MALARIA

SONIA NAZIR
Faculty of pharmacy
FUUAST University
KARACHI
Wednesday, September 28,
2016
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•Term malaria comes from “mal' 'aria” or “bad air”.
•Malaria is a mosquito-borne infectious disease of
humans and other animals caused by parasitic
protozoan (a group of single-celled
microorganisms) belonging to the Plasmodium type.
•Malaria is air infected with a noxious substance
capable of causing disease in human beings.
INTRODUCTION

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HISTORY OF MALARIA
•Malaria has been noted for more than 4,000 years.
•The symptoms of malaria were described in ancient Chinese medical
writings.
•In 2700 BC, Malaria became widely recognized in Greece by the 4th century
BCE, and it was responsible for the decline of many of the city-state
population.
•A number of Roman writers attributed malarial diseases to the swamps.
•Romans noticed that they got sick when they took walks in the night air.

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•Approximately 100 years ago, Dr. Ronald Ross, a British Medical
Officer in Hyderabad, India discovered that mosquitoes
transmitted malaria.
•He first recognized that the black pigment associated with human
disease was also present in the gut of the mosquito and later
showed that when infected mosquitoes bit chickens the disease
was indeed transmitted.
•His discovery of the malarial parasite proved that malaria was
transmitted by mosquitoes, and laid the foundation for the
method of combating the disease
•For his studies he received the 1902 Nobel Prize in Medicine.

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CAUSES OF MALARIA
•Malaria is caused by the Plasmodium parasite.
•The parasite can be spread to humans through the bites of infected
mosquitoes.
•Because the parasites that cause malaria affect red blood cells, people can
also catch malaria from exposures to infected blood, including:
 From mother to unborn child.
Through blood transfusion.
By sharing needles used to inject drugs

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TYPES OF PLASMODIUM CAUSING MALARIA
Plasmodium falciparum :
It's the most common type of malaria parasite and is responsible for most malaria deaths
worldwide.
Plasmodium vivax :
Mainly found in Asia and South America,
Plasmodium ovale :
Fairly uncommon and can remain in your liver for several years without producing symptoms.
Plasmodium malariae:
This is quite rare and usually only found in Africa.
Plasmodium knowlesi :
This is very rare and found in parts of southeast Asia.

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LIFE CYCLE OF PLASMODIUM:
•The Plasmodium parasite is mainly spread by female Anopheles
mosquitoes, which mainly bite at dusk and at night.
•When a mosquito bites a human host, sporozoites are released
from the salivary glands of the mosquito into the bloodstream.
•These reach the liver and undergo a cycle of development in
hepatocytes.
•The resulting merozoites lyses out of liver cells and subsequently
infect erythrocytes to undergo asexual proliferation.
•Here a single merozoite gives rise to ~16 daughter cells, which
then re-infected red cells and thereby maintain the asexual cycle.
•The length of the cycle determines the periodicity of the fevers
and chills associated with malaria.

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SYMPTOMS OF MALARIA:
A high temperature (fever) Sweats and chills Headaches
Vomiting Muscle painDiarrhea

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•Other symptoms include:
Convulsions
Coma
Anemia
Generally feeling unwell
•Symptoms usually appear between 7 and 18 days after becoming infected.
•In some cases the symptoms may not appear for up to a year, or occasionally even longer.
•It's important to be aware of the symptoms of malaria if you're travelling to areas where
there's a high risk of the disease.
•Some malarial parasites can enter the body but will be dormant for long periods of time.
SYMPTOMS OF MALARIA:

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•Malaria must be recognized promptly in order to treat the patient in time and to prevent
further spread of infection in the community via local mosquitoes.
•Malaria can be suspected based on the patient's travel history, symptoms, and the physical
findings at examination
•However, for a definitive diagnosis to be made, laboratory tests must demonstrate the
malaria parasites or their components.
•The diagnosis can be done as follows:
CLINICAL DIAGNOSIS:
Clinical diagnosis is based on the patient's symptoms and on physical findings at
examination.
DIAGNOSIS OF MALARIA

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In severe malaria clinical findings are more striking and may
increase the index of suspicion for malaria.
If possible, clinical findings should always be confirmed by a
laboratory test for malaria.
MICROSCOPIC DIAGNOSIS:
Malaria parasites can be identified by examining under the
microscope a drop of the patient's blood, spread out as a "blood
smear" on a microscope slide.
This technique remains the gold standard for laboratory
confirmation of malaria.

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ANTIGEN DETECTION:
•Various test kits are available to detect antigens derived from malaria parasites.
•Such immunologic ("immuno-chromatographic") tests most often use a dipstick or cassette
format, and provide results in 2-15 minutes.
•These "Rapid Diagnostic Tests" (RDTs) offer a useful alternative to microscopy in situations
where reliable microscopic diagnosis is not available.
•Malaria RDTs are currently used in some clinical settings and programs.
•The use of this RDT may decrease the amount of time that it takes to determine that a patient
is infected with malaria.

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MOLECULAR DIAGNOSIS:
•Parasite nucleic acids are detected using polymerase chain reaction (PCR).
•Although this technique may be slightly more sensitive than smear microscopy, it is of limited
utility for the diagnosis of acutely ill patients in the standard healthcare setting..
•PCR is most useful for confirming the species of malarial parasite after the diagnosis has been
established by either smear microscopy or RDT.
SEROLOGY:
•Serology detects antibodies against malaria parasites, using either indirect immuno-
fluorescence (IFA) or enzyme-linked immuno-sorbent assay (ELISA).
•Serology does not detect current infection but rather measures past exposure.

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•Malaria can be a severe, potentially fatal disease (especially when caused by
Plasmodium falciparum) and treatment should be initiated as soon as possible.
•Patients who have severe P. falciparum malaria or who cannot take oral
medications should be given the treatment by continuous intravenous infusion.
•How to treat a patient with malaria depends on
1. The type (species) of the infecting parasite
2. The area where the infection was acquired and its drug-resistance status
3. The clinical status of the patient
4. Any accompanying illness or condition
5. Pregnancy
6. Drug allergies, or other medications taken by the patient
TREATMENT OF MALARIA:

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•Most drugs used in treatment are active against the parasite forms in
the blood (the form that causes disease) and include:
1. Chloroquine
2. Atovaquone -proguanil
3. Artemether -lumefantrine
4. Mefloquine
5. Quinine
6. Quinidine
7. Doxycycline (with quinine)
8. Clindamycin (with quinine)
9. Artesunate
TREATMENT OF MALARIA:

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•Malaria is a serious illness that can get worse very quickly. It can be fatal if not treated
promptly.
•It can also cause serious complications, including:
1. SEVERE ANEMIA:
Where red blood cells are unable to carry enough oxygen around the body, leading to
drowsiness and weakness
2. CEREBRAL MALARIA:
In rare cases, the small blood vessels leading to the brain can become blocked, causing
seizures, brain damage and coma.
•The effects of malaria are usually more severe in pregnant women, babies, young children
and the elderly.
•Pregnant women in particular are usually advised not to travel to malaria risk areas.
COMPLICATIONS OF MALARIA

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Many cases of malaria can be avoided. An easy way to remember is the ABCD approach to
prevention:
•Awareness of risk:
Find out whether you're at risk of getting malaria before travelling.
•Bite prevention:
Avoid mosquito bites by using insect repellent, covering your arms and legs, and using an
insecticide-treated mosquito net.
•Check whether you need to take malaria prevention tablets:
If you do,make sure you take the right antimalarial tablets at the right dose, and finish the
course.
•Diagnosis:
Seek immediate medical advice if you develop malarial symptoms, as long as up to a year after
you return from travelling
PREVENTION OF MALARIA

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MALARIA IN PAKISTAN
•Pakistan has a population of 180 million inhabitants of
which 177 million are at risk of malaria.
•With 3.5 million presumed and confirmed malaria cases
annually.
•Pakistan accounts for 43.2% of the population at high
risk of malaria in the Eastern Mediterranean Region of
World Health Organization (WHO) and 23.4% of the
confirmed cases.
•Epidemiologically, Pakistan is classified as a moderate
malaria endemic country with a National API averaging
at 1.59 (MIS, 2013) and wide diversity within and
between the provinces and districts.

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Major transmission period:
post monsoon i.e. from August to November.
Major vector species:
Anopheles culicifacies and A. stephensi,
Causative organisms :
Plasmodium falciparum
Plasmodium vivax.
Malariogenic potential :
The malariogenic potential of Pakistan has a negative impact on its socio-economic growth
and productivity, as the main transmission season is spiraled with the harvesting and sowing
of the main crops

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Risk factors for malaria:
• Unpredictable transmission patterns.
• Low immune status of the population.
• Poor socioeconomic conditions.
• Mass population movements.
• Natural disasters including floods and heavy rain fall in a few areas.
• Lack of access to quality assured care at the most peripheral health settings.
• Low antenatal coverage.
• Internally displaced population (IDPs) crisis.

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Domc 2012 Data Showing Highly Endemic Districts For Annual
Parasite Incidence
DISTRICT RATE WITH AVERAGE
Baluchistan Average API of 7.68 ranging
from 7 to 27
FATA Average API of6.83 ranging
from 6 to 118
SINDH Average API of 2.92 ranging
from 5.2 to 12
KPK average API of 2.76 ranging
from 6 to 32
PUNJAB average API of 0.19
AJK average API of 0.10

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The Malaria Indictor Survey (Mis) Was Conducted In 2013 In 38 (Gf
R-10) Highly Endemic Districts Of The Country Showing :
DISTRICT PREVELANCE RATE (%)
Baluchistan 6.2%
FATA 13.9%
KPK 3.8%
• In 2013, 281,755 confirmed malaria cases were reported through National malaria disease
surveillance system.
• 3.1 million cases were clinically diagnosed and treated at public sector outpatient facilities and
244 deaths due to malaria were reported in District Health Information System (DHIS) 2013.

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WORLD WIDE PREVALENCE OF MALARIA
•Malaria transmission occurs in five WHO regions.
•Globally, an estimated 3.2 billion people in 95 countries and
territories are at risk of being infected with malaria and developing
disease (map), and 1.2 billion are at high risk.
•According to the World Malaria Report 2015, there were 214 million
cases of malaria globally in 2015 (uncertainty range 149–303 million)
and 438 000 malaria deaths (range 236 000–635 000) , representing
a decrease in malaria cases and deaths of 37% and 60% since 2000,
respectively..
•The burden was heaviest in the WHO African Region, where an
estimated 90% of all malaria deaths occurred, and in children aged
under 5 years, who accounted for more than two thirds of all deaths

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IN 2015:
Cases:
214 million cases were reported in 2015
Incidence:
37% global decrease in malaria incidence
between 2000 and 2015.
Mortality:
60%estimated decrease in global malaria deaths
between 2000 and 2015
WORLD WIDE PREVALENCE OF MALARIA

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REFERENCES:
https://www3.nd.edu/~haldarlb/index.ht
m
https://www.mmv.org/curing-malaria
http://www.mayoclinic.org/diseases-
conditions/malaria/diagnosis-
treatment/treatment/txc-20168001
https://.dmc.gov.pk
http://en.wikipedia.org/wiki/Malaria
http://www.cdc.gov/malaria/
http://www.nlm.nih.gov/medlineplus/mal
aria.html
www.who.int/gho/malaria/en

MALARIA

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MALARIA