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Pictures of P. falciparum
Etiology
Causative organism: Plasmodia
P. Vivax: tertian malaria
P. Malariae: quartan malaria
P. Falciparum: malignant malaria
P. Ovale: tertian malaria
Pathogenicity: merozoite, malarial pigment &
products of metabolism
Plasmodium falciparum
Most dangerous form of malaria
Risk of cerebral malaria, renal failure, acute respiratory
distress syndrome, severe anemia
Prompt treatment is essential
Untreated infection in a non-immune person would
likely be fatal
Once person is treated and cured, there is no risk of
relapse (but you can get infected again…)
P. falciparum has no dormant liver stage (hypnozoite)
P. vivax and P. ovale
Less likely to be life threatening than P.
falciparum
Symptoms (especially fever) can still be
dramatic
Different drugs are used to treat blood and
liver stage parasites
Etiology
Two period:
human - whole asexual reproduction
mosquito - sexual parasitic stage
Two host:
human - intermediate host
mosquito - final host
notes:
clinical symptoms: erythrocytic stage
relapse: exerythrocytic stage
infectivity: sporozoite
Epidemiology
Source of infection
Patient, parasite carrier
Route of transmission
female mosquito biting person
blood transfusion
Susceptibility:
universal susceptibility
no-cross-immunity
re-infection
Epidemic features:
sporadic or endemic, tropic or subtropic
What is the Malaria Vector?
Spread by bite of infected female
Anopheles mosquitoes
Night-biting mosquitoes
Indoor-biting mosquitoes
Pathogenesis
Mechanism of attack
merozoite
RBC rupture malaria pigment
products of metabolism
blood stream allergy
Mosquito Stages
Exo-erythrocytic
(hepatic) Cycle:
P. falciparum
Erythrocytic Cycle:
Gametocytes
P. vivax
P. ovale
P. malariae
Pathology
Anemia:
P. Vivax - retiform RBC
P. Malariae - mature RBC
P. Falciparum - every RBC
Prolifeation of mononuclear phagocyte
hepatomegaly
splenomegaly
Cerebral edema & congestion
Symptoms of Malaria
Fever is by far the most common symptom, but is
by no means the only one
Incubation period:
quartan malaria: 24-30 day
tertian malaria: 13~15 day
malignant malaria: 7~12 day
Clinical manifestation
Typical attack
Chill: abrupt onset, shivering, pale face,cyanosis. Last
10 min or 1~2hr.
High fever: T rise to 40oC with malaise, myalgia,
thirsty. Last 2~6 Hr.
Sweating: profuse sweating with restlessness
regular 48 hr. or 72 hr. Cycle
Clinical manifestation
Signs
anemia
splenomegaly
hepatomegaly, ALT elevate
Clinical manifestation
Ring stage
Trophozoite
Schizont
Gametocyte
Plasmodium malariae
Ring stage
Trophozoite
Schizont
Gametocyte
Plasmodium ovale
Ring
Trophozoite
Schizont
Gametocyte
Diagnosis
Epidemiological data
endemic zone
blood transfusion
Clinical manifestation
Laboratory findings
Diagnostic treatment:
chloroqunine for 3 days
Differential Diagnosis
Typhoid fever
Septicemia
Leptospirosis
Encephalitis B
Roll Back Malaria
(RBM)
Founded by:
World Health Organization (WHO),
United Nations Development Program (UNDP),
United Nations Children's Fund (UNICEF)
and World Bank
Includes national governments, civil society and
non-governmental organizations, etc.
Provides framework for coordination between
Ministries of Health and various organizations
Roll Back Malaria (RBM)
The goal of Roll Back Malaria, established as a
health initiative by WHO and its partners in 1998, is
to halve the world's malaria burden by 2010.
At the Africa Summit on RBM, April 2000, Heads of
State or senior representatives from 44 malaria-
afflicted countries in Africa agreed to a series of
interim goals to be attained by 2005.
Global program with clear strategies
Provides framework for Action
Touts prevention and treatment
Roll Back Malaria (RBM)
Goals - At least 60%
Chloroquine-resistant infection
mefloguine:
artemisinine
Treatment
Pernicious attack
Chloroquine: 10mg/kg iv drop in 4 hr. Then
5mg/kg, iv drop in 2 hr.
Quinine: 500mg iv drop in 4 hr.
Radical therapy
Chloroquine (3 day) + primaquine ( 8 day )
P- falciparum resistance to chloroquine
Source: WHO global database on drug resistance 1996-2004
Countries with at least one study indicating chloroquine total failure rate > 10%
Chloroquine total failure rate < 10%
No failure reported
No recent data available
P. falciparum resistance to sulfadoxine/pyrimethamine
Source: WHO global database on drug resistance 1996-2004
Countries with at least one study indicating pyrimethamine-sulfadoxine total failure rate > 10%
P yrimethamine-sulfadoxine total failure rate < 10%
No failure reported
No recent data available
P. falciparum resistance to mefloquine
Source: WHO global database on drug resistance 1996-2004
Countries with at least one study indicating mefloquine total failure rate > 20%
Countries with at least one study indicating mefloquine total failure rate > 10%
Mefloquine total failure rate < 10%
No failure reported
No recent data available
P.vivax malaria distribution and
Reported Treatment or Prophylaxis Failures or True
Resistance, 2004
There are now more trials involving artemisinin and its derivatives than
other antimalarial drugs, so although there are still gaps in our
knowledge, there is a reasonable evidence base on safety and efficacy
from which to base recommendations.
Response to increasing resistance
Combination therapies
recommended by WHO
FDC
• Artemether/lumefantrine
• Artesunate + amodiaquine
ACTs
• Artesunate + SP
• Artesunate + mefloquine
Prevention
Drug prophylaxis
chloroquine: 0.3g once a week
doxycycline
Kill mosquito
Vaccination
TOGETHER WE CAN BEAT MALARIA
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