Plasmodium falciparum malaria poses a serious global health threat, with approximately 250 million cases and 1 million deaths annually. Drug resistance has developed to former first-line treatments such as chloroquine and sulfadoxine-pyrimethamine. Prompt diagnosis and treatment with artemisinin-based combination therapies can reduce the spread of resistance. A malaria vaccine is still in development but one candidate, RTS,S, has shown promise in clinical trials in reducing malaria cases and severity.
Antimalarial drug efficacy and drug resistance(yemen)Ghamdan Al Tahish
Antimalarial drug efficacy
Antimalarial drug resistance
Treatment failure
Emergence and spread of resistance to antimalarial drugs
Monitoring antimalarial drug efficacy and drug resistance
Criteria for antimalarial treatment policy change
The old antimalarial drug policy in Yemen
Monitoring the efficacy of AMDs in Yemen 2002-2005
Monitoring antimalarial drug efficacy and drug resistance in Yemen 2009-2010
Drug resistance against malaria
Seminar Prepared by:
Mohammed Musa
Mohammed Saadi
Ali Abdulazeem
Nora Shaker
Shilan Adnan
Parasitology
College of Medicine - University of Kirkuk
No commercially available malaria vaccine at the present time.
RTS,S/AS01 is the most advanced vaccine candidate against malaria.
Commonest infectious disease in the tropics
200 millions per year affected with malaria
3 millions per year die due to malaria
Antimalarial drug efficacy and drug resistance(yemen)Ghamdan Al Tahish
Antimalarial drug efficacy
Antimalarial drug resistance
Treatment failure
Emergence and spread of resistance to antimalarial drugs
Monitoring antimalarial drug efficacy and drug resistance
Criteria for antimalarial treatment policy change
The old antimalarial drug policy in Yemen
Monitoring the efficacy of AMDs in Yemen 2002-2005
Monitoring antimalarial drug efficacy and drug resistance in Yemen 2009-2010
Drug resistance against malaria
Seminar Prepared by:
Mohammed Musa
Mohammed Saadi
Ali Abdulazeem
Nora Shaker
Shilan Adnan
Parasitology
College of Medicine - University of Kirkuk
No commercially available malaria vaccine at the present time.
RTS,S/AS01 is the most advanced vaccine candidate against malaria.
Commonest infectious disease in the tropics
200 millions per year affected with malaria
3 millions per year die due to malaria
molecular markers for antimalarial drug resistanceAnil kumar
this presentation deals with the drugs for choice for malaria, their mode of action, resistance development and its distribution, how to evaluate resistance development and reasons for developing resistance.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
Malaria(Plasmodium falciparum)- Epidemiology, Life Cycle, Prevention and Erad...Sarath
Malaria(Plasmodium falciparum)- Epidemiology, Life Cycle, Prevention and Eradication.
Contains Videos in two slides. So try using Power Point 2010.
My email : doc.sarathrs@gmail.com
This study was designed to investigate the infection rate of nosocomial Acinetobacter spp. in Khalifa hospital, Ajman. A retrospective study was carried out from 2005 to 2008. Bacteriological cultures were used to isolate the organisms by the DADE BEHRING Microscan® to identify the organisms and their antibiotic sensitivity.
Njiru, 2012 has described that " Lack of effective point of care diagnostic tests applicable in resource-poor endemic areas is a critical barrier to effective treatment and control of infectious diseases.” Therefore, Innovations in biotechnology that combine molecular biology, microfabrication and bioinformatics are moving nucleic acid technologies from futuristic possibilities to common laboratory techniques and modes for diagnoses. In this context, LAMP (Loop Mediated Isothermal Amplification) is a highly sensitive and specific DNA/RNA amplification method. Advantage of LAMP is isothermal reaction condition and therefore, LAMP is affordable because of no need to have expensive thermal cycler.
molecular markers for antimalarial drug resistanceAnil kumar
this presentation deals with the drugs for choice for malaria, their mode of action, resistance development and its distribution, how to evaluate resistance development and reasons for developing resistance.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
Malaria(Plasmodium falciparum)- Epidemiology, Life Cycle, Prevention and Erad...Sarath
Malaria(Plasmodium falciparum)- Epidemiology, Life Cycle, Prevention and Eradication.
Contains Videos in two slides. So try using Power Point 2010.
My email : doc.sarathrs@gmail.com
This study was designed to investigate the infection rate of nosocomial Acinetobacter spp. in Khalifa hospital, Ajman. A retrospective study was carried out from 2005 to 2008. Bacteriological cultures were used to isolate the organisms by the DADE BEHRING Microscan® to identify the organisms and their antibiotic sensitivity.
Njiru, 2012 has described that " Lack of effective point of care diagnostic tests applicable in resource-poor endemic areas is a critical barrier to effective treatment and control of infectious diseases.” Therefore, Innovations in biotechnology that combine molecular biology, microfabrication and bioinformatics are moving nucleic acid technologies from futuristic possibilities to common laboratory techniques and modes for diagnoses. In this context, LAMP (Loop Mediated Isothermal Amplification) is a highly sensitive and specific DNA/RNA amplification method. Advantage of LAMP is isothermal reaction condition and therefore, LAMP is affordable because of no need to have expensive thermal cycler.
Hereditary spherocytosis is an inherited condition related to RBC destruction. its diagnosis is require to differentiate immune hemolytic anemia and G-6-P-D deficiency anemia
Content Based Image Retrieval Approaches for Detection of Malarial in Blood I...CSCJournals
Malaria is a serious global health problem, and rapid, accurate diagnosis is required to control the disease. An image processing algorithm to automate the diagnosis of malaria in blood images is proposed in this paper. The image classification system is designed to positively identify malaria parasites present in thin blood smears, and differentiate the species of malaria. Images are acquired using a charge-coupled device camera connected to a light microscope. Morphological and novel threshold selection techniques are used to identify erythrocytes (red blood cells) and possible parasites present on microscopic slides. Image features based on colour, texture and the geometry of the cells and parasites are generated, as well as features that make use of a priori knowledge of the classification problem and mimic features used by human technicians. A two-stage tree classifier using backpropogation feedforward neural networks distinguishes between true and false positives, and then diagnoses the species (Plasmodium falciparum, P. vivax, P. ovale or P. malariae) of the infection. Malaria samples obtained from the various biomedical research facilities are used for training and testing of the system. Infected erythrocytes are positively identified with two measurable parameters namely sensitivity and a positive predictive value (PPV), which makes the method highly sensitive at diagnosing a complete sample, provided many views are analyzed.
To Present an up-to-date summary of the best microbiology practice related to malaria diagnostics
PGY-3, IAU Clinical Microbiology Residency
Dammam, KSA
Malaria is a life-threatening disease. It’s typically transmitted through the bite of an infected Anopheles mosquito. Infected mosquitoes carry the Plasmodium parasite. When this mosquito bites you, the parasite is released into your bloodstream.
Once the parasites are inside your body, they travel to the liver, where they mature. After several days, the mature parasites enter the bloodstream and begin to infect red blood cells. Within 48 to 72 hours, the parasites inside the red blood cells multiply, causing the infected cells to burst open.
The parasites continue to infect red blood cells, resulting in symptoms that occur in cycles that last 2 to 3 days at a time.
National Vector Borne Disease Control Program.pptxDR.SUMIT SABLE
WELL THIS IS ABOUT VECTOR BORNE DISEASE CONTROL PROGRAMME AND MALERIA IN DEPTH . OVERALL OVERVIEW OF NVBDCP HAS GIVEN AND THEN DETAILS ABOUT MALERIA ARE DISCUSSED AND ALL OTHER DISEASES IN PROGRAMME ARE ALSO COVERED.
Presented by Dr. Jenkins at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
Presented by Dr. Brecher at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
Presented by Ms. Hindler at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
Presented by Dr. Hall at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
Presented by Dr. Miller at the 40th Annual Symposium "Diagnostic and Clinical Challenges of 20th Century Microbes", held on Nov 18, 2010 in Philadelphia.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
- 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
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.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Multidrug Resistance malaria vani vannappagari mbbs ph d
1. Multi-Drug Resistant Malaria:
Plasmodium falciparum at our door step
Vani Vannappagari, MBBS, MPH, PhD.
WorldWide Epidemiology , GlaxoSmithKline
Presented at the 41st Annual Symposium
“Global Movement of Infectious Pathogens and Improved Laboratory
Detection”
Eastern PA Branch-American Society for Microbiology
November 17, 2011
Thomas Jefferson University, Philadelphia
2. Malaria: Morbidity and Mortality
There are ~250 million malaria cases annually
~A million malaria related deaths annually
85% of deaths occur among the <5 year age group
– By some calculations a child dies of malaria, every 30
seconds
Over 3.2 Billion people are at risk for malaria and over 1.2
billion people are at high risk for malaria.
3. Protozoa from the Plasmodium genus
Five species causing human disease
– Plasmodium falciparum
– Plasmodium vivax
– Plasmodium ovale
– Plasmodium malariae
– Plasmodium knowlesi
P. falciparum, the most virulent, accounts for >75% of
malaria cases in SSA where ~80% of malaria cases and
~90% of malaria deaths occur
P. vivax accounts for 10-20% of malaria cases in SSA;
outside of SSA, it accounts for >50% of all malaria cases
4. Malaria Cases Due to Plasmodium falciparum
World Malaria Report, 2008
5. Malaria Cases Due to Plasmodium falciparum
and Plasmodium vivax
Feachem, Lancet. 2010 November 6; 376(9752): 1566–1578
7. Diagnosis of Malaria
Prompt and accurate diagnosis
Ideal diagnostic tests need to be rapid, affordable,
low-maintenance, minimal training, able to detect
low density parasitemia and distinguish species
There are several methods of diagnosing malaria
including:
– Clinical
– Microscopy
– Rapid Diagnostic Tests
– Polymerase Chain Reaction (PCR)
– Other tests
8. Clinical Symptoms as a Guide to Diagnosis
WHO recommendations for laboratory-confirmed diagnosis of malaria
infections prior to treatment in all cases
Clinical features cannot reliably distinguish severe malaria from other
severe viral and bacterial infections in children
Specificity of clinical diagnosis (i.e. declared fever) is only 20-60%
compared with microscopy
127 (6%) of 2048 children admitted to hospital in Kenya and
Mozambique with severe falciparum malaria had concurrent positive
blood cultures (Bassat, 2009)
At autopsy, seven of 31 (22.6%) Malawian children with a clinical
diagnosis of cerebral malaria were found to have died from other causes.
(Taylor, 2004)
9. Microscopy
Operational Gold Standard for malaria diagnosis
Under optimum conditions, microscopy can detect 20-50
parasites per μL blood
Advantages of using microscopy include parasite
quantification and species identification
Achieving high sensitivity requires training and quality
control of microscopists, adequate equipment, and
maintenance
11. P. falciparum panel detection score of malaria RDTs at low (200) and high (2000
or 5000) parasite density (parasites/μl) according to target antigen type (HRP2
or pLDH)
12. Polymerase Chain Reaction (PCR) Tests –Gold
Standard
Numerous PCR assays have been developed for the laboratory diagnosis
of malaria, including nested and real-time PCR techniques
PCR-based assays are highly specific and sensitive, capable of detecting
as few as 5 parasites per μL of blood
PCR can readily detect mixed-species infections and may be automated
to enable the processing of large numbers of samples.
PCR tests are mostly used in research settings for diagnostic
confirmation and identification of molecular markers of resistance
In areas with high transmission, detection of low-level parasitaemia may
not be clinically relevant
13. Nucleic Acid Lateral Flow Immunoassay (NALFIA)
NALFIA is a simple readout system for nucleic acids and has been
successfully applied for the detection of food-borne pathogens
such as Bacillus cereus and Salmonella
Rapid immunochromatographic test to detect labeled amplicon
products on a nitrocellulose stick coated with specific antibodies
Lower detection limit is 0.3 to 3 parasites/μL, 10-fold more
sensitive than gel electrophoresis analysis
More sensitive than microscopy and a good alternative to detect
PCR products while circumventing using electricity or expensive
equipment
First step toward molecular field diagnosis
14. Loop-Mediated Isothermal Amplification (LAMP)
LAMP (Loop-mediated isothermal amplification), allows
rapid amplification and detection of a target genetic
sequence with minimal instrumentation and simplified
sample processing
Can detect 1-6 parasites / l with minimal sample
processing that requires no sophisticated equipment
and the results can be read with the naked eye
Early results have proved the utility of this approach for (-) (+)
identifying parasite-positive individuals in population
surveys, even at low transmission intensities
Currently prototype still under study
15. Other Diagnostic Methods
Fluorescence microscopy
Flow cytometry
Life lens smart phone application
– Smartphone application.
– A user takes a photo of a blood sample using a phone and
the high resolution imaging sensor determines whether
the blood is infected with malarial parasites
16. Frequently Used Diagnostic Methods
Clinical diagnosis - least expensive and most commonly used
method in most malaria endemic areas
Globally, ~73% of reported suspected malaria cases in 2009
were parasitologically-confirmed before treatment
In SSA, only ~35% confirmed before treatment
Fosters drug resistance
Microscopy - most popular parasitological method of
detecting malaria infection
Only available in better-equipped clinics
Use of RDTs also on the rise, but still remain out of reach to
many due to cost
18. Recommended Treatments for Uncomplicated
P. falciparum Malaria
First-line treatments
Artemisinin-based combination treatments (ACTs)
Recommended ACTs include: artemether plus
lumefantrine, artesunate plus amodiaquine,
artesunate plus mefloquine, and artesunate plus
sulfadoxine-pyrimethamine
Second-line treatments
Alternative ACT known to be effective in that particular
region
Artesunate plus tetracycline or doxycycline or
clindamycin
Quinine plus tetracycline or doxycycline or clindamycin
19. Recommended Treatments for Severe P. falciparum
Malaria
First-line treatment
Parenteral artesunate
Second-line treatment
Artemether or quinine if parenteral artesunate is
not available
20. P. falciparum Drug Resistance
P. falciparum has become variably resistant to all drug
classes except artemisinin derivatives
Particularly resistant to former first-line drugs
chloroquine (median treatment failure rate up to 100%)
and sulfadoxine-pyrimethamine (median treatment
failure rate as high as 52.8% in some areas)
Chloroquine remains effective only in Central America
22. Multi-Drug Resistance
Multi-drug resistance has been established in southeast Asia,
South America, and SSA
There is high and increasing global resistance of P.
falciparum to amodiaquine, mefloquine and lumefantrine
23. Factors Contributing to Development of
Resistance
Uncontrolled use of combination therapies
Monotherapy
Sub-therapeutic levels, substandard and counterfeit drugs.
24. Delaying the Development and Spread of Resistance
Early diagnosis and appropriate treatment of malaria
– Treatment: prompt provision of antimalarial drugs (ACTs
for P. falciparum and chloroquine and primaquine for P.
vivax).
Optimizing insect vector control (Indoor residual spraying of
insecticide, insecticide treated bed nets)
Strengthening disease management and surveillance
systems and monitoring for drug resistance
25. Vaccine Targets based on the life cycle of the
parasite
Pre-erythrocytic
vaccines
Blood-stage vaccines
Transmission-blocking
vaccines
26. Challenges in Developing a Malaria Vaccine
Parasite has developed immune evasion strategies
Each infection presents thousands of antigens
Different antigens at different stages of the life cycle
Multiple infections (different strains and/or different
species)
Inadequate data on the immune response to infection
27. Most Advanced Vaccine Candidate - RTS,S Malaria
RTS,S is a fusion protein of a portion of the
circumsporozoite protein (CSP) with the hepatitis B
surface antigen produced as a recombinant particle and
combined with a proprietary adjuvant AS02
(GlaxoSmithKline)
Phase II trials showed reduction of clinical malaria by 35%
-55% and severe malaria by 49%
Phase 3 trials begun in 2009 to recruit up to 16,000
children in 7 African countries
Results expected in 2012
30. Population at risk for malaria in 2009 according to
World Health Organization Regions
Region Population* Population at risk Population at risk
for malaria* (low & for malaria* (high
high) (%) only) (%)
Africa 821.8 696.3 (84.7) 567.0 (69.0)
Americas 543.3 158.5 (29.2) 42.1 (7.7)
East Mediterranean 555.2 307.3 (55.3) 115.9 (20.9)
Europe 276.9 2.6 (0.9) 0.2 (0.1)
South-East Asia 1,783.3 1,249.2 (70.0) 449.5 (25.2)
Western Pacific 1,637.8 866.4 (52.9) 68.5 (4.2)
Total 5,618.2 3,280.3 (58.4) 1,243.2 (22.1)
*-Millions
Source: World Malaria Report 2010
31. Estimated numbers of malaria cases (in millions)
and deaths (in thousands) by WHO Region, 2008
Region No. of malaria No. of deaths * % of deaths
cases * under 5 years
Africa 208 (155-276) 767 (621-902) 88
The Americas 1 (1-1) 1 (1-2) 30
East Mediterranean 9 (7-11) 52 (32-73) 77
Europe 0 0 3
South-East Asia 24 (20-29) 40 (27-55) 34
Western Pacific 2 (1-2) 3 (2-5) 41
Total 243 (190-311) 863 (708-1003) 85
*-(5th-95th Percentile)
Source: World Malaria Report 2009
32. The prevalence of mixed Plasmodium infections detected
at admission by microscopy and PCR
Countries Mixed infections; Mixed infections; Cryptic species
microscopy (%) PCR (%)
Australia 0/23 (0) 4/23 (17) Pv
Thailand 1/137 (0.5) 9/173 (5) Pv
Thailand 1/196 (0) 25/196(13) Pv; Pm
Thailand 0/48 (0) 6/48(12.5) Pf; Pv
Thailand 18/475 (4) 356/548 (65) Pf; Pv; Pm; Po
Venezuela 0/100 (0) 17/100(17) Pf; Pv
Equatorial Guinea 11/159 (7) 44/159 (28) Pf; Pm; Po
Spain 2/192 (1) 9/192 (5) Pv; Pm; Po
Papua New 80/1470 (0.01) 113/173 (65) Pf; Pv; Pm; Po
Guinea
Laos 2/58 (3.4) 27/117 (23.1) Pf; Pv; Pm; Po
Thailand 7/300 (2.3) 26/151 (17) Pf; Pv; Pm; Po
Source: Maymax et al. Trends in Parasitology 2004
33. Countries with the highest number of confirmed P.
falciparum cases in 2009
Microscopy/RDTs Microscopy/RDTs P. falciparum
Country Population taken positive cases*
Uganda 32,709,864 3,6112,418 1,301,337 1,275,310
India 1,198,003,273 103,395,721 1,563,344 837,130
Ghana 23,837,261 2,899,497 1,104,370 924,095
Ethiopia 82,824,732 1,328,114 1,036,316 594,751
Benin 8,934,986 --- 889,597 534,590
Liberia 3,954,977 1,003,961 839,581 212,657
Indonesia 229,964,721 2,461,428 544,470 212,501
Togo 6,618,613 734,303 391,338 191,357
Myanmar 50,019,774 940,050 436,068 121,636
Congo 3,683,181 203,160 92,855 92,855
Note: Microscopy slides/RDTs taken may be lower than microscopy slides/RDTs positive if a country did not
report number of RDTs examined (taken), * Proportion of P. falciparum out of total confirmed malaria cases
Source: World Malaria Report 2010
34. Populations at high risk for malaria infection
High transmission areas
– Children under five years
– Pregnant women
– HIV infected individuals
– Travellers from non-endemic areas
Low transmission areas
– All age groups
– Travellers from non-endemic areas
35. Glucose-6-phosphate Dehydrogenase (G6PD) Deficiency
G6PD is required by all cells for protection from damage by oxidation.
For the red cell, this is the sole source of protection against oxidant
damage in the form of free radicals generated by the conversion of
oxy- to deoxyhemoglobin and by peroxides generated by
phagocytosing granulocytes.
Approximately 330 million people worldwide affected with highest
prevalence in individuals of African, Mediterranean and Asian
heritage.
Since this is an X-linked gene, prevalence among females is higher
but they are generally asymptomatic. Many variants of G6PD alleles
have been identified
37. G6PD variants
• Class I: severely deficient, associated with chronic
nonspherocytic hemolytic anemia
–
• Class II: severely deficient (1%-10% residual activity),
associated with acute intermittent hemolytic anemia
(G6PD Mediterranean)
–
• Class III: moderately deficient (10%-60% residual
activity) - intermittent hemolysis usually associated with
infection or drugs
• Class IV: normal activity (60%-100%)
• Class V: increased activity (>100%-150%)
38. Treatment of Malaria
Objectives of treatment include:
– Prevent progress to severe disease and complications
– Prevent development of antimalarial drug resistance
– Reduce transmission
39. Treatment guidelines for uncomplicated falciparum malaria
Artemisinin-based combination therapies (ACT) are the recommended
treatments for uncomplicated falciparum malaria.
ACTs should include at least 3 days of treatment with an artemisinin
derivative
The following ACTs options are recommended:
– Artemether + lumefantrine; artesunate + amodiaquine; artesunate +
mefloquine; artesunate + sulfadoxine-pyrimethamine; and
dihydroartemisinin + piperaquine .
Second-line antimalarial treatment:
– Alternative ACT known to be effective in the region;
– Artesunate plus tetracycline or doxycycline or clindamycin.
– Quinine plus tetracycline or doxycycline or clindamycin.
Source: WHO Guidelines for the Treatment of Malaria, 2010
40. Treatment guidelines for severe falciparum malaria
For adults, artesunate i.v. or i.m
– Quinine remains an acceptable alternative
For children (especially in the malaria endemic areas of Africa) the
following options are recommended as there is insufficient evidence to
recommend any of these antimalarial medicines over another:
– artesunate i.v. or i.m.; quinine (i.v. infusion or divided i.m. injection);
artemether i.m.
Give parenteral antimalarials for a minimum of 24hrs once started
(irrespective of the patient's ability to tolerate oral medication earlier),
and, thereafter, complete treatment by giving a complete course of:
– an ACT; artesunate + clindamycin or doxycycline; quinine +
clindamycin or doxycycline
Source: WHO Guidelines for the Treatment of Malaria, 2010
41. Treatment guidelines for special populations –pregnant
women
First trimester:
– Quinine + clindamycin
– An ACT is indicated only if this is the only treatment immediately
available, or if treatment with quinine + clindamycin fails or
compliance issues with a 7-day treatment.
Second and third trimesters:
– ACT known to be effective in the country/region or artesunate +
clindamycin or quinine + clindamycin
Source: WHO Guidelines for the Treatment of Malaria, 2010
42. Treatment guidelines for other special populations
Lactating women
– Lactating women should receive standard antimalarial treatment
(including ACTs) except for dapsone, primaquine and tetracyclines.
Infants and young children
– ACTs with attention to accurate dosing and ensuring
Travellers returning to non-endemic countries:
– atovaquone-proguanil
– Artemether +lumefantrine
– dihydroartemisinin + piperaquine
– quinine + doxycycline or clindamycin.
Source: WHO Guidelines for the Treatment of Malaria, 2010