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    Malaria

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    Arthur Samuel Shavani
    Malaria is an infectious disease caused by protozoan parasites that infect red blood cells. It is transmitted via mosquito vectors and infects hundreds of millions of people annually, causing over 1 million deaths per year, mostly among young children in Africa. There are four species of Plasmodium parasites that cause malaria in humans. The most severe form is caused by P. falciparum. Diagnosis involves microscopic examination of blood smears or rapid antigen tests to detect the parasite. Treatment depends on the species and severity of infection, with artemisinin-based combination therapies as first-line treatment for uncomplicated P. falciparum malaria. An effective vaccine against malaria is currently in development.

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    Malaria

    Uploaded by

    Arthur Samuel Shavani
    281 views28 pages
    Malaria is an infectious disease caused by protozoan parasites that infect red blood cells. It is transmitted via mosquito vectors and infects hundreds of millions of people annually, causing over 1 million deaths per year, mostly among young children in Africa. There are four species of Plasmodium parasites that cause malaria in humans. The most severe form is caused by P. falciparum. Diagnosis involves microscopic examination of blood smears or rapid antigen tests to detect the parasite. Treatment depends on the species and severity of infection, with artemisinin-based combination therapies as first-line treatment for uncomplicated P. falciparum malaria. An effective vaccine against malaria is currently in development.

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    Malaria is an infectious disease caused by protozoan parasites that infect red blood cells. It is transmitted via mosquito vectors and infects hundreds of millions of people annually, causing over 1 million deaths per year, mostly among young children in Africa. There are four species of Plasmodium parasites that cause malaria in humans. The most severe form is caused by P. falciparum. Diagnosis involves microscopic examination of blood smears or rapid antigen tests to detect the parasite. Treatment depends on the species and severity of infection, with artemisinin-based combination therapies as first-line treatment for uncomplicated P. falciparum malaria. An effective vaccine against malaria is currently in development.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    281 views28 pages

    Malaria

    Uploaded by

    Arthur Samuel Shavani
    Malaria is an infectious disease caused by protozoan parasites that infect red blood cells. It is transmitted via mosquito vectors and infects hundreds of millions of people annually, causing over 1 million deaths per year, mostly among young children in Africa. There are four species of Plasmodium parasites that cause malaria in humans. The most severe form is caused by P. falciparum. Diagnosis involves microscopic examination of blood smears or rapid antigen tests to detect the parasite. Treatment depends on the species and severity of infection, with artemisinin-based combination therapies as first-line treatment for uncomplicated P. falciparum malaria. An effective vaccine against malaria is currently in development.

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    Attribution Non-Commercial (BY-NC)
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    Download as ppt, pdf, or txt
    of 28

    is a vector-borne infectious disease caused by protozoan parasites.

    Malaria has infected humans for over 50,000 years, and may have been a human pathogen for the entire history of our species. It causes about 400900 million cases of fever and approximately one to three million deaths annually. This represents at least one death every 30 seconds. If the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years.

    Malaria

    The

    term malaria originates from Medieval Italian: mala aria bad air"; and the disease was formerly called ague or marsh fever due to its association with swamps over 40% of the population lives in areas where malaria transmission occurs (i.e., parts of Africa, Asia, the Middle East, Central and South America, Hispaniola, and Oceania).
    Source: WHO, 2003

    The primary vector species are A. culicifacies and


    A. stephensi. In most parts of the country, the transmission occurs post-monsoon, between July and November

    1998

    2001

    2003

    2002

    1999

    2000

    Sindh

    Roll Back Malaria Monitoring and Evaluation Generated:4/27/2005

    2003 2002

    2003 2002
    NWFP

    Baluchistan

    2003 2002

    2003 2002
    FATA

    Punjab

    2003 2002

    PATHOGENESIS

    Plasmodium species which infect humans Plasmodium vivax (tertian) Plasmodium ovale (tertian) Plasmodium falciparum (tertian) Plasmodium malariae (quartan)

    Malaria Life Cycle

    Sporogony
    Oocyst Sporozoites Mosquito Salivary Gland

    Zygote

    Hypnozoites Exoerythrocytic (hepatic) cycle


    (for P. vivax and P. ovale)

    Gametocytes

    Merozoites
    Erythrocytic Cycle

    Schizont

    preerythrocytic sporogony

    Schizont

    Schizogony

    Merozoites Trophozoites

    Some characteristics of infection with four species of human Plasmodia


    P.v.
    Incubation period (days) Erythrocytic cycle (hours) Primary attack Febrile paroxysms (hours) Relapses

    P.o. 17 (16-18) or longer 50 Mild

    P.m. 28 (18-40) or longer 72 Mild

    P.f. 12 (9-14) 48 Severe in nonimmunes 16-36 or longer -

    15 (12-17) or up to 612 months 48 (about) Mildsevere 8-12 ++

    8-12 ++

    8-10 -

    Schizogenic periodicity and fever patterns


    Schizogenic periodicity is length of asexual erythrocytic phase 48 hours in P.f., P.v., and P.o. (tertian) 72 hours in P.m. (quartan) Initially may not see characteristic fever pattern if schizogeny not synchronous With synchrony, periods of fever or febrile paroxsyms assume a more definite 3 (tertian)- or 4 (quartan)- day pattern

    Malaria Diagnosis
    Clinical Diagnosis Malaria Blood Smear Fluorescent microscopy Antigen Detection Serology Polymerase Chain Reaction

    Malaria Clinical Diagnosis


    Early symptoms Headache Malaise Fatigue Nausea Muscular pains Slight diarrhea Slight fever, usually not intermittent Could mistake for influenza or gastrointestinal infection

    Malaria Clinical Diagnosis


    Signs Anemia Thrombocytopenia Jaundice Hepatosplenomegaly respiratory distress syndrome renal dysfunction Hypoglycemia Mental status changes

    Malarial Clinical Diagnosis, Paroxysm


    Slight fever may worsen just prior to paroxysm Paroxysm Cold stage - rigors Hot stage Max temp can reach 40-41o C, splenomegaly easily palpable Sweating stage Lasts 8-12 hours, start between midnight and midday

    Malaria Lab Diagnosis


    Blood Smear
    Remains the gold standard for diagnosis Giemsa stain distinguishes between species and life cycle stages parasitemia is quantifiable Threshold of detection thin film: 100 parasites/ l thick film: 5 -20 parasites/ l

    Schizont

    Ring form

    Gametocytes

    Trophozoite

    Malaria Antigen Detection


    Immunologic assays to detect specific antigens Commercial kits now available as immunochromatographic rapid diagnostic tests (RDTs), used with blood -P. falciparum histidine-rich protein 2 (PfHRP-2) -parasite LDH (pLDH) Cannot detect mixed infections Cross reactivity with rheumatoid factor reportedly corrected

    RBM Partnership Secretariat, Malaria Medicines & Supplies Services Copenhagen 31 January 2006

    Malaria distribution and reported case of resistance or treatment failure

    Malaria diagnosis
    90% of Malaria Deaths Occur Among or RDT) Parasitological confirmation (microscopyChildren Under Five Years before treatment of Age Antimalarial treatment should therefore be given Exceptions: with fever (>37.5 oC) or a history of fever to children and no other obvious cause. age, from areas of high children under 5 years of I n children of 5 years of age and above, malaria clinical progressively less likely as a cause of becomesdiagnosis fever, as immunity is acquired. where parasitological suspected severe malaria In older children and in adults, malaria diagnosis should be based on a parasitological confirmation.

    transmission where treatment is based on

    confirmation is not immediately possible

    Changing antimalarial treatment policy

    Treatment failure of >10% (as assessed through monitoring of therapeutic efficacy at 28 days) New treatment an average cure rate of > 95% as assessed in clinical trials

    Treatment of uncomplicated falciparum malaria


    Artemisinin-based combination therapies (ACT) are the treatments recommended for all cases of uncomplicated falciparum malaria including: in infants, in people living with HIV/AIDS for home-based management of malaria pregnant women in the 2nd and 3rd trimesters Exception: 1st trimester of pregnancy

    Treatment of uncomplicated falciparum malaria


    First-line treatment: The following ACTs are presently recommended: artemether-lumefantrine artesunate + amodiaquine artesunate + mefloquine artesunate + sulfadoxine-pyrimethamine Efficacy of ACTs depend on the efficacy of the partnermedicine The artemisinin derivatives (oral formulations) and partner medicines of ACTs are not recommended as monotherapy

    Artemether-lumefantrine
    Currently available as co-formulated tablets > 14 Yrs containingTab. Artem DSof artemether days) 120 mg of 20 mg plus 2+0+2 (for 3 and lumefantrine. 3-8 recommended treatment is a 6-dose The total Yrs Tab. Artem DS plus 1+0+1 (for 3 regimen of artemether-lumefantrinedays) a day for 3 twice days.

    Treatment of uncomplicated falciparum malaria


    Second-line treatment: alternative ACT quinine + tetracycline or doxycycline or clindamycin

    Artesunate (2 mg/kg OD)+ tetracycline (4 mg/kg 6 hourly) Artesunate (2 mg/kg OD)+ doxycycline (3.5 mg/kg OD) Artesunate (2 mg/kg OD)+ clindamycin (10 mg/kg BD). Quinine (10 mg salt/kg three times a day) + tetracycline Quinine (10 mg salt/kg three times a day) + doxycycline Quinine (10 mg salt/kg three times a day) + clindamycin.

    Any of these combinations to be given for 7 days

    Treatment of severe falciparum malaria


    Any of Inj. Artem 80 mg I/M 2 stat then the following antimalarial medicines are recommended Inj. Artem 80 mg I/M x OD for 4 days Artesunate i.v. or i.m artemether i.m. quinine (i.v. infusion or i.m. injection).

    Full course of ACT or quinine + clindamycin or doxycycline when patient can tolerate oral treatment

    Treatment of Plasmodium Vivax & Ovale Infection


    Tab. Nivaquine 4 stat then 2 after 6 hrs. then 1+0+1 for next two days (total Chloroquine phosphate30mg 1xOD 10 tab.) 1 Gm stat, followed by 500 + Tab. Primaquine for 14 days mg at 6, ______________________________________ base 24 & 48 hours + Primaquine 30 mg >14 Yrs daily for 14 days. ( provided G6PD normal) Tab. Artem DS plus 2+0+2 (for 3 days) + Tab. Primaquine 30mg 1xOD for 14 days

    Where ACT has been adopted as the first-line treatment for P. falciparum Yrs 3-8 malaria, it may also be used for Tab. Artem DS plus 1+0+1 (for 3combination with P. vivax malaria in days) + Tab. Primaquine 30mg 1xOD for 14 days primaquine for radical cure.

    Approaches That Should Be Avoided


    Partial treatments should not be given even when patients are considered to be semi-immune or the diagnosis is uncertain. A full course of effective treatment should always be given once a decision to give antimalarial treatment has been reached. The artemisinins and partner medicines of ACTs should not be available as monotherapies.

    Malaria Vaccine
    An effective vaccine
    against malaria has been developed and could be licensed by 2010.
    (BBC NEWS 15 October 2004)

    The research is very high


    quality and the findings are very encouraging.
    (Allan Shapira of Roll Back Malaria)

    We believe a malaria


    vaccine, even of moderate efficacy, could make a huge impact. (Lead researcher Professor
    Pedro Alonso)

    CONTACT: [email protected] [email protected]

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