Malaria

Classification of species, The definitive, intermediate host, mode of infection, life cycle of malaria. Plasmodium falciparum, cerebral malaria, the pathogenesis of malaria, clinical features, algid malaria, black water fever, Lab diagnosis- microscopic, QBC, Thick and thin smears, Fluorescent microscopy.
Non-microscopic - Molecular methods PCR, Antigen dectection
Treatment- NVBDCP, prevention

1. MALARIA

2. CASE
•A 48 year oldmale
presented in the OPD
with history of
•High grade fever
associated with chills
•profuse sweating
•headache.

3. Malaria
•Causative agents :
•Plasmodium vivax
•Plasmodium falciparum
•Plasmodium malariae
•Plasmodium ovale

4. CLASSIFICATION
Phylum : Apicomplexa.
Class : Haematozoa.
Order : Haemosporina
Genus : Plasmodium

5. Definitive Host
•Female Anopheles
mosquito [sexual phase]
Intermediate Host
•Man [ asexual phase]

6. Mode of infection
•through biteof infected female anophelesmosquito (vector)
Infective form
•Sporozoites

7. Life Cycle

8. •Life Cycle of Plasmodium Vivax

9. The Human Cycle:
Schizogony

10. Pre-Erythrocytic
Schizogony

11. Sporozoiteswhichareelongatedandspindleshaped
becomeroundedinlivercells,undergomultiplenuclear
divisiontoformSchizont.

12. In 8-10 days, Merozoitesareliberated

13. Merozoites invade RBC

14. Erythrocytic Schizogony

15. Early trophozoiteisformed

16. merozoites

17. Gametogony

19. The Mosquito Cycle :
Sporogony

20. \
Extrinsic
incubation
period
(1-4 weeks)

21. Plasmodium vivax

22. The Human Cycle: Pre-erythrocytic Schizogony
In 8 daysMerozoites liberated per schizont
are 10,000 in number.
Some sporozoites go into dormant state, known as Hypnozoites,(clinical relapses)

23. (infectreticulocytesandyoungRBCs)
ErythrocyticSchizogony(48hrs)
AllstagesofErythrocyticSchizogonycanbeseen
intheperipheralbloodsmear.

24. Erythrocytic Stages of Plasmodium Vivax
(12-24merozoites
perSchizont)
Trophozoite
Malaria pigment
Female
Male
Schuffner's dots

25. Plasmodium
falciparum

26. The Human Cycle: Pre-erythrocytic Schizogony
In 6 days
Merozoites liberated per schizont
are 30,000 in number.
No hypnozoites

27. (infectbothyoungandmatureRBCs)
(Latetrophozoites,schizontsareformedin
capillariesofinternalorgans,andnotin
peripheralblood)
Gametogonyafter10days
Femalegametocyte
Malegametocyte
Multiplerings,
accoleform
innormalsizedRBCs

28. Erythrocytic Stages of Plasmodium falciparum
Trophozoite
Malaria pigment
Maurer's dots
Male
Female
Gametocytes
schizonts
multiple rings
accole form

29. Erythrocytic Stages of Plasmodium falciparum
Peripheral circulation
Vascular beds of internal organs
Trophozoite
Gametocytes
schizonts

31. Pathogenesis
Theclinicalmanifestationsinmalariaaredueto:
•Responseofhosttoparasiticantigens
•Anaemiainmalariaisduetoincreasedclearance
ofbothparasitizedandnonparasitizedRBCsby
thespleen.
•Tissuehypoxiaduetoobstructionofbloodflow
byparasitizedRBCs.

32. Capillaries of brain
plugged with
parasitized RBCs

33. Clinical Features
Fever with chills & rigor
Anaemia
Spleenomegaly

34. Fever
Sweating stage : 2–4 hours
Hot stage : 2–6 hours
Cold stage : 15–60 mins

35. Types of
Malarial
Fever
Plasmodium vivax: Benign Tertian
Plasmodium falciparum: Malignant Tertian
Plasmodium malariae: Quartan
Plasmodium ovale: Benign Tertian

36. Complications of Falciparum Malaria

37. 1.Pernicious malaria
•Cerebral malaria
•Algid malaria
•Septicemicmalaria2.Black water fever

38. Cerebral Malaria
üP.falciparum in capillaries of internal organs, secrete protein
knobs on surface of RBCs.
üThis promotes aggregation of infected RBCs to non infected
RBCs and capillary endothelial cells, causing capillary
plugging in brain.
üIt leads to anoxia, ischaemia and haemorrhage in brain.
üManifested by headache, hyperpyrexia, coma, paralysis.
Capillary plugging

39. Algid Malaria
•Patientpresentswithsevereabdominal
pain,vomiting,diarrhoeaandprofound
shock.
•Thissyndromeischaracterizedby
peripheralcirculatoryfailure,rapid
threadypulse,lowBP,coldclammyskin.

40. Septicemic Malaria
It is characterized by high
continuous fever with dissemination
of the parasite to various organs,
leading to multi organ failure.
Death occurs in 80% of the cases.

41. Blackwater Fever
•Seen in falciparum malaria patients on
inadequate treatment with quinine.
•Development of anti-erythrocyte antibodies.
•Massive, sudden, intravascular hemolysis
occurs.
•characterized by massive absorption of
hemoglobin by the renal tubules, leading to
haemoglobinuria, excessive pigment in urine
gives brown black colourto urine.

42. Lab Diagnosis

43. Peripheral blood smear
examination
Antigen detection-By rapid
immunochromatographic test
QBC –Quantitative Buffy Coat
Culture
Molecular method

44. Peripheral blood smear examination
•For Microscopy
üthick and thin blood film.
•Romanowsky stain
i.Field’s stain
ii.Giemsa stain
iii.Leishman stain
iv.Jaswant Singh and Bhattacharya (J.S.B) stain

46. •THICK FILM
§Lysed RBCs, many layers
§Larger volume
(0.25 µl blood/100 fields)
§Good screening test
•THIN FILM
§Single layer of RBCs
§Small volume
(0.005µl blood/100 fields)
§Species differentiation

51. Rapid immunochromatographyTest for
Antigen detection
Histidine-rich
protein II (HRP –II)
: P. falciparum.
Parasite lactate
dehydrogenase
(pLDH)
Parasite aldolase:
all Plasmodium
spp.

55. Culture
RPMI 1640 medium:-
(Roswell Park
Memorial Institute
and 1640 denotes the
number of passages).
Dulbecco’s Modified
Eagle
Medium(DMEM)

56. Molecular
method
•PCR

57. TREATMENT

58. Treatment of vivax malaria
(NVBDCP guideline)•Chloroquine:
25mg/kg divided
over three days,
i.e.10 mg/kg on
day 1and 2 and 5
mg/kg on day 3
•Primaquine: 0.25
mg/kg daily for
14 days

59. Treatment of falciparum
malaria (NVBDCP
guideline,India)
•ACT-SP (artesunate-
sulfadoxine/pyrimethami
ne)
•Artesunate(25mg/kg)
for 3 days
•Sulfadoxine(25mg/kg)/
pyrimethamine(1.25mg/
kg), 1 tablet given on
first day
•Primaquine

60. Prevention
•For adult:
•Residual spraying:
dichlorodiphenyltrichloroethane (DDT) and
malathion.
•Individual protection: bed nets and protective
clothing

61. For larva
•Larvicide-mineral oil or Paris green
•Biological larvicide-Gumbusia affinis
(fish) and Bacillus thuringensis (bacteria)
•Source reduction ( to reduce the
mosquito breeding sites) includes
environmental sanitation, water
management and improvement of the drainage system.

62. Thank you