Malaria (Everything about it)

this presentation involves the definition of malaria, causes, clinical feature, phathophysiology, life cycle, diagnosis, treatment and prevention.

1. case 3.2 (malaria) Presenter: Arwa Hussain Al-Onayzan. ID: 215007943. Serial number: 66.

2. 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 .

3. 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.

4. 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.

5. 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. falciparum West, East and central 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.

6. What do you think about the risk factor of malaria?

7. 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.

8. Life cycle of malaria Microbiology 3 th book by Richard A. Harvey.

9. Life cycle of malaria

10. 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.

11. 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.

12. 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.

13. 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.

14. What do you think about the signs and the symptoms of malaria?

15. 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.

16. Diagnosis of malaria 1) Medical history. 2) Physical examination. 3) Laboratory diagnosis: Microscopy Immunological techniques Molecular techniques 1- Films of blood (Thick and thin blood smear study). 2- Quantitative Buffy Coat (QBC) test. 1- Antibody-based techniques(serologic tests): Indirect fluorescent antibody test (IFAT) Enzyme- linked immunosorbent assay (ELISA) 2- Antigen-based techniques Rapid Diagnostic Tests (RDTs) Polymerase Chain Reaction (PCR)   

17. P. Falciparum P. Vivax P. Malaria P. Ovate Quinine, Mefloquin, Sulfadoxine and Pyrimethamine. Chloroquine With primaquine. Treatment of malaria T o 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. Chloroquine-sensetive areas Chloroquine-resistant areas Chloroquine.

18. 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.

19. 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

20. CNS Cerebral malaria (coma, convulsions) Renal * Hemoglobinuria (black water fever) * Oliguria *Acute renal failure Blood * Severe hemolytic anemia. *DIC(Disseminated intravascular coagulation). *ARDS Metabolic * Hypoglycemia. *Metabolic acidosis Gastrointestinal / liver * Diarrhea . *Jaundice. * Splenic rupture. Other * Shock- hypotention . *Hyperpyrexia. Complication of malaria

21. 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.

22. Any Question?

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