CASE 3.

2 (MALARIA)
Presenter: Arwa Hussain Al-Onayzan.
ID: 215007943.
Serial number: 66.
 Our case
• A 17-year-old women admitted to hospital after returning

from vacation in Malawi.

• She didn’t take preventing measures regarding malaria.

• 3 days after returning she had cold shiver, headache, dry

cough, lost weight and her stools became loose.

• Upon admission, she was ill, pale and slightly confused.

• Her lab test showed she had P. falciparum infection.

• She was treated with artemether and lumefantrine.

 Learning objectives:
• Definition of malaria and types of malaria parasites.
• Epidemiology of malaria.
• Risk factor of malaria.
• Life cycle of malaria.
• Incubation period of the parasite.
• Pathophysiology of malaria.
• Signs and symptoms of malaria.
• Laboratory diagnosis of malaria.
• Treatment and prevention of malaria.
• Complication of malaria.
 Definition of Malaria and type of
malaria parasite
Is an infection of liver and RBCs caused by
protozoan parasites of the genus plasmodium.

Malaria is caused by 5 species of plasmodium:

• P. falciparum (the most common and dangerous).
• P. vivax.
• P. ovale.
• P. malaria.
• P. knowlesi.
 Epidemiology of malaria
• Malaria is widely distributed in tropics and subtropics of
Africa, Asia and Latin America.
• Malaria affecting 400 million people word-wide.
• Malaria causing 2 million death each year.

species Distribution
P. West, East and central
falciparum Africa, Middle East, Far
East, South America.
P. vivax India, North and East
Africa, Far East, South
America
P. ovale Tropical Africa, India, Far
East
P. malaria Tropical Africa.
What do you think about the
risk factor of malaria?
 Risk factors of malaria
 Living or traveling in a region where malaria is present.

 Traveling to area where malaria is common:

- Without taking medicine to prevent malaria.

- Being outdoors, especially in rural areas.
- Not taking steps to protect yourself from mosquito bites.

 Pregnant women.
 Children under 5 years of age.
 Patients with HIV/AIDS.
Life cycle of malaria

Microbiology 3th book by Richard A. Harvey.

Life cycle of malaria
 Incubation period of the parasite

species Incubation period (Liver cycle)

P. falciparum 7-14 days

P. vivax 12-17 days ( with relapse up to 3 years)

P. ovale 9-18 days ( with relapse up to 20 years)

P. malaria 13-40 days.

 Con…
• The time between the fever episodes can be
characteristics of the infecting plasmodium species.

species Duration of fever (erythrocytic cycle)

P. falciparum 36-48 h, Malignant tertian malaria.
P. vivax 48h, Benign tertian malaria.
P. ovale 48h, Ovale tertian malaria.
P. malaria 72h, Quartan malaria.
 Pathophysiology of malaria
• Showers of new merozoites are released from the RBCs
at intervals of approximately 48h for P.vivax, P.ovale and
P.falciparum and 72h for P.malaria. The episodic shaking,
chills, and fever coincide with this release.

• The parasites destroy large numbers of infected RBC,

thereby causing a hemolytic anemia.
 Pathophysiology of malaria
• A characteristic brown malaria pigment derived from
hemoglobin, called hematin is released from ruptured
RBCs and produces discoloration of the spleen, liver,
lymph nodes and bone marrow.

• Activation of defense mechanisms in the host leads to a

marked hyperplasia of mononuclear phagocytes,
producing massive splenomegaly and occasional
hepatomegaly.
What do you think about the signs
and the symptoms of malaria?
 Signs and symptoms of malaria
• Cycles of shaking chills followed by fever and profuse sweating.
• Hemolytic anemia.
• Jaundice.
• Dark pigmented urine (blackwater fever)
• Stools became increasingly loose.
• Hepatomegaly.
• Splenomegaly.
• Headache.
• Dry cough.
• Lost weight.
 Diagnosis of malaria
• 1) Medical history.
• 2) Physical examination.
• 3) Laboratory diagnosis:

Microscopy Immunological techniques Molecular

techniques

1- Films of blood (Thick 1- Antibody-based Polymerase Chain

and thin blood smear techniques(serologic tests): Reaction (PCR)
study). • Indirect fluorescent antibody
test (IFAT)
2- Quantitative Buffy • Enzyme- linked immunosorbent
Coat (QBC) test. assay (ELISA)
2- Antigen-based techniques
• Rapid Diagnostic Tests (RDTs)
 Treatment of malaria
To treat Malaria we most understand 2 concept:
• The geographic pattern of susceptibility of P. Falciparum
to antimalarial drugs.
• The type of plasmodium species causing the infection.

P. Falciparum P. Vivax P. Malaria P. Ovate

Chloroquine Chloroquine-
-resistant sensetive Chloroquine
areas areas With
primaquine.
Quinine, Mefloquin, Chloroquine.
Sulfadoxine and
Pyrimethamine.
 Prevention of malaria
1- Prevent mosquito bite by:
Covering the limbs.
Using insects repellents.
Sleeping under mosquito nets.
Stagnant water should be avoided.

2- Chemical prophylaxis for travelers:

When you traveling to area:
Without chloroquine resistance: chloroquine is used.
With chloroquine resistance: melfloquine or doxycycline
may be used.
 Complication of malaria

species Major complication

P. falciparum Cerebral malaria, haemolytic anaemia

(blackwater fever), jaundice,
hypoglycaemia
P. vivax Relapse due to liver hypnozoites.

P. malaria Nephrotic syndrome

P. Ovate Relapse due to liver hypnozoites

 Complication of malaria
CNS Renal
Cerebral malaria * Hemoglobinuria (black water
fever)
(coma, convulsions)
*Oliguria
*Acute renal failure

Blood Metabolic
*Severe hemolytic anemia.
*DIC(Disseminated
*Hypoglycemia.
intravascular coagulation). *Metabolic acidosis
*ARDS

Gastrointestinal /liver Other

*Diarrhea. *Shock-hypotention.
*Jaundice.
*Hyperpyrexia.
*Splenic rupture.
 Summary
• Malaria is an infection of liver and RBCs.

• Caused by 5 different species of plasmodium.

• Malaria is one of the most serious problems.

• Symptoms: Fever( which may be periodic), chills, sweeting,

hemolytic anemia and splenomegaly.

• Diagnosis is by seeing plasmodium in a peripheral blood

smear.

• Treatment and prophylaxis depend on the species and

drug sensitivity.
Any Question?
 Reference
• The Merck Manual of Diagnosis & Therapy, page 1540.
• Medical Microbiology book Murray 7th, page 765.
• Clinical Microbiology made ridiculously simple book 3th
( p.240-244).
• Medical Microbiology made memorable (p.80).
• Microbiology Lippincott's Third Edition (P.221-222)