3. Malaria
• Malaria is caused by Plasmodium parasites.
• P. falciparum is the most prevalent malaria parasite
on the African continent. It is responsible for most
malaria-related deaths globally.
• P. vivax,P.ovale & P.malariae are benign .. Rarely
progress to severe malaria.
5. Fever paroxysms
• An abrupt onset of an initial ‘cold stage’ associated with a
dramatic rigor (paroxysm ) in which the patient visibly
shakes.
• An ensuing ‘hot stage’ during which the patient may have a
temperature >40°C, be restless and excitable, and vomit or
convulse.
• Finally, the sweating stage, during which the patient's
temperature returns to normal (defervesces) and sleep may
ensue.
• Such a paroxysm can last 6-10 h.• A prolonged asymptomatic period may follow lasting ;
• 38-42 h in the case of p.vivax and p.ovale malaria (‘tertian’
fever)
• 62-66 h in P. malariae infections (‘quartan’ fever).
6. • paroxysms associated
with synchrony of
merozoite release
• between paroxysms
temper-ature is normal
and patient feels well
• falciparum may not
exhibit classic paroxysms
(continuous fever)
9. WHO criteria for sever falciparum
malariaOne or more of the following clinical or laboratory features
10. 1- Cerebral malaria (CM):
• ‘unrousable coma in the presence of peripheral
parasitaemia where other causes of encephalopathy
have been excluded'.
▫ Febrile convulsion in children , hypoglycemia.
• Most important complication of flaciparum malaria.
• Mortality rates of 20% among adults and 15%among
children.
• Focal deficits are uncommon
• Retinal hemorrhages may be observed ;30 to 40
percent of cases.
11. 2- Hypoglycemia
• Hypoglycemia is a common complication of severe malaria,
although the usual signs (sweating, tachycardia, neurologic
impairment) are difficult to distinguish from systemic
symptoms due to severe malaria.
• Hypoglycemia occurs as a result of the following
factors:
I. Diminished hepatic gluconeogenesis
II. Depletion of liver glycogen stores
III. Increase in the consumption of glucose by the host (and, to
a much lesser extent, the parasite)
IV. Quinine-induced hyperinsulinemia
• Hypoglycemia is associated with a poor prognosis, particularly
in children and pregnant women.
12. 3- Acidosis
• Acidosis is an important cause of death from severe
malaria; it is caused by several factors, including:
▫ Anaerobic glycolysis in host tissues where sequestered
parasites interfere with microcirculatory flow
▫ Parasite lactate production
▫ Hypovolemia
▫ Insufficient hepatic and renal lactate clearance
• The prognosis of severe acidosis is poor.
13. 4- Hematological abnormalities
• Anemia in the setting of malaria occurs as a result of
the following factors: ( common in children )
Hemolysis of parasitized red cells
Increased splenic sequestration and clearance of
erythrocytes with diminished deformability
Cytokine suppression of hematopoiesis
Shortened erythrocyte survival
Repeated infections and ineffective treatments
• Disseminated intravascular coagulation (DIC)
14. 5-LIVER DYSFUNCTION
• Mild hemolytic jaundice is common in malaria.
• Severe jaundice is associated with P. falciparum
infections; is more common among adults than
among children;
• Results from
▫ hemolysis,
▫ hepatocyte injury
▫ cholestasis.
• When accompanied by other vital-organ dysfunction
(often renal impairment), liver dysfunction carries a
poor prognosis.
15. • 6- NONCARDIOGENIC PULMONARY EDEM A;
Adults w ith severe falciparum malaria may develop
noncardiogenic pulmonary edema even after several days
of antimalarial therapy .
Pathogenesis unclear.
• 7- RENAL IMPAIRM ENT
Renal impairment is common among adults w ith severe
falciparum malaria but rare among children.
Pathogenesis unclear.
