2. malaria.pptx for bsc nursing student.

For bsc nursing students

1. MALARIA 1

2. HISTORY AND FUTURE RESEARCH DR.T.V.RAO MD 2 One of the oldest known diseases. King Tut died of malaria. Malaria has been infecting humans for over 50,000 years. References to malaria have been recorded for nearly 6000 years, starting in China. Used to be common in Europe and North America. First advances in malaria were made in 1880 by a French army doctor named Charles Laveran. He looked into infected red blood cells and discovered the parasite was a protist. This was the first time a protist was discovered to cause a disease. Carlos Finlay discovered that mosquitoes transmitted diseases.

3. It was discovered more than 100 years ago A French army doctor in Algeria observed parasites inside red blood cells of malaria patients and proposed for the first time that a protozoan caused disease Charles Louis Alphonse Laveran DR.T.V.RAO MD 3

4. Ronald Ross discovered that mosquitoes transmitted malaria in 1898. First effective medicine was discovered by Pierre Pelletier and Joseph Caventou. This medicine is called quinine, which comes from the bark of cinchona trees in Peru. No effective vaccine: only immunity is a result of multiple infections. RONALD ROSS DISCOVERS THE ROLE OF MOSQUITOS AND TRANSMISSION DR.T.V.RAO MD 4

5. MALARIA DR.T.V.RAO MD 5 40% of the world’s population lives in endemic areas (present in a community t all time but in relatively low frequency.) 1-2million deaths (90% Africa) increasing problem (re-emerging disease) drug resistance (  mortality)

6. causative agent = Plasmodium species protozoan parasite member of Apicomplexa 4 species infecting humans transmitted by anopholine mosquitoes P. falciparum P. vivax P. malariae P. ovale

7. WHAT IS MALARIA? DR.T.V.RAO MD 7 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 40% of the worlds population lives in malaria zones Malaria zones are: Africa, India, Middle East, Southeast Asia, Central and South America, Eastern Europe, and the South Pacific

8. WHAT DETERMINES THE SPREAD OF MALARIA? ? Malaria spread depends on: Rainfall pattern Types of mosquitoes in the area Some areas constantly have a high rate of malaria. Other areas have “malaria seasons” or occasional epidemics of malaria. DR.T.V.RAO MD 8

9. MALARIA – VECTORS Anopheles balabacensis DR.T.V.RAO MD 9 A. freeborni A. gambiae A. stephensi

10. CHARACTERISTIC OF LIFE CYCLE DR.T.V.RAO MD 10 Intermediate host : human Final host : mosquito Infective stage : sporozoite Infective way : mosquito bite skin of human Parasitic position : liver and red blood cells Transmitted stage : gametocytes Schizogonic cycle in red cells : 48 hrs/P.v Sporozoite : tachysporozite and bradysporozite

11. MOSQUITOES AND MALARIA The spread of malaria depends on the life cycle of the mosquito. Adult mosquitoes lay their eggs on water. The eggs hatch to become larvae and then pupae, before turning into adults. Adult females mosquitoes only live 2 to 4 weeks. So you can reduce malaria by attacking any of these four stages of the mosquito. DR.T.V.RAO MD 11

12. 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 (primary body) sporozoites invade salivary glands DR.T.V.RAO MD 12

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14. INCUBATION PERIOD DR.T.V.RAO MD 14 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 .

15. Clinical Features DR.T.V.RAO MD 15 characterized by acute febrile attacks (malaria paroxysms) periodic episodes of fever alternating with symptom-free periods manifestations and severity depend on species and host status immunity, general health, nutritional state, genetics recrudescences and relapses can occur over months or years can develop severe complications (especially P. falciparum )

16. CLINICAL MANIFESTATIONS Anemia Splenomegaly Cerebral malaria Malaria nephropathy Congenital malaria usually fatal DR.T.V.RAO MD 16

17. WHAT ARE THE SIGNS AND SYMPTOMS OF MALARIA? DR.T.V.RAO MD 17 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.

18. UNCOMPLICATED MALARIA DR.T.V.RAO MD 18 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)

19. IS IT FALCIPARUM? DR.T.V.RAO MD 19 WHAT DOES THE SMEAR SHOW? >3% PARASITEMIA MONOTONOUS SMALL RINGS NO TROPHOZOITES OR SCHIZONTS BANANA SHAPED GAMETOCYTES MULTIPLY INFECTED CELLS CELLS OF ALL SIZES INFECTED

20. 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. DR.T.V.RAO MD 20

21. LABORATORY DIAGNOSIS ---- laboratory diagnosis of malaria is confirmed by the demonstration of malarial parasites in the blood film under microscopic examination. Thin film Thick film DR.T.V.RAO MD 21

22. Various test kits are available to detect antigens derived from malaria parasites. Such immunologic ("immunochromatographic") tests most often use a dipstick or cassette format, and provide results in 2-15 minutes. These "Rapid Diagnostic Tests" (RDTs) offer a useful alternative to microscopy in situations where reliable microscopic diagnosis is not available ANTIGEN DETECTION METHODS DR.T.V.RAO MD 22

23. 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. SEROLOGY IN MALARIA DR.T.V.RAO MD 23

24. Parasite nucleic acids are detected using polymerase chain reaction (PCR). Although this technique may be slightly more sensitive than smear microscopy, it is of limited utility for the diagnosis of acutely ill patients in the standard healthcare setting. PCR results are often not available quickly enough to be of value in establishing the diagnosis of malaria infection. MOLECULAR DIAGNOSIS OF MALARIA DR.T.V.RAO MD 24

25. PCR is most useful for confirming the species of malarial parasite after the diagnosis has been established by either smear microscopy PCR IS USEFUL IN SPECIES DETECTION DR.T.V.RAO MD 25

26. TREATMENT Faciparum? Y e s Fansidar or Artemeter/Lumefantrine No Vivax or Ovale Chloroquine Primaquine Malariae Chloroquine DR.T.V.RAO MD 26

27. TREATMENT DR.T.V.RAO MD 27 HALOFANTRINE MALARONE ATOVAQUONE / PROGUANIL TAFENOQUINE QUININE based regimens CHLOROQUINE / PROGUANIL IS AN INFERIOR REGIMEN AND SHOULD NOT BE USED

28. Use mosquito repellants. Wear long pants and long sleeves. Wear light-colored clothes. Use window screens Use bed nets. WHAT ARE WAYS TO PREVENT MOSQUITO BITES? DR.T.V.RAO MD 28

29. ORIGINAL ERADICATION PLANS Interruption of transmission of main species infecting humans by DDT spraying Malaria disappears spontaneously in under 3 years Dichlorodiphenyltrichloroethane D S R o .T u .V r . c R e AO : G MD abaldon 56

30. OTHER WAYS TO PREVENT MALARIA DR.T.V.RAO MD 30 Who is at the highest risk of malaria? Travelers to an area high in malaria Travelers often take prophylactic (preventive) medicines to prevent malaria. Pregnant women (especially those with HIV) 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?

31. MALARIA VACCINE DR.T.V.RAO MD 31 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.

32. THANK YOU