Malaria is a protozoal disease transmitted through the bite of infected Anopheles mosquitoes. It is caused by Plasmodium parasites and affects hundreds of millions of people annually, mostly in tropical areas. The most severe form is caused by P. falciparum. People are infected through mosquito bites, and the parasite undergoes asexual and sexual reproduction stages in the human and mosquito hosts respectively. Symptoms include cyclic fever, chills, sweating and can progress to severe complications like cerebral malaria. Diagnosis involves microscopic examination of blood films to identify the malarial parasites. Treatment depends on the Plasmodium species and includes antimalarial drugs like chloroquine and primaquine.
Malaria is a Vector-borne parasitic disease found in 91 countries worldwide. >120 Plasmodium species infect mammals, birds, and reptiles. Only five are known to infect human. Plasmodium falciparum causes majority of deaths due to high levels of parasitemia, sequestration of parasite in critical organs and causing severe anemia
Malaria is a Vector-borne parasitic disease found in 91 countries worldwide. >120 Plasmodium species infect mammals, birds, and reptiles. Only five are known to infect human. Plasmodium falciparum causes majority of deaths due to high levels of parasitemia, sequestration of parasite in critical organs and causing severe anemia
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Malaria.ppt.2003
1.
2. Malaria is a protozoal disease transmitted by
the bite of infected anopheles mosquito
3. Most important of parasitic diseases of
humans
Causes more than 300 millions infections and
more than 100 million deaths every year
Almost all deaths are caused by falciparum
malaria
4. Man is the only important reservoir
Vector is female Anopheles mosquito
Temperature: below 86º F, above 68º F
Rainfall: thrive in tropical areas
Altitude: rarely exist above 2000 meters
Terrain: coastal areas and lowlands with
lots of water breeding sites
5. Mosquito vector: ANOPHELES
Transmission also possible through:
1.1. BloodBlood
transfusiontransfusion
2.2. ContaminatedContaminated
needleneedle
3.3. OrganOrgan
transplanttransplant
6. Two Phases
In Man - Asexual called schizogony
In Mosquito - Sexual called sporogony
The infective form for man is called the sporozoite
The form required for sexual cycle is the
gaemetocyte (male and female)
9. TERTIAN MALARIA
(48 HOURS)
Benign Tertian (BT)
Benign P. vivax, P. ovale
Malignant Tertian (MT)
P. falciparum
QUARTAN MALARIA
(72 HOURS)
Quartan
P. malariae
QUOTIDIAN MALARIA (24
HOURS)
P. knowlesi
10. 1. Incubation period
2. Prodromal period
3. Clinical forms
Typical form, Mild form,
Cerebral malaria, Recrudescence,
Relapse.
11. P. Falciparum 12 days
P. Knowlesi 9-12 days
P. Vivax 14 days*
P. Ovale 14 days*
P. Malariae 30 days
* May be 8 - 10 months or longer for some strains
12. Classical cyclic paroxysm:
Cold stage: chills and shaking
Hot stage: warm, headache, vomiting
Sweating stage: weakness
Feel well for a period of time, then cycle repeats itself
14. Cerebral malaria
Severe anaemia
Hypoglycaemia
Acidosis
Respiratory distress
“Black water fever”
15. Recrudescence
Parasites in red blood cells were suppressed
by specific drugs, or immunity, but not
eradicated, and proliferated again after a
short time, and induce clinical
manifestations.
16. Relapse
Clinic signs of malaria about six months to 1
year or longer after primary attack.
caused by Hypnozoites of P. vivax
and P. ovale.
17. Blood complete picture:
Anaemia
Demonstration of the Malarial Parasite (MP)
Thick film
Thin film
18. P.falciparum P. vivax P.ovale P. malariae P. knowlesi
•Mature
trophozoite and
schizont absent
•Normal size of
RBC
•Multiple
infection
•Applique form
•Banana shaped
gametocyte
•All stages
seen
•Enlarged
RBC
•Ameboid
trophozoite
•12-24
merozoites in
schizont
•All stages seen
•Normal/ Large
RBC
•8-12 merozoites
in schizont
•All stages seen
•Normal RBC
•6- 12
merozoites in
schizont
•All stages seen
•Rings resemble
falciparum
•Trophozoite
and schizont
resemble
malariae
•Upto 16
merozoites in
schizont
19. Examination of he thick film is the Gold
Standard for detection of the organism
Approximately 20 fold more blood is
examined in each oil immersion field than a
thin film
Thin film are the Gold standard for species
identification
20. Acridine orange stain
Dark Field Microscopy (Hemozoin detection)
Polymerase Chain Reaction (PCR)
Immunochromatograhic antigen detection
(ICT)
HRP-2 ----- P. falciparum
Aldolase --- Non- falciparum species
LDH ---- All Palsmodium species
24. 1. Attack the parasite in the human host
2. Reduce contact between humans and
mosquitoes
3. Decrease mosquito population
25.
26.
27.
28. Primaquin
30mgX QID x1-2 days before to 7 days after
Chloroquin
300 mgX 2 weeks before to 4 wks after
29. Chloroquine
600mg stat, 300mg after 6hrs, 150mg- BDx 2 days
Artemether-lumefantrine (Artem DS)
2 tabs X BDX 3days
Primaquine
0.5mgbase/kg x QID x 14 daysm
Editor's Notes
The only important host reservoir for Plasmodium is Man. The vector is the female Anopheles mosquitoes. The female needs blood for egg development; male mosquitoes don’t feed on blood.
To transmit the parasite, the mosquitoes must be able to breed, feed on humans, and live long enough for the parasite to complete its life cycle.
Any place that harbors Anopheles mosquitoes is potentially at risk for malaria. However, certain environmental conditions must exist for the parasite to survive.
-Temps between 68-86 oF (20o and 30 oC). Plasmodia don’t survive below average temps of 59 o F (15 o C).
-High rainfall & mean relative humidity of 60%. High rainfall increases mosquito breeding sites and high humidity increases mosquito life-span, both of which increase the likelihood of a mosquito becoming infected and transmitting the parasite.
-Anopheles spp. are found in coastal areas, lowlands, and highlands. They have been found up to about 2500 meters (8200 ft) altitude.
-Females lay eggs in surface water; some species prefer open sunlit shallow seepage water, while others prefer impounded water with floating vegetation and debris. Most of the mosquitoes are found within a few kilometers of their rural breeding site.
Ref: 1,2.
-Of over 400 Anopheles species, 60 are potential malaria vectors and only about 30 of those are considered effective vectors.
-MOST of these are exclusive night feeders- dusk to dawn -BUT in shaded forests or jungle areas they may feed throughout the day
-The picture on this slide shows a female with an abdomen full of blood – note how much her abdomen has expanded. After a blood meal her weight will increase by 3-5 times.
There are a few other less common modes of transmission of malaria. These are:
Blood Transfusion
Contaminated needle
Organ Transplant
Congenital
Ref: 2,5.
-Incubation period is the time between introduction of the infectious agent and the development of symptoms. The incubation period varies somewhat with species of parasite, and knowing the incubation periods can sometimes help you rule out malaria as a cause of fever. The incubation periods are:
(a) P. falciparum - 9 to 14 days
(b) P. vivax - 12 to 17 days
(c) P. ovale - 16 to 18 days
(d) P. malariae - 18 to 40 days
-Note that no matter which species, malaria takes almost 2 weeks to incubate.
-Unfortunately, it’s not possible to rule out malaria based on too long a time after exposure. This is because the incubation period of malaria can be prolonged by inadequate chemoprophylaxis. If some medication is taken but too infrequently, the low level of drug will slow the growth of parasites. This can result in clinical malaria developing atypically, with milder symptoms at first, and much later than expected.
Ref: 1,2.
-Malaria can present with a non-specific prodrome lasting up to several days. Symptoms include malaise, anorexia, headache, myalgia and low grade fever. However, malaria can also start more suddenly, with acute onset of severe illness.
-After several more days, the classic cyclic "paroxysms" may develop. These include 3 stages – cold, hot, & sweating. It may take 3-7 days for the cycles to appear, if they appear at all. Until then the fevers may be erratic.
-The cold stage lasts 15 minutes to several hours. Symptoms include feeling cold, shivering, and teeth chattering. Temp rises rapidly, skin is pale and cold, may see cyanosis of the lips and nail beds.
-The hot stage lasts 2 to 6 hours. Fever is up to 106F with falciparum and up to 104F with others. Symptoms include severe headache, malaise, myalgia, anorexia, nausea and vomiting, diarrhea, dry cough, and shortness of breath; may have delirium.
-The defervescence or sweating stage lasts 2 to 4 hours. The fever falls rapidly; there is profuse sweating. Afterward, the patient may be exhausted and sleep for hours, but is much improved.
-After an interval free of fever the cycle of chills, fever, and sweating is repeated either daily, every other day, or every 3rd day.
-With falciparum, fevers tend to be persistent with intermittent spikes. Falciparum malaria is typically not as cyclic as the other three. But remember that these classic paroxysms often are not present, and that malaria can have ANY pattern.
Ref: 1.
There are 3 major points of attack with this type of approach:
Attack the parasite in the human host. Since the dz is spread from infected humans to a mosquito to other humans, reducing the length of time parasites survive in a malaria patient will decrease the potential for spread of the disease.
Reduce contact between humans and mosquitoes. Preventing mosquito bites is the primary method of preventing disease transmission (also helps for all other mosquito born inf. Dzs). Once infection occurs, malaria can still be averted with the use of secondary prevention with chemoprophylaxis (medication to prevent illness from developing). But best is to prevent being bitten and infected in the first place
Decrease mosquito population- the fewer the vectors, the less chance parasites can be spread from infected people.
Ref: 1.
