin and thick blood
films stained with Giemsa and Leishman
stains reveal all erythrocyte stages except in
P.F (only ring & Gametcyte) .

27. Blood film

28. DIAGNOSIS
Indirect :
1- serological test: ELISA are of value in
chronic and relapsing case but not in acute malaria
2- PCR : useful for diagnosis and
identification of species of plasmodium.
3- rapid immunodiagnostic test as strip or
dipstick tests for detection of circulating parasite
antigen using monoclonal antibodies.

29. Treatment
Supportive ttt:
 Bed rest
 Fluid replacement with care to avoid pul.
Edema
 Antipyretics or cold foment.
 Blood & platlet transfusion
 Treatment of hypoglycemia
 Corticosteroids may be used for life saving
 Renal dialysis in case of an/oliguia

30. Specific ttt‫الصحة‬ ‫وزارة‬ ‫بروتوكول‬

32. Specific ttt ‫الصحة‬ ‫وزارة‬ ‫بروتوكول‬
‫ثم‬

35. Prevention & control
 Massive ttt of cases to prevent transmission of
infection to mosquitos
 Mosquito control
 Chemoprophylaxis.
 No vaccines untill now

36. `
 Apomefloquine 250mg
8 tablet 65 LE.