Академический Документы
Профессиональный Документы
Культура Документы
Epidemiology
In 2012, malaria caused an estimated 627 000 deaths
Etiology
Malaria is caused by the protozoan parasite
Plasmodium. Human malaria is caused by four
different species of Plasmodium:
P. falciparum (malaria tropica)
P. malariae (malaria quartana)
P. ovale (malaria ovale)
P. vivax (malaria tertiana)
P. Knowlesi (Humans occasionally become
infected with Plasmodium species that normally
infect animals, such as P. knowlesi)
Transmission
The malaria parasite is transmitted by female
Anopheles mosquitoes,
between dusk and dawn.
which
bite
mainly
Vector
Pathogenesis
Cont..
The gametocytes, male (microgametocytes) and
Fatigue
Malaise
Shaking chills
Arthralgia
Myalgia
on species)
The classic paroxysm begins with a period of shivering and chills,
which lasts for approximately 1-2 hours and is followed by a high fever.
Finally, the patient experiences excessive diaphoresis, and the body
temperature of the patient drops to normal or below normal.
Cont..
Less common symptoms include the following:
Anorexia and lethargy
Nausea and vomiting
Diarrhea
Jaundice
Manifestasion of Plasmodium
Infection
Uncomplicated malaria
Severe malaria
Uncomplicated malaria
Uncomplicated malaria is defined as symptomatic malaria without signs of
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).
Classically (but infrequently observed) the attacks occur every second
day with the "tertian" parasites (P. falciparum, P. vivax, and P. ovale) and every
third day with the "quartan" parasite (P. malariae).
More commonly, the patient presents with a combination of the following
symptoms:
-Chills
- headaches
Cont..
Physical findings may include:
Elevated temperatures
Perspiration
Weakness
Enlarged spleen
Mild jaundice
Enlargement of the liver
Increased respiratory rate
(CDC)
Severe malaria
Clinical features:
impaired consciousness or unrousable coma
prostration, i.e. generalized weakness so that the patient is unable
walk
or sit up without assistance
failure to feed
multiple convulsions more than two episodes in 24 h
deep breathing, respiratory distress (acidotic breathing)
circulatory collapse or shock, systolic blood pressure < 70 mm Hg in
adults
and < 50 mm Hg in children
clinical jaundice plus evidence of other vital organ dysfunction
haemoglobinuria
abnormal spontaneous bleeding
pulmonary oedema (radiological)
Laboratory findings:
hypoglycaemia (blood glucose < 2.2 mmol/l or < 40
mg/dl)
metabolic acidosis (plasma bicarbonate < 15 mmol/l)
severe normocytic anaemia (Hb < 5 g/dl, packed cell
volume < 15%)
haemoglobinuria
hyperparasitaemia (> 2%/100 000/l in low intensity
transmission areas or > 5%
or 250 000/l in areas of high stable malaria transmission
intensity)
hyperlactataemia (lactate > 5 mmol/l)
renal impairment (serum creatinine > 265 mol/l).
Malaria relapse
In P. vivax and P. ovale infections, patients having
Incubation period
Plasmodium falciparum
Plasmodium vivax
9 14 days
12 17 days
12mo
Plasmodium ovale
16 18 days
Plasmodium malariae 18 40 days
Plasmodium knowlesi 9 12 days
P. falciparum
Malaria tropica
Incubation period 9 14 days
P falciparum is able to infect RBCs of all ages, resulting in high levels of
P. vivax
Malaria tertiana
Incubation period 12 17 days
If this kind of infection goes untreated, it usually lasts
P. ovale
Malaria ovale
P. malariae
Malaria quartana
infected
with
this
species
of Plasmodium remain asymptomatic for a much
longer period of time than do those infected
with P vivax or P ovale.
Recrudescence is common in persons infected
with P malariae. It often is associated with a
nephrotic syndrome, possibly resulting from
deposition of antibody-antigen complex on the
glomeruli.
P. knowlesi
have been documented in Malaysian Borneo,
Diagnosis
Clinical sign and symptom
Microscopic examination remains the "gold standard" for laboratory
confirmation of malaria.
Blood smears (thick and thin smear)
Thick smears
Three thick and thin smears 12-24 hours apart should be
obtained. The highest yield of peripheral parasites occurs during or soon
after a fever spike; however, smears should not be delayed while
awaiting fever spikes. Thick smears are 20 times more sensitive than
thin smears, but speciation may be more difficult. The parasitemia can
be calculated based on the number of infected RBCs. This is a
quantitative test.
Thin smears
Thin smears are less sensitive than thick smears, but they allow
identification of the different species. This should be considered a
qualitative test.
RDT (Rapid diagnostic Test) -> Immunochromatographic tests based on
antibody
Treatment
ACT options now recommended for treatment of
uncomplicated falciparum malaria in alphabetical
order are:
artemether plus lumefantrine,
artesunate plus amodiaquine,
artesunate plus mefloquine,
artesunate plus sulfadoxine-pyrimethamine,
dihydroartemisinin plus piperaquine.
Treatment
Differential diagnosis
Dengue Fever
Influenza
Leptospirosis
Meningitis
Typhoid Fever
Pneumonia
Thankyou