MALARIA - GENERAL MEDICINE BY AKASH SURESH.pptx

MALARIA - GENERAL MEDICINE
BY AKASH SURESH
THIRD YEAR BDS
MALABAR DENTAL COLLEGE AND RESEARCH CENTRE,EDAPPAL

1. MALARIA C AKASH SURESH THIRD YEAR BDS MALABAR DENTAL COLLEGE AND RESEARCH CENTRE

2. Contents : INTRODUCTION DEFINITION ETIOLOGY LIFECYCLE (PATHOPHYSIOLOGY) INCUBATION PERIOD OF MALARIAL PARASITE CLINICAL FEATURES SEVERE MANIFESTATIONS INVESTIGATIONS DIFFERENTIAL DIAGNOSIS TREATMENT PREVENTION REFERENCE C

3. Malaria is one of the oldest known disease with evidence of its existence dating back thousands of years. ROMAN EMPIRE (1 ST CENTURY CE) : THE TERM “MALARIA” : MALA : BAD, ARIA : AIR, because people believed it was caused by swamp fumes. In 1880 , French doctor ALPHONSE LAVERAN identified the malaria parasite in the blood. INTRODUCTION

4. In 1897 , British physician RONALD ROSS demonstrated that female anopheles mosquitoes transmitted the disease. The 20th century saw significant progress with the development of drugs like chloroquine and in 2021 WHO approved the first malaria vaccine “MOSQUIRIX”. Despite advances, malaria remains a global health issue, especially in sub-Saharan Africa, with millions of cases and deaths annually. INTRODUCTION

5. DEFINITION Malaria is a mosquito-borne infectious disease caused by Plasmodium parasites, leading to symptoms such as fever, chills, and anemia. It is diagnosed through blood smears or rapid tests and treated with antimalarial drugs. Plasmodium falciparum is the most dangerous species. Prevention focuses on mosquito control and prophylaxis.

6. ETIOLOGY Malaria is caused by infection with protozoan parasites of the genus Plasmodium , which are transmitted to humans through the bite of infected female Anopheles mosquitoes.

7. ETIOLOGY : OTHERMODES OF TRANSMISSION

8. ETIOLOGY PLASMODIUM VIVAX PLASMODIUM FALCIPARUM PLASMODIUM OVALE PLASMODIUM MALARIAE PLASMODIUM KNOWLESI There are five plasmodium parasite that can cause malaria in humans.

9. ETIOLOGY PLASMODIUM VIVAX PLASMODIUM FALCIPARUM PLASMODIUM OVALE PLASMODIUM MALARIAE PLASMODIUM KNOWLESI The first two types are the most common. Plasmodium falciparum is the most dangerous of these parasites, infection with it can kill rapidly (within several days), whereas the other species cause illness but usually not death. Falciparum malaria is particularly frequent in sub- saharian Africa and Oceania.

10. PATHOPHYSIOLOGY The life cycle of plasmodia is complex. It occurs in two different stages: Asexual Cycle Sexual Cycle

11. PATHOPHYSIOLOGY (INFECTIOUS FORM) (DORMANT STAGE) (PRODUCES SYMPTOMS) --(CYCLE REPEATS EVERY 48 HOURS (MICROGAMETOCYTES & MACROGAMETOCYTES) ANOTHER

12. INCUBATION PERIOD OF MALARIA PARASITE 9 TO 14 DAYS 16 TO 18 DAYS 8 TO 17 DAYS P.FALCIPARUM 18 TO 40 DAYS P.VIVAX P.OVALE P.MALARIAE

13. CLINICAL FEATURES [UNCOMPLICATED MALARIA] COLD STAGE : Sudden onset of shivering and feeling cold.(15-60minutes) HOT STAGE: High Fever,Severe headache,nausea and vomiting.(2-6hours) SWEATING STAGE : Profuse sweating, fatigue (2-4 hours) This cycle repeats every 48 hrs in P.falciparum,vivax,ovale and every 72 hours in P.Malariae .

14. SWEATING CHILLS WITH RIGORS CLINICAL FEATURES HEADACHE SPLEEN ENLARGEMENT FATIGUE BACK PAIN DRY COUGH FEVER NAUSEA & VOMITING ARTHALGIA CONVULSIONS

15. SEVERE MANIFESTATIONS Severe falciparum malaria is most dangerous form of malaria and is responsible for most of the deaths. Cerebral malaria is the most serious complication. It is characterized by confusion, coma, convulsions and neurological signs. Severe intravascular hemolysis may lead to hemoglobinuria (black water fever) Complications are more frequent in children and pregnant females

16. SEVERE MANIFESTATIONS CEREBRAL MALARIA HYPERPYREXIA HYPOGLYCEMIA SEVERE ANEMIA RENAL FALIURE BLEEDING PULMONARY EDEMA HYPOTENSION CONVULSIONS

17. DIAGNOSIS LABORATORY DIAGNOSIS: Microscopy (Gold Standard): Peripheral Blood Smear (Thick & Thin Smears) Thick smear: for detecting malaria positive or not. Thin smear: Helps in species identification and parasite quantification. Both Stained with Giemsa stain and examined under a microscope.

18. DIAGNOSIS RAPID DIAGNOSTIC TESTS (RDTS): Detect malaria antigens in a finger-prick blood sample. POLYMERASE CHAIN REACTION (PCR): Detects Plasmodium DNA in the blood. Highly sensitive and useful for low parasitemia and species differentiation. SEROLOGICAL TESTS (ANTIBODY DETECTION): Detects antibodies against Plasmodium, useful for epidemiological studies, not for acute diagnosis.

19. DIAGNOSIS OTHER SUPPORTIVE TESTS: Complete Blood Count (CBC): May show anemia, thrombocytopenia (low platelets), and leukopenia. Liver Function Tests (LFTs): Elevated bilirubin and liver enzymes in severe malaria. Blood Glucose Levels: Hypoglycemia is common in severe malaria. Renal Function Tests: To assess kidney damage in complicated malaria.

20. DIFFERENTIAL DIAGNOSIS Pharyngitis Tonsilitis Ear Infection Dengue Fever Pneumonia Leptospirosis Typhoid Fever Severe Bacterial Sepsis

21. TREATMENT Drugs Used In Malaria : Chloroquine Quinine Mefloquine Primaquine Artesunate Artemether

22. TREATMENT Treatment of P. vivax malaria : Confirmed P. vivax cases should be treated with chloroquine in full therapeutic dose of 25 mg/kg. Prevention of relapse : P. vivax or P. ovale parasites remain dormant in the liver cells in the form of hypnozoites which can later cause a relapse. For its prevention, primaquine should be given at a dose of 0.25 mg/kg body weight daily for 14 days under supervision. Primaquine is contraindicated in pregnant women, infants and known G6PD deficient patients.

23. TREATMENT Treatment of Uncomplicated P. falciparum malaria : Artemisinin Combination Therapy (ACT) should be given to all the confirmed P. falciparum cases found positive by microscopy . This is to be accompanied by single dose of primaquine (0.75 mg/kg body weight) on Day 2. ACT consists of an artemisinin derivative combined with a longacting antimalarial (amodiaquine, lumefantrine, mefloquine, piperaquine or sulfadoxine -pyrimethamine ).

24. TREATMENT Treatment of malaria in pregnancy: The ACT should be given for treatment of P. falciparum malaria in second and third trimesters of pregnancy, while quinine is recommended in the first trimester. Plasmodium vivax malaria can be treated with chloroquine Treatment of mixed infections: Mixed infections with P. falciparum should be treated as falciparum malaria. Anti-relapse treatment with primaquine can be given for 14 days, if indicated.

25. PREVENTION Usage of Environmental Protection Agency- registered insect repellent. Dressed in long sleeves and pants. Apply permethrin on the clothes . Usage of mosquito net while sleeping.

26. PREVENTION : SOURCE REDUCTION Source reduction is a critical strategy in the fight against malaria, focusing on eliminating the breeding sites of the Anopheles mosquitoes , the primary vectors responsible for transmitting the malaria parasite.

27. PREVENTION : SOURCE REDUCTION

28. PREVENTION : DRY DAY Health Ministry has appealed to the public to observe ‘dry day’ in all homes on Sunday to prevent the possibility of vector-borne diseases including dengue fever and malaria due to the intermittent rain. Dry day’ is observed by taking measures to ensure that water does not get stagnated to prevent the breeding of mosquitoes.

29. REFERENCE -AK Tripathi, Kamal Sawlani – Essentials of Medicine for Dental Students – 2nd Edition -Davidson’s Essentials of Medicine – 2nd Edition -Harrison’s Principles of Internal Medicine, 18th Edition

30. THANK YOU