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Malaria
- 1. MALARIA BY: TEMEGEN GIRMA C1, SPHMMC Addis Ababa, Ethiopia
- 2. INTRODUCTION • Name is derived from Italian Mal’ aria or bad air. • Malaria is a vector-borne infectious disease caused by protozoan parasites. • It is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa.
- 3. Definition • Malaria is an acute and chronic illness characterized by paroxysms of fever, chills, sweats, fatigue, anemia, and splenomegaly.
- 5. Malaria epidemiology in Ethiopia
- 6. Disease burden • In 2019, there were 229 million cases of malaria & 409 000 deaths. Africa was a home to 94% of all malaria cases and deaths. • Children under 5 years of age are accounted for 67% (274 000) of all malaria deaths worldwide. • Malaria kills more people than AIDS.
- 7. Burden of malaria in Ethiopia • Malaria remains a major public health challenge. a large and mobile population heterogeneous transmission, and the presence of both Pf and Pv malaria parasites. Today, 60 percent of Ethiopia’s population is at risk of contracting malaria.
- 8. Etiology • Malaria is caused by an infection by one of the ff five intracellular Plasmodia protozoa species, they are: 1) P. falciparum 2) P. vivax 3) P. malariae, 4) P. ovale, & 5) P. knowlesi.
- 10. Route of transmission 1. Vector transmission 2. Direct transmission 3. Congenital Transmission
- 11. Congenital Malaria • The first sign or symptom most commonly occurs between 10-30 days of age . Signs and symptoms include fever, restlessness, drowsiness, pallor, jaundice, poor feeding, vomiting, diarrhea, cyanosis, and hepatosplenomegaly. Malaria is often severe during pregnancy and may have an adverse effect on the fetus or neonate owing to maternal illness or placental infection even in the absence of transmission from mother to child.
- 12. • The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.
- 13. Pathogenesis (Life cycle) • Has 2 hosts. • The malaria life cycle is a complex system with both sexual and asexual aspects . cycle of all species that infect humans is basically the same. • There is an exogenous sexual phase in the mosquito called sporogony during which the parasite multiplies. • There is also an endogenous asexual phase that takes place in the vertebrate or human host that is called schizogeny
- 16. Affinity of parasites to Erytrocytes • , Plasmodium spp Type of RBC they ❤ P.vivax P.ovale Younge P.malariae Old RBCs P,falciparium All
- 17. Clinical Manifestations • Malaria paroxysm(periodic febrile episodes alternating with symptom-free periods) preceded by Prodromal period. • Prodromal symptoms include headache, fatigue, anorexia, myalgia, slight fever, and pain in the chest, abdomen, and joints
- 18. P.falciparium P.vivax P.ovale P.malariae Incubation period 9-14 days 12-17 days 16-18 days 18-40 days
- 19. How Malaria present Clinically Stage 1(cold stage) • Chills for 15 mt to 1 hour • Caused due to rupture from the host red cells escape into Blood • Preset with nausea, vomitting,headache Stage 2(hotstage) Fever may reach upto 40c may last for several hours starts invading newer red cells.
- 20. Stage 3(sweating stage) Patient starts sweating, concludes the episode Cycles are frequently Asynchronous Paroxysms occur every 48 – 72 hours
- 21. More commonly, the patient presents with a combination of the following symptoms • Fever Chills Sweats Headaches Nausea and vomiting Body aches General malaise.
- 22. Complications • Severe malaria is more common in P. falciparum because of several process: a) higher-density parasitemia b) polyclonal activation c) Abnormality in RBCs
- 23. Complications of P.falciparum MALARIA • Severe malarial anemia • Cerebral malaria • Malarial retinopathy • Respiratory distress • Hypoglycemia • Seizures • Circulatory collapse (algid malaria) • Long-term cognitive impairment • HSM / TSS • AKI • Jaundice • Prostration
- 25. Malarial Retinopathy 1) Retinal Whitening 2) Vessel changes 3) Retinal hemorrhage 4) Papiledema
- 26. Predisposing factors for complications of P. falciparum malaria 1) Extremes of age. 2) Pregnancy 3) Immunosuppressed - patients on steroids, anti- cancer drugs, immunosuppressant drugs 4) Splenectomy. 5) Lack of previous exposure to malaria (non- immune) or lapsed immunity
- 27. Diffrential Diagnosis • influenza Hepatitis, Sepsis, Pneumonia, Meningitis, encephalitis, Endocarditis, Gastroenteritis, Pyelonephritis, Babesiosis, Brucellosis, . • Leptospirosis, Tuberculosis, Relapsing fever Typhoid fever, Yellow fever, Amebic liver abscess, Hodgkin disease, and collagen vascular disease
- 28. Diagnosis .
- 29. • Clinical diagnosis • Microscopic diagnosis • Antigen detection • Molecular diagnosis
- 30. Microscopic diagnosis • Blood smear with Giemsa stain
- 32. Antigen detection • Various test kits are available to detect antigens derived from malaria parasites. • provide results in 2- 15 minutes.
- 33. Molecular diagnosis • PCR based techniques:- Detects DNA or RNA sequences specific to Plasmodium. • PCR detection may detect asymptomatic parasitemia in children with very-low-level parasitemia. • PCR is more sensitive than microscopy but is technically more complex.
- 34. Treatment ,
- 35. Antimalarial Classification Target of Therapy Therapeutic Class Drug Examples To alleviate symptoms Blood schizontocidal drugs • Artemisinin • Chloroquine (in vivax only) • Quinine (in pregnancy) To prevent Relapses Tissue schizontocidal drugs • Primaquine To prevent Spread Gametocidal drugs • Primaquine
- 36. Treating malaria caused by P. vivax, P. ovale, P. malariae or P. knowlesi • First line: Chloroquine phosphate followed by Primaquine • Alternative: ACTs
- 37. Treating uncomplicated P. falciparum malaria • First line : ACT Artemether + lumefantrine • Alternative: Quinine dihydrochloride
- 38. Treating severe complicated malaria • IV or IM artesunate 2.4 mg/kg body weight (preferred); OR • IM artemether (alternate); OR • IV or IM quinine infusion (if artesunate or artemether is not available)
- 39. Treating severe malaria • IV or IM artesunate for at least 24 h and until they can tolerate oral . Once a patint has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of ACT.
- 40. Chemoprophylaxis of Malaria for Children P. Falciparum • chloroquine • Mefloquine • Doxycycline For P. vivax: • Primaquine phosphate
- 43. Prevention & Control • Avoid mosquito bites • Preventing breeding of mosquitoes • Treatment • Health education • Blood screening for malaria
Editor's Notes
- {normochromic normocytic} anemia The Hyperreactive Malarial Splenomegaly Syndrome (HMS) originally called the tropical splenomegaly syndrome (TSS) or Big spleen disease refers to cases of splenomegaly in the tropics for which no cause was found despite thorough investigation 1-3. It is seen among residents of endemic areas of malaria and it is not species specifi. It occurs mainly in tropical Africa, but also in parts of South America, the Middle East, South Asia, and Southeast Asia 2. Tropical Splenomegaly Syndrome is characterised by massive splenomegaly, hepatomegaly, marked elevations in levels of serum Ig M and malaria antibody 3
- World malaria report, released on 30 November 2020 e approximately half the world's population (Fig. 314.1 ). The principal areas of transmission are Africa, Asia, and South America.
- The long lifespan and strong human-biting habit of the African vector species is the main reason why approximately 90% of the world's malaria cases are in Africa.
- Several factors contribute to Ethiopia’s malaria burden – approximately 68 million people.
- The long lifespan and strong human-biting habit of the African vector species is the main reason why approximately 90% of the world's malaria cases are in Africa.
- The main difference between the life cycle of P. vivax and Plasmodium falciparum (P. falciparum) is the development of latent forms – known as hypnozoites
- A circulatory collapse is defined as a general or specific failure of the circulation, either cardiac or peripheral in nature. Circulatory collapse (algid malaria) is a rare complication that manifests ashypotension, hypothermia, rapid weak pulse, shallow breathing, pallor, and vascular collapse. Prostration is defined as the inability to sit, stand, or eat without support, in the absence of impaired consciousness.
- The greatest defense in the human body againist malaria is the spleen.
- The first symptoms of malaria (most often fever, chills, sweats, headaches, muscle pains, nausea and vomiting) are often not specific and are also found in other diseases (such as the “flu” and common viral infections). Likewise, the physical findings are often not specific (elevated temperature, perspiration, tiredness). In severe malaria (primarily caused by Plasmodium falciparum), clinical findings (confusion, coma, neurologic focal signs, severe anemia, respiratory difficulties) are more striking and may increase the index of suspicion for malaria.
- The concentration of erythrocytes on a thick smear is 20-40 times that on a thin smear and is used to quickly scan large numbers of erythrocytes TF.Used for detecting malaria: a larger volume of blood is examined allowing detection of even low levels of parasitaemia. Also used for determining parasite density and monitoring the response to treatment Tf Gives more information about the parasite morphology and, therefore, is used to identify the particular infecting species of Plasmodium.
- A chemical, called a buffer, to facilitate the testing process is added. The chemical causes the antibodies in the blood to flow along the test stick. When they pass over the section with the antigens, if there are any antibodies for HIV present then they will stick to these antigens and change colour.
- relapses begin to occur 5–7 weeks aftr treatment if radical curatie treatment with primaquine is not given.
- The clinical objecties of treatig uncomplicated malaria are to cure the infectin as rapidly as possible and to prevent progression to severe disease. “Cure” is defied as eliminatin of all parasites from the body.
- The main objectie of the treatment of severe malaria is to prevent the patint from dying. Secondary objecties are preventin of disabilitis and preventin of recrudescent infectin.
- Chloroquine and mefloquine should be started 1-2 wk prior to departure and continued for 4 wk after last exposure. Doxycycline should be started 1-2 days prior to departure and continued for 4 wk after last exposure. Do not use in children younger than 8 yr of age or in pregnant women.