Malaria pediatric children Lecture.pptx

Malaria pediatric Lecture

1. Malaria Background and Burden Epidemiology and Risk Factors Transmission and Life Cycle Pathogenesis, Clinical Features and Complications Diagnosis Treatment Prevention and Control 1

2. Background and Burden 1 Malaria: Mal – Aria ( Italy ) 4000 years ago The most important parasitic disease 50 % world population at risk Global mortality 1 Million / year ( Mostly children + pregnant women ) 75% Sudan population ( 24 millions ) at risk Malaria  9% of hospital admissions in Sudan 2

3. Background and Burden 2 Caused by Plasmodium parasite, 5 species P. falciparum P. vivax P. ovale P. malariae P. knowlesi Transmission methods Female Anopheles mosquitoe bite Blood transfusion Organ transplant Congenital malaria Airport malaria Needle transmission 3

4. Malaria Global Distribution 4

5. Epidemiology and Risk Factors Distribution Subsaharan Africa ( 90% of cases ) South America Asia ( including Middle East ) Eastern Europe Risk Factors Travel to known endemic areas Children Pregnant women Genetics Absent Duffy Ag, Sickle cell trait  Protects against malaria Human behaviour  Agriculture, Migration 5

6. Life Cycle 6

7. Pathogenesis Pathogenesis is caused by blood stage parasites ( Merozoites ) When the parasite develops in the erythrocyte, numerous known and unknown waste substances such as hemozoin pigment and other toxic factors accumulate in the infected red blood cell. These toxic factors are released into the bloodstream when the infected cells lyse and release invasive merozoites . The hemozoin and other toxic factors such as glucose phosphate isomerase (GPI) stimulate macrophages and other cells to produce cytokines and other soluble factors which act to produce fever and rigors . RBCs infected with Plasmodium falciparum adhere to the vascular endothelium of venular blood vessel walls and do not freely circulate in the blood. When this sequestration of infected erythrocytes occurs in the vessels of the brain  Cerebral Malaria 7

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9. Clinical Features Uncomplicated Malaria Fever Sweating Nausea & Vomiting Headache, Joint pains, General malaise Severe Malaria Cerebral malaria Severe anaemia Hypotension Jaundice 9

10. Brain section  C erebral malaria 10

11. Jaundice in severe malaria 11

12. Complications Cerebral malaria Haemoglobinuria Acute kidney failure Acute respiratory distress syndrome Cardiovascular collapse Malaria Relapse : caused by P vivax & P ovale hypnozoite stage Malaria Recrudescence : caused by P falciparum & P malariae 12

13. Haemoglobinuria 13

14. Diagnosis Microscopy of blood film ( Thick and Thin ) Antigen Detection Tests ( Immuno -Chromatography tests ) Serology ( IgG and IgM antibodies ) Molecular tests eg Polymerase Chain Reaction ( PCR ) 14

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16. Differences between malaria parasites P. falciparum P. vivax P. ovale P. malariae Hypnozoite -- + + -- Size of RBC normal normal normal normal Parasite size 1/3 1/3 1/3 1/6 Multi parasite -- -- + -- Schffnrs duts -- -- + -- * Trophzoite : Size of RBC normal enlarge enlarge normal Parasite size 67% 100% 67% 100% Parasite shape ameboid band ameboid compact Suffner duts -- + + -- Maure duts + -- -- -- not seen in P.B malaria pigment 16

17. Outline of Treatment Mild Falciparum Malaria Artemesinin Combined Therapy ( ACT ) Complicated Falciparum Malaria Artesunate IV Quinine IV Exchange transfusion Non-falciparum Malaria Chloroquine orally 17

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19. Prevention and Control Prevention Chemo-prophylaxis Protection against mosquitoe bite eg Bed Net Control Use of larvicides Spray mosquitoe insecticide Treatment of cases 19

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21. Suggested References ( 1 ) Parasitic Diseases Division , CDC www.cdc.gov/nczved/divisions/dpd ( 2 ) Manson Tropical Diseases Publication Year : 2014 Edition : 23 rd Authors : Jeremy Farrar & Others 21