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Dr.T.V.Rao MD
DR.T.V.RAO MD
Alphonse Laveran
DR.T.V.RAO MD
Giovanni Grassi
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DR.T.V.RAO MD
DR.T.V.RAO MD
DR.T.V.RAO MD
DR.T.V.RAO MD
WHAT IS MALARIA?
Malaria is a parasite that enters the blood. This parasite is a protozoan called plasmodium. 3 to 700 million people get malaria each year, but only kills 1 to 2 million
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Rainfall pattern
(How does this affect mosquito breeding?) Types of mosquitoes in the area How close are people to the breeding sites? Some areas constantly have a high rate of malaria. Other areas have malaria seasons or occasional epidemics of malaria.
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Anemia
Acute febrile illness Infected Mosquito Severe illness Respiratory distress Cerebral malaria Death
Anemia Chronic effects Infected Human Neurologic/ cognitive Developmental Impaired growth and development Malnutrition
Infant mortality
Impaired 12 productivity
MALARIA PARASITE (PLASMODIUM) Pathogen of malaria P.vivax ; P.falciparum ;P.malariae ; P.ovale P.vivax ; P.falciparum are more common Plasmodium is a wide distribution in many tropical or subtropical regions of the world
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MALARIA VECTORS
Anopheles balabacensis
A. gambiae
A. freeborni
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A. stephensi
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Life Cycle
sporozoites injected during mosquito feeding invade liver cells exoerythrocytic schizogony (merozoites) merozoites invade RBCs repeated erythrocytic schizogony cycles gametocytes infective for mosquito fusion of gametes in gut sporogony on gut wall in hemocoel sporozoites invade salivary glands
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Invasive Stages
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SPECIES CHARACTERISTICS
PV PO PM PF
Periodicity(hrs.)
Parasites/Ml RBC Age
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20-50 Young
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9-30 Young
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6-20 Old
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50-2000 Any
Hyponozoite
Duration (yrs.)
Yes
1.5-5
Yes
1.5-5
No
3->50
No
1-2
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MORPHOLOGY
Malarial parasite trophozoites are generally ring shaped, 1-2 microns in size, although other forms (ameboid and band) may also exist. The sexual forms of the parasite (gametocytes) are much larger and 7-14 microns in size. P. falciparum is the largest and is banana shaped, while others are smaller and round.
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EXO-ERYTHROCYTIC
S
HYPNOZOITES
GAMETOCYTES
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ERYTHROCYTIC
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Exoerythrocytic Schizogony
hepatocyte invasion asexual replication 6-15 days 1000-10,000 merozoites no overt pathology
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Hyponozoite Forms
some EE forms exhibit delayed replication (ie, dormant) merozoites produced months after initial infection only P. vivax and P. ovale
relapse = hypnozoite
recrudescence = subpatentt
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IS IT FALCIPARUM?
WHAT DOES THE SMEAR SHOW?
>3% PARASITEMIA
MONOTONOUS SMALL RINGS NO TROPHOZOITES OR SCHIZONTS BANANA SHAPED GAMETOCYTES MULTIPLY INFECTED CELLS APPLIQUE FORMS CELLS OF ALL SIZES INFECTED
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Uninfected RBC
4 hr.
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2 hr.
12 hr.
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Gametocytogenesis
alternative to asexual replication induction factors not known ring gametocyte
drug treatment #'s immune response #'s
sexual dimorphism
microgametocytes macrogametocytes
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GAMETOCYTES
Male gametocyte
Female gametocyte
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GAMETOCYTE OF P. FALCIPARUM
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Gametogenesis
occurs in mosquito gut exflagellation most obvious
3X nuclear replication 8 microgametes formed
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Sporogony
occurs in mosquito (9-21 d) fusion of micro- and macrogametes zygote ookinete (~24 hr) ookinete transverses gut epithelium ('trans-invasion')
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Sporogony
ookinete oocyst
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Sporogony
sporozoites migrate through hemocoel sporozoites 'invade' salivary glands
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INCUBATION PERIOD
Following the infective bite by the Anopheles mosquito a period of time (the "incubation period") goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days.
The shorter periods are observed most frequently with P. falciparum and the longer ones with P. malariae.
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Malaria Paroxysm
paroxysms associated with synchrony of merozoite release between paroxysms temperature is normal and patient feels well falciparum may not exhibit classic paroxysms (continuous fever) tertian malaria quartan malaria
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CLINICAL MANIFESTATIONS
1 Anemia 2 Splenomegaly
3 Cerebral malaria
4 Malaria nephropathy 5 Congenital malaria usually fatal 6 black water fever
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Symptoms of malaria include fever and flu-like illness, including shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Malaria may cause anemia and jaundice (yellow coloring of the skin and eyes) because of the loss of red blood cells. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death.
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UNCOMPLICATED MALARIA
The classical (but rarely observed) malaria attack lasts 6-10 hours.
It consists of a cold stage (sensation of cold, shivering) ; a hot stage (fever, headaches, vomiting; seizures in young children) and finally a sweating stage (sweats, return to normal temperature, tiredness)
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IS IT FALCIPARUM?
WHAT DOES THE SMEAR SHOW?
>3% PARASITEMIA
MONOTONOUS SMALL RINGS NO TROPHOZOITES OR SCHIZONTS BANANA SHAPED GAMETOCYTES MULTIPLY INFECTED CELLS APPLIQUE FORMS CELLS OF ALL SIZES INFECTED
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----a
specific attack that it is up to months or even years after the primary attacks. ----The bradysporozoites in the liver spend a rest and sleeping times of months or even years , then they start develop in Exoerythrocytic stage and erythrocytic stage. at this time, the patient occurs paroxysm , showing as periodic fever like the primary attacks, it is called relapse. ----Relapse only occurs in
DR.T.V.RAO MD
RELAPSE
P.vivax
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MALIGNANT MALARIA
Malaria caused by P.falciparum. is more severe than that caused by other plasmodia. ----The serious complication of P.falciparum. involves cerebral malaria (involving the brain); massive haemoglobinuria (blackwater fever) in which the urine becomes dark in color, because of acute hemolysis of RBC; acute respiratory distress syndrome; severe gastrointestinal symptoms; shock and renal failure which may cause death.
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LABORATORY DIAGNOSIS
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Thin film
Thick film
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SEROLOGY IN MALARIA
Serology detects antibodies against malaria parasites, using either indirect immunofluorescence (IFA) or enzyme-linked immunosorbent assay (ELISA). Serology does not detect current infection but rather measures past exposure.
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TREATMENT
Faciparum?
Yes
No
Fansidar or Artemeter/Lumefantrine
Vivax or Ovale
Malariae
Chloroquine
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TREATMENT
HALOFANTRINE MALARONE ATOVAQUONE/PROGUANIL
TAFENOQUINE
QUININE based regimens CHLOROQUINE/PROGUANIL
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Source: Gabaldon
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Pregnant women are given intermittent preventive treatment. They are given at least 2 doses of a malaria drug during their pregnancy. Young children
How can you protect young children?
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MALARIA VACCINE
Scientists are working on a new malaria vaccine. The vaccine would help protect children from deadly malaria. The vaccine boosts the immune response against malaria. However, the vaccine is still being tested.
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Programme Created by Dr.T.V.Rao MD for Medical and Health Care Workers in the Developing World
Email
doctortvrao@gmail.com
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