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Malaria
- 1. Malaria Dr. V. S.Swathi Assistant Professor
- 2. Definition • Malaria isa life-threatening disease caused by parasites that are transmitted through the bites of female anopheles mosquito. It is preventable and curable
- 4. Epidemiology • In theworld, 219 million cases of malaria were found in 2017. Estimated deaths related to malaria were 4,35,000 • In India, 6% of world malaria cases were found in 2017. Among them, 6% of cases leads to death
- 5. Types Malaria due toPlasmodium vivax • It spreads across the globe and predominantly found in India • It results to death and serious issues Malaria due to Plasmodium ovale • It mainly found in tropical west african region • it is rarest type of malaria because parasite resides in the host's body for extended periods, sometimes up to years after mosquito bite Malaria due to Plasmodium malariae • It found in tropical and subtropical regions of central and south america, africa and south east asia • It is a non lethal disease Malaria due to Plasmodium falciparam • It found in south east asia, south america and africa • Largest number of death are due to this type
- 6. Risk factors • Live/visit areas where disease is predominant • Young children and infants • Elders • Pregnant women and their unborn children • Travellers • Poverty • Lack of knowledge • Little or no access to health care • Patients with HIV • Patient with immune suppression • Patients receiving blood transfusion • Lack of protective clothing • Exposed sleeping accommodation • Lack of immunisation • Areas with stagnant water
- 7. Etiology Transmitted by femaleanopheles mosquito Caused by: • Plasmodium falciparam • Plasmodium vivax • Plasmodium ovale • Plasmodium malariae
- 8.
- 11. Clinical Presentation Initial stage •Non specific fever • Chills or rigors • Diaphoresis • Malaise • Vomiting • Orthostatic hypotension • Electrolyte abnormalities
- 12. Erythrocyte phase Prodrome: • Headache •Anorexia • Malaise • Fatigue • Myalgia Non specific complaints • Abdominal pain • Diarrhoea • Chest pain • Arthralgia
- 13. Paroxym • High fever •Chills • Rigors Cold phase • Severe pallor • Cyanosis of lips Hot phase • High fever Sweating phase • Follows hot phase by 2-6 hours where fever resolves
- 14. • Marked fatigue •Drowsiness • Warm and dry skin • Tachycardia • Cough • Severe headache • Nausea • Vomiting • Abdominal pain • Diarrhoea • Delirium
- 16. Complications • Lactic acidosis •Hypoglycaemia • Anaemia • Acute renal failure • Pulmonary oedema • Thrombocytopenia • Heart failure • Cerebral congestion • Seizures • Coma • Adult respiratory syndrome
- 17. Diagnosis • Smear test •Lab test • Computed tomography • Magnetic resonance imaging
- 19. Non Pharmacological Treatment •Use of mosquito repellents • Avoid travelling to malaria prone areas • Cover body totally • Use window screens • Use insecticide- impregnated nets
- 20.
- 21. Drugs used intreatment of malaria Drug Category Mode of action Dose Adverse effects Chloroquine Anti malarial drug Active against erythrocyte form of plasmodium vivax, ovale and falciparam 300mg base once weekly, begin 1-2 weeks before travel and continue up to 4 weeks after travel for chemoprophylaxis 600mg base on first day then 300mg base 6 hours, 24 hours and 48 hours for uncomplicated chloroquine susceptible malaria Abnormal ECG Prolonged QT Amnesia Pruritis Retinopathy Hydroxychloroquine Anti malarial drug It prevents growth and replication of parasite by decreasing the pH of vacuole 310mg base once weekly, begin 1-2 weeks before travel and continue up to 4 weeks after travel for chemoprophylaxis 310mg base on first dose then 6 hours, 24 hours and 48 hours for uncomplicated chloroquine susceptible malaria Irritability Weakness Leucopoenia Thrombocytope nia Anaemia
- 22. Mefloquine Anti malarial drug It prevents growthand replication of parasite by decreasing the pH of vacuole 228mg base once weekly, begin 1-2 weeks before travel and continue up to 4 weeks after travel for chemoprophylaxis 648mg base on first dose then 456mg base 6 hours, 24 hours and 48 hours for Uncomplicated Plasmodium falciparam malaria Anxiety Difficulty in concentration Insomnia Tinnitus Vertigo Primaquine Anti malarial drug Disrupts plasmodium mitochodria 30mg base once weekly, begin 1-2 days before travel and continue up to 7 days after travel for chemoprophylaxis 30mg base orally once daily for 14 days Abdominal pain Arrhythmias Nausea Vomiting Visual disturbances
- 23. Atovaquone Anti malarial drug Inhibits electron transport chain in plasmodium 250mgfour times daily for 3 days with food or milk for Uncomplicated chloroquine resistance malaria Abdominal pain Cough Diarrhoea Dyspnoea Fever Proguanil Anti malarial drug Inhibits parasites’ dihydrofolate reductase leads to decrease in DNA synthesis 100mg four times daily for 3 days with food or milk Uncomplicated chloroquine resistance malaria Abdominal pain Itching Diarrhoea Myalgia Fever Artemether Anti malarial drug Inhibit nucleic acid and protein synthesis in parasite 20mg four times daily for 3 days with food or milk Uncomplicated chloroquine resistance malaria Abdominal pain Anorexia Arthralgia Asthenia Fever
- 24. Lumafantrine Anti malarial drug Inhibitnucleic acid and protein synthesis in parasite 120mg four times daily for 3 days with food or milk Uncomplicated chloroquine resistance malaria Abdominal pain Anorexia Arthralgia Asthenia Fever Quinidine Anti malarial drug Inhibit formation of beta haematin(toxic product) from parasite leads to decrease in digestion of RBC from parasites 6.25mg/kg for 1-2 hours then 0.0125mg/ kg/ min for about 24 hours for Severe malaria Abdominal pain Diarrhoea Anorexia Light headedness QT prolongation Doxycycline Tetracycline Inhibit protein synthesis in parasites 100mg once daily for 7 days for Uncomplicated Plasmodium falciparam malaria Anorexia Diarrhoea Dysphagia Enterocolitis Teeth discolouration
- 25. Resources • https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC6607595/ • https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC6122616/ •https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC6122616/ • https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC6030775/ • https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC5714960/