Hints on Malaria, epidemiology, transmission and life cycle, clinical manifestations, diagnosis, treatment and prevention.

1. Eugine Mbuh Nyanjoh
BMLS.,MSc. MMP
Director of Rapha Higher Institute of health Kumba
Email: eugine.nyanjoh@raphakumba.com

2. • Background information
• Causes of malaria
• Transmission of malaria
• Pathogenesis
• Signs and symptoms
• Diagnoses
• Treatment
• Prevention and control
• References

3. • 3.2 billion people are still at risk of being infected by
malaria
• Children < 5years and Pregnant women are the
highest risk groups
• 212 million new cases reported in 2015
– WHO African region -90%
– South-Asia – 7%
– East Mediterranean – 2%
• 429000 malaria related deaths occurred in 2015
– WHO African region -92%
– South-Asia – 6%
– East Mediterranean – 2%

6. • Five Plasmodium species :
• Plasmodium falciparum: malignant tertian malaria
• Plasmodium vivax: benign tertian malaria
• Plasmodium ovale : benign tertian malaria
• Plasmodium malariae: quartan malaria
• Plasmodium Knowlesi

7. 1. Bite of infected female Anopheles mosquito
• Anopheles gambiae (principal vector)
• Anopheles albimanus
• Anopheles freeborni
• Anopheles maculatus
• Anopheles stephensi
2. Blood transmission
3. Contaminated needles
3. Congenital transmission
4.Organ transplantation

8. Bite of infected female Anopheles
mosquitos
Congenitally
Contaminated needles
Transfusion of blood

10. Exo-erythrocytic
(hepatic) cycle
Hypnozoites
Sporozoites
Salivary Gland
Gametocytes
Erythrocytic
Cycle
Zygote
Oocyst
Stomach Wall
Pre-erythrocytic
(hepatic) cycle
sporozoites

11. • Pathologic changes involve blood and forming system, spleen and
liver.
• Most severe in Plasmodium falciparum malaria.
• During growth in RBC, the Pasmodium consumes and degrades
haemoglobin altering the O2 transport properties of RBCs.
• RBC destruction leading to anaemia
• Membrane protuberances occur on RBC leading to cytoadherance
and rossetting which ultimately results to sequestrantion of
parasites in vital organs.
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12. • Cytoadherance and rosetting compromise the microcirculation,
metabolism and allows parasite development away from
principal host defenses and splenic processing and filtration.
• In pregnancy, parasitized RBCs and malaria parasite
sequester in the placenta.
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13. • Malaria can be classified as uncomplicated or
complicated malaria
• Clinical features of uncomplicated malaria include:
• Headache, lassitude, fatigue, abdominal discomfort
and muscle and joint aches,
• Followed by fever, chills, anorexia, vomiting and
worsening malaise.
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14. • Complicated or severe malaria
• In addition to features of uncomplicated malaria, the
following are features indicate severe malaria;
• Cerebral malaria/ unarousable coma
• Metabolic acidosis
• Severe haemolytic anaemia/black water fever
• Hypoglycaemia
• Acute renal failure
• Pulmonary oedema
• Disseminated intravascular coagulation (DIC),
• Hypotension
• Convulsions
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15. Hot stage
Cold
stage
Sweating
Malarial Paroxysm
cold stage
•feeling of intense cold
•vigorous shivering
•lasts 15-60 minutes
hot stage
•intense heat
•dry burning skin
•throbbing headache
•lasts 2-6 hours
sweating stage
•profuse sweating
•declining temperature
•exhausted and weak →
sleep
•lasts 2-4 hours

16. Plasmodium
falciparum::
Plasmodium vivax,
Plasmodium ovale
Plasmodium
malariae:

17. • Microscopy (the imperfect goldstandard)
• Rapid Diagnostic Tests (RDTs)
• Molecular Diagnostic Methods e.g PCR

18. • Preparation, staining and observation of thin and thick blood films

19. • Microscopic Examination of blood films cont‘d
Thick blood film Thin blood film

24. • WHO recommends ACTs as the best treatment of
uncomplicated malaria in children and adults
(except pregnant women in the first trimester)
• Artemether + Lumefantrine (Coartem)
• Artesunate + Amodiaquine (Camoquin)
• Artesunate + Mefloquine
• Dihydroartemisinin + Piperquine
• Artesunate +Sulfadoxine-pyrimethamine

25. • Pregnant women
• Patients co-infected with HIV
• Non-immune travelers returning from endemic
settings

26. Severe malaria
• Parenteral artesunate is the treatment of choice for
severe malaria .
• If artesunate is not available, quinine is used.
• The quinine infusion is discontinued once the patient
is able to take oral medication.
• Complications such as severe anaemia,
hypoglycaemia, coma are also managed

27. • The WHO recommends a three-pronged approach for
prevention and control of malaria ;
• Use of insecticide treated nets (ITNs) to prevent
infection
• Intermittent Preventive Treatment (IPT) especially in
pregnant women
• Early diagnosis and Effective management malaria
illness.

29. • Window screens

30. • Candidate RTS, S/AS01

31. Thank you for your kind
attention