Malaria is a global parasitic disease caused by Plasmodium parasites transmitted via mosquito bites. It is most prevalent in Africa, where it is a leading cause of mortality and disease burden. The document discusses the global scope of malaria, its transmission and life cycle, clinical manifestations ranging from uncomplicated to severe malaria including cerebral malaria, diagnostic criteria, risk factors and prognostic indicators.
Subheading: Epidemiology in World, In Nepal, Pathogenesis, Clinical Features, Treatment and Prevention.
Presented by:
Medical Students at Manipal College of Medical Sciences
Learning objectives
At the end of this unit, the students will be able to know about:
Epidemiological aspects of blood, and tissue sporozoan
Life cycle and pathogenesis of each blood, and tissue sporozoan
Necessary laboratory procedures for the detection and identification of blood, and tissue Sporozoa.
An infection is the invasion of an organism's body tissues by disease causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable disease, is an illness resulting from an infection.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Global burden of malaria
• Most important parasitic disease of humans
• Disease burden: 300 – 500 Mil. Cases; 90% in
Africa
• 103 countries in the world are malarious.
• 2 Bil. people exposed to the risk of infection
annually.
• Eliminated from north America, Europe and Russia
• Residents of non-endemic areas may also have
• Travel malaria
• Airport malaria
• Mortality very high in this group
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3. Malaria transmission occurs in more than 100 countries. Majority of which,
possess tropical or subtropical zones where anopheles mosquito habitats
exist.
A child dies every 5 seconds from malaria in Africa
New methods estimate the number of malaria cases to be 243 million clinical
cases and 863 thousands deaths (2008 estimates)
More than 85% of malaria cases and 90% of malaria deaths occur in Africa
south of the Sahara
Responsible for 1 in 4 childhood deaths in Africa
Accounts for 10% of Africa’s disease burden
It is the leading cause of Under-5 mortality in Africa [20%]
It accounting for about 40% of public health expenditure in many African
homes
In Nigeria, N132 billion is lost annually from malaria.
Global burden of
malaria
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4. ETIOLOGY
• The parasite (Plasmodium) is introduced into the host through a
bite by a female Anopheles mosquito
• Plasmodium is an obligate intracellular blood protozoa with 100
species but only 4 [+1] species implicated in malaria.
• They are Plasmodium falciparum, vivax, ovale & malariae.
• Plasmodium falciparum is the most common and causes the most
lethal infection in the tropics and subtropics, as it destroys RBCs of
all ages and multiply infects red cells to a high degree
• Plasmodium malariae destroys the aged RBCs, causing a mild
infection.
5. • Plasmodia ovale and vivax destroy young RBCs, resulting in a
mild infection but relapse due to the presence of hypnozoites in
the hepatic tissues.
• Plasmodium falciparum is responsible for 80-90% of malarial
infection either alone or in combination.
• Plasmodium vivax is uncommon in Africa.
• Less common means of infection includes:
-Congenital acquisition through the placenta.
-Infected blood transfusion.
-Perinatally due to mingling of blood during birth.
ETIOLOGY
6. Endemicity and immunity to
malaria
Endemicity refers to the amount or severity of malaria in an area
or community.
Measured by parasitaemia or palpable spleen rates:
A. Hypoendemicity - little transmission and the disease has little
effect on the population. (<10%)
B. Mesoendemicity - varying intensity of transmission; typically
found in rural communities of the sub-tropics. (10-50%)
C. Hyperendemicity - intense but seasonal transmission;
immunity is insufficient to prevent the effects of malaria on all
age groups. (51-75%)
D. D. Holoendemicity - intense transmission occurs throughout
the year. As people are continuously exposed to MPs they
gradually develop immunity to the disease. (>75%)
7. Endemicity and immunity to
malaria
Depending on the intensity of transmission,
malaria can be stable or unstable, reflecting
different epidemic scenarios.
• Stable malaria: Sustained incidence over several years.
Seasonal fluctuations in transmission may occur but
epidemics are unlikely.
• Unstable malaria: Marked variations in the incidence of
malaria over time. Population does not develop
immunity and people of all ages are susceptible to
severe disease when transmission increases.
8. Predisposition
Malaria and hemoglobinopathies
• Geographical distribution of sickle-cell gene closely
follows that of endemic P. falciparum malaria
• Subjects with sickle cell trait (Hb AS) have less severe
malaria than individuals with AA genotype
Susceptibility to malaria is increased by:
• Splenectomy
• Pregnancy (especially primigravidae)
• Malnutrition www.medrockets.com
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9. Pathogenesis
• P. falciparum causes most severe disease because it
can infect RBCs of any age
• Immunity can be natural or acquired
• Natural:
• Duffy-negative blood group-P. vivax (lacks receptor)
• Genotype AS
• Thalassemia
• G6PD deficiency
• Pyruvate Kinase deficiency
• Functional spleen
• Acquired: Following attack of malaria
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12. PATHOLOGY
• It is due to Haemolysis of infected RBCs and adherence of
infected RBCs to capillaries.
• Profound anaemia is seen in prolonged attack due to haemolysis
of RBCs.
• More severe haemolysis due to P. falciparum infection, as it
invades RBCs of all ages.
• Liberation of toxic haemozoin and antigenic substances upon
rupture of schizonts, which may further damage the capillaries.
• Adherence of parasitized cells to capillaries of major organs-
brain, kidney, lungs, gut, liver, could cause organ congestion and
anoxia.
13. OTHER GENETIC FACTORS.
• These factors influence the susceptibility to malaria by reducing the
ability of MP to penetrate the RBCs, thus reduce the severity of
acute malaria & prevalence of chronic malaria.
-HbS
-G-6-PD deficiency
-HbF
-HbE
-Thalassemia
-Duffy-negative genotype
-Well-nourished children (Malnutrition does not increase the severity
of malaria, as well-nourished children are more likely to suffer from
severe malaria)
14. Innate or Acquired
INATE- Red cell abnormalities –sickle cell trait, G6PD
deficiency, Thalassaemia trait, ovalocytosis etc. Duffy
antigen in W/Africans and vivax
ACQUIRED-require repeated exposure. Neonates
protected by maternal Ig G in the first 6 months.
Antiparasite dx occurs at 10 yrs of age in area of stable
transmission.
Well-nourished children (Malnutrition does not
increase the severity of malaria, as well-nourished
children are more likely to suffer from severe
malaria)
PROTECTION AGAINST MALARIA
15. The clinical course of P. falciparum
Following a bite by an infected mosquito, many people do
not develop any signs of infection. If infection does
progress, the outcome is one of three depending on host
and parasite factors:
A. Asymptomatic parasitaemia
(“clinical immunity”)
B. Acute, uncomplicated malaria
C. Severe malaria
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16. MALARIA – Clinical syndromes
Chronic Disease
Chronic or Recurrent
Asymptomatic
Infection
Placental Malaria
& AnaemiaAnaemia
Infection
During
Pregnancy
Developmental
Disorders
Transfusions
Death
Low
Birth weight
Increased
Infant
Mortality
Acute Disease
Non-severe
Acute Febrile
disease
Cerebral
Malaria
Death
17. ACUTE UNCOMPLICATED MALARIA
-Most cases in tropics and its clinical manifestation (symptoms) includes :
1.FEVER
-commonest symptom in childhood, though variable, showing remarkable
periodicity.
-bouts of fever corresponds to the maturation & rupture of erythrocytic
schizonts with subsequent discharge of merozoites into the
bloodstream.
-P.vivax , ovale .. 48hrs (tertian)
-P.malariae .. 72hrs (quartan)
-P. falciparum .. Irregular tertian (malignant tertian pattern)
18. Acute Uncomplicated contd
-Obscured periodicity is seen in younger children, who are non- or
semi- immune, as it corresponds to the level of parasitaemia.
-Malaria febrile paroxysms are preceded by 3 defined stages,
especially in older children viz the cold, hot & sweating stages.
2. HEADACHE..very common symptom in older children.
3.VOMITTING..bilious especially in the absence of diarrhoea.
4. PALLOR..usually mild to moderate from haemolysis.
5. PAIN & OTHER ACHES..commonly seen in children presenting with
acute malaria.
6. DIARRHOEA..P. falciparum in infants.
7. COUGH..atypical in younger children.
• OTHER SYMPTOMS- General malaise, anorexia,
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19. Clinical signs
-On examination;
• Fever
• Pallor
• Jaundice is not a feature except in haemoglobinuria or if there is
underlying pathology eg in sickle cell anaemia, sepsis, G-6-P-D
deficiency
• Hepatomegaly
• Splenomegaly
• Hepatosplenomegaly
• Tender enlarged spleen (rare cases).
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20. • It is a life threatening condition of P.falciparum malaria.
• It is diagnosed by the presence of asexual form of the
P.falciparum in the peripheral blood smear of a Patient who
presents with a potentially fatal complications of acute malaria,
provided all diagnosis in other systems have been excluded.
• The essential pathology is by deep microvasculature parasite
sequestration with obstruction of vascular flow resulting in
hypoxic-ischaemic injury to the tissues, with greatest affectation
to the brain.
SEVERE MALARIA
(Acute complicated malaria)
21. Types & Diagnostic features of severe
malaria.
• Prostration (generalized weakness)
• Hyperparasitaemia (5% of RBCs or 250,000 cu. ml)
• Cerebral malaria..altered sensorium ( 30minutes)
• Hyperpyrexia (rectal temp 40C)
• Severe anaemia (Hb5.0g/dl or PCV0.15 or Hb3.1mmol/L)
• Severe jaundice (Serum bilirubin 51 mol/L)
• Hypoglycaemia (RBS 2.2 mol/L)
• Renal failure (Oligouria or anuria & Serum creatinine 265mol/L.)
• Shock (hypotension, rapidly thready pulse, pallor)
• Pulmonary oedema (clinical & radiological diagnosis)
• Clotting disturbance (bleeding episodes)
• Electrolyte & Acid-base balance (clinically, low serum levels, pH7.2)
22. SEVERE MALARIA [any of these]
Clinical features:
• impaired consciousness or unrousable coma:
• prostration: generalised weakness so that the patient is unable walk or sit up
without assistance. Child is unable to feed.
• multiple convulsions – more than two in 24 hours
• deep breathing, respiratory distress: acidotic breathing
• circulatory collapse or shock: systolic blood pressure <70mmHg in adults and
<50mmHg in children
• jaundice
• haemoglobinuria: coke coloured urine
• abnormal spontaneous bleeding
• pulmonary oedema: clinical and radiological
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23. SEVERE MALARIA[any of these]
Laboratory findings
• hypoglycaemia: blood glucose <2.2mmol/L or <40mg/dl
• metabolic acidosis: plasma bicarbonate <15mmol/L
• severe anaemia: (Hb < 5g/dl, packed cell volume < 15%,)
• haemoglobinuria
• hyperparasitaemia: Parasite density >250,000/UL of blood or >5%
parasitised red blod cells
• hyperlactataemia: lactate >5mmol/L
• renal impairment: serum creatinine >265micromol/L
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24. CEREBRAL MALARIA
• It is a rapidly progressive encephalopathy due to sludging of the
cerebral capillaries by RBCs parasitized by asexual forms of P.
falciparum and leading to cerebral hypoxia, edema.
• It is the most serious complication of falciparum malaria in children &
occurs usually in children aged 6 mths to 5 yrs
• It is more prevalent in well-nourished children.
• Pathognomonic feature is the presence of ring haemorrhages
surrounding the capillaries & arterioles in a brain biopsy and excess
haemozoin (malarial pigment). Slatey grey appearance of brain
tissue.
25. CEREBRAL MALARIA contd
• The ‘Mechanical theory’ postulates a phenomenom of reduced
deformability and cyto-adherence in parasitized RBCs &
rosetting in unparasitised RBCs causing obstruction of the
cerebral capillaries & arterioles.
WHO diagnostic criteria are
• Asexual parasitaemia of P. falciparum on blood film
• Altered sensorium lasting > 30 minutes. There is either no
response or non-purposeful response to painful stimuli.
• Exclusion of other causes of encephalopathy eg meningitis
[normal CSF ], encephalitis, hypoglycemia
26. • Acute falciparum malaria which may be complicated by ARF &
rarely by AGN.
• Also known to cause Quartan malarial nephropathy as it is
caused by P. malariae. This is rarely reported in recent times.
• BLACKWATER FEVER
-Is a syndrome of intravascular haemolytic episode with
subsequent haemoglobinuria associated with falciparum malarial
infection.
-it is most likely due to hypersensitivity to incompletely killed
parasites & usually follows inadequately treated acute P.
falciparum infection or suppression by quinine.
MALARIAL NEPHROPATHY
27. • ANAEMIA IN MALARIA
Multifactorial causes. They include :
-Haemolysis
-Sequestration of RBCs in RES & deep tissues.
-Dyserythropoiesis
-Capillary haemorrhages
-Haemodilution due to expansion of plasma volume.
-Bone marrow suppression.
-Hypersplenism from hyperreactive splenomegaly
• ALGID MALARIA
-It is characterised by shock [circulatory collapse].
-Usually associated with gram negative sepsis
30. Poor Prognostic symptoms 3
• Haematology
• Leukocytosis (>12,000/L)
• Severe anemia (PCV <15%)
• Coagulopathy
• Decreased platelet count (<50,000/L)
• Prolonged prothrombin time (>3 s)
• Prolonged partial thromboplastin time
• Decreased fibrinogen (<200mg/dL)
• Parasitology
• Hyperparasitemia
• Increased mortality at >100,000/L
• High mortality at >500,000/L
• >20% of parasites identified as pigment-containing trophozoites and
schizonts
• >5% of neutrophils with visible pigment
31. DIAGNOSIS
• In endemic regions, malaria should be considered a cause in of
fever in a febrile child.
• Confirmation is by microscopic demonstration of the parasite in
a thick & thin blood smear stained with Giemsa stain (gold
standard in developing countries)
• Finding of only the Ring forms (asexual forms) of P. falciparum is
diagnostic.
• The thick film reveals the presence and the count[load] of the
parasite while the thin film identifies the plasmodial spp.
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32. • Non-microscopic techniques are been developed and involves
the detection of plasmodial Ag, anti-plasmodial Abs or the
parasitic metabolic products.
• Examples include; paraSight, F-test, ICT malaria P.F test,
optiMal assay, PCR, ELISA,.
• Other investigations, depend on presentation.
DIAGNOSIS
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33. BLOOD FILM
• Thick smears
• Parasite density
• Thin smears
• Specie
identification
34. DIFFERENTIAL DIAGNOSIS
• This is very broad; in fact any “fever” in the tropics is assumed to
be malaria until proven otherwise.
• Viral ailments:
• Influenza, hepatitis & even common cold.
• Typhoid fever,
• Yellow fever,
• Tuberculosis,
• Pneumonia,
• Meningitis,
• Septicaemia.
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35. Aim Of Treating Malaria
• To fight an established infection, and this includes
• Elimination of the parasites.
• Supportive measures to overcome morbidity
associated with infection
• Monitoring to ensure early diagnosis and treatment
of complication that can lead to death within hours.
TREATMENT
36. Clinical Case Management &
Basic Supportive Care
• Rehydration
• Monitor Blood Sugar
• Anticonvulsants –to control seizures – rectal
diazepam.
• Dialysis in renal shut down.
• Blood transfusion for anaemia- PCV < 20%.
• Antibacterial for bacterial infections - aspiration
pneumonia and sepsis
• Exchange blood transfusion
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37. • WHO has recommended the use of Artemisinin Combination Therapy for the
treatment of uncomplicated malaria. The recommended ACTs include:
• Artemether-lumefantrine (Nigeria) 1.5/9 mg/kg twice daily for three days
• Artesunate+Amodiaquine Artesunate 4 mg/kg once dly for 3 days + Amodiaquine
10mg base/kg on days 1, 2, & 3
• Artesunate+Mefloquine Artesunate 4 mg/kg once daily for 3 days + mefloquine 25
mg base/kg (mefloquine 8.3mg/kg daily for 3 days)
• Dihydroartemisinin-piperaquine This a new ACT that has been shown to be safe and
equally effective
UNCOMPLICATED MALARIA
38. Specific Antimalarial Treatment
for Severe Malaria
• The recommended treatment for severe malaria is
Artesunate Injection
• Give 2.4 mg/kg IV bolus, repeat 1.2 mg/kg after 12 hours and
then 1.2 mg/kg daily until patient can tolerate oral medication
(or for a minimum of 48 hours). Thereafter given follow-on
treatment using a full 3-day course of ACT
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39. Possible alternatives if not available include
Intravenous quinine Give 20 mg/kg of Quinine dihydrochloride salt as
loading dose diluted in 10 ml/kg of 4.3% dextrose in 0.18% saline or 5%
dextrose over a period of 4 hours. Then 12 hours after the start of the loading
dose, give 10 mg salt /kg infusion over 2 hours every 12 hours until when
patient is able to take orally. Change oral ACT once patient can tolerate oral
medication
OR
Intramuscular Artemether:- 3.2 mg/kg IM on the first day and then 1.6
mg/kg daily for a maximum of 3 days until the patient can take oral
treatment, then give a full 3-day course of ACT.
Specific Antimalarial Treatment
for Severe Malaria
40. Advantages of ACT:
• High efficacy and rapid clearance of parasites
• Artemisinin reduces gametocyte carriage thus reduces
malaria transmission
• Artemisinin derivatives – most rapidly schizonticidal
antimalarial drugs known to date
• Used for >2 centuries in china and still effective
(artemisinin derivatives do not remain in the blood
stream for long)
• Relatively good safety profile despite initial anxiety
following pre-clinical findings
• Reduction in malaria transmission
41. Prevention & Control
• Good personal hygiene
• Environmental hygiene
• Good Nutrition and immunity
• Early diagnosis and treatment
• Presumptive treatment of severe cases. Make every effort to establish diagnosis in
the laboratory before treatment. However, this should not delay treatment in cases of
suspected severe malaria.
• Ensure compliance
• Protection against mosquito bites
• Chemoprophylaxis- indications
• Sickle cell anaemia
• Patients on immunosuppressive therapies or disease states
• Non-immune or semi-immune children
• Pregnant women
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42. MALARIA CONTROL-
WHAT IS RBM
• This is a global movement mobilizing support for local
initiative. It is a coordinated approach to strengthen public and
private health care. It involves multiple strategies targeted to
meet local malaria control needs. It was established 31st July
1998
• Six Principles of RBM
• Early detection
• Rapid diagnosis and Effective Treatment
• Multiple prevention
• Focused research
• Well coordinated actions
• Dynamic movement
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