Malaria

This PPT is about Malaria, including its epidemiology in the Ethiopian context

1. MALARIA BY: TEMEGEN GIRMA C1, SPHMMC Addis Ababa, Ethiopia

2. INTRODUCTION Name is derived from Italian Mal ’ aria or bad air. Malaria is a vector-borne infectious disease caused by protozoan parasites . It is widespread in tropical and subtropical regions, including parts of the Americas , Asia, and Africa .

3. Definition Malaria is an acute and chronic illness characterized by paroxysms of fever, chills, sweats , fatigue, anemia, and splenomegaly .

4. Epidemiology Malaria belt

5. Malaria epidemiology in Ethiopia

6. Disease burden In 2019, there were 229 million cases of malaria & 409 000 deaths. Africa   was a home to 94% of all malaria cases and deaths . Children under 5 years of age are accounted for 67% (274 000) of all malaria deaths worldwide. Malaria kills more people than AIDS.

7. Burden of malaria in Ethiopia Malaria remains a major public health challenge. a large and mobile population heterogeneous transmission, and the presence of both Pf and Pv malaria parasites. Today, 60 percent of Ethiopia’s population is at risk of contracting malaria.

8. Etiology Malaria is caused by an infection by one of the ff five intracellular Plasmodia protozoa species, they are : P. falciparum P. vivax P. malariae , P . ovale , & P. knowlesi .

9. Route of transmission Vector transmission Direct transmission Congenital Transmission

10. Congenital Malaria The first sign or symptom most commonly occurs between 10-30 days of age . Signs and symptoms include fever, restlessness, drowsiness , pallor, jaundice, poor feeding, vomiting, diarrhea , cyanosis, and hepatosplenomegaly.  Malaria is often severe during pregnancy and may have an adverse effect on the fetus or neonate owing to maternal illness or placental infection even in the absence of transmission from mother to child.

11. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

12. Pathogenesis (Life cycle) Has 2 hosts. The malaria life cycle is a complex system with both sexual and asexual aspects . cycle of all species that infect humans is basically the same. There is an exogenous sexual phase in the mosquito called sporogony during which the parasite multiplies . There is also an endogenous asexual phase that takes place in the vertebrate or human host that is called schizogeny

13. Affinity of parasites to Erytrocytes , Plasmodium spp Type of RBC they ❤ P.vivax P.ovale Younge P.malariae Old RBCs P,falciparium All

14. Clinical Manifestations Malaria paroxysm( periodic febrile episodes alternating with symptom-free periods ) preceded by Prodromal period. Prodromal symptoms include headache, fatigue, anorexia, myalgia, slight fever, and pain in the chest, abdomen, and joints

15. P.falciparium P.vivax P.ovale P.malariae Incubation period 9-14 days 12-17 days 16-18 days 18-40 days

16. How Malaria present Clinically Stage 1(cold stage) Chills for 15 mt to 1 hour Caused due to rupture from the host red cells escape into Blood Preset with nausea, vomitting,headache Stage 2( hotstage ) Fever may reach upto 40c may last for several hours starts invading newer red cells.

17. Stage 3 (sweating stage) Patient starts sweating, concludes the episode Cycles are frequently Asynchronous Paroxysms occur every 48 – 72 hours

18. More commonly, the patient presents with a combination of the following symptoms  Fever  Chills  Sweats  Headaches  Nausea and vomiting  Body aches  General malaise.

19. Complications Severe malaria is more common in P. falciparum because of several process: higher-density parasitemia polyclonal activation Abnormality in RBCs

20. Complications of P.f alciparum MALARIA Severe malarial anemia Cerebral malaria Malarial retinopathy Respiratory distress Hypoglycemia Seizures Circulatory collapse (algid malaria) Long-term cognitive impairment HSM / TSS AKI Jaundice Prostration

21. Malarial Retinopathy 1) Retinal Whitening 2) Vessel changes 3) Retinal hemorrhage 4) Papiledema

22. Predisposing factors for complications of P. falciparum malaria Extremes of age . Pregnancy Immunosuppressed - patients on steroids, anti- cancer drugs, immunosuppressant drugs Splenectom y. Lack of previous exposure to malaria ( non-immune ) or lapsed immunity

23. Diffrential Diagnosis  influenza  Hepatitis,  Sepsis,  Pneumonia,  Meningitis, encephalitis,  Endocarditis,  Gastroenteritis ,  Pyelonephritis,  Babesiosis ,  Brucellosis, .  Leptospirosis,  Tuberculosis,  Relapsing fever  Typhoid fever,  Yellow fever,  Amebic liver abscess,  Hodgkin disease, and collagen vascular disease

24. Diagnosis .

25. Clinical diagnosis Microscopic diagnosis Antigen detection Molecular diagnosis

26. Microscopic diagnosis Blood smear with Giemsa stain

27. Antigen detection Various test kits are available to detect antigens derived from malaria parasites. provide results in 2- 15 minutes.

28. Molecular diagnosis PCR based techniques:- Detects DNA or RNA sequences specific to Plasmodium . PCR detection may detect asymptomatic parasitemia in children with very-low-level parasitemia . PCR is more sensitive than microscopy but is technically more complex .

29. Treatment ,

30. Antimalarial Classification Target of Therapy Therapeutic Class Drug Examples To alleviate symptoms Blood schizontocidal drugs • Artemisinin • Chloroquine (in vivax only) • Quinine (in pregnancy) To prevent Relapses Tissue schizontocidal drugs • Primaquine To prevent Spread Gametocidal drugs • Primaquine

31. Treating malaria caused by P. vivax , P. ovale , P. malariae or P. knowlesi First line : Chloroquine phosphate followed by Primaquine Alternative : ACTs

32. Treating uncomplicated P. falciparum malaria First line : ACT Artemether + lumefantrine Alternative : Quinine dihydrochloride

33. Treating severe complicated malaria IV or IM artesunate 2.4 mg/kg body weight ( preferred ); OR IM artemether (alternate ); OR IV or IM quinine infusion (if artesunate or artemether is not available)

34. Treating severe malaria IV or IM artesunate for at least 24 h and until they can tolerate oral . Once a patint has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of ACT.

35. Chemoprophylaxis of Malaria for Children P. Falciparum chloroquine Mefloquine Doxycycline For P. vivax : Primaquine phosphate

36. Prevention & Control Avoid mosquito bites Preventing breeding of mosquitoes Treatment Health education Blood screening for malaria