Class sporozoa Genus Plasmodium P.vivax---- Benign tertian malaria P.malariae--- Quartan malaria P.falciparum---Malignant tertian Subtertian malaria P.ovale----- ovale tertian Benign tertian malaria

P vivax Mature schizont

P vivax Trphozoites

P vivax trophozoite

P malariae

P malariae

P falciparum (rings & gametocyte)

P falciparum

P Ovale

Life cycle Vertebrate host---asexual cycle---schizogony Invertebrate host---sexual cycle---sporogony

Prepatent period Incubation period Latent malaria Relapse Recrudescence

Pathology Anemia & tissue anoxia Anemia: Destruction of RBC by the parasite Haemolysis of non infected RBC(Autoimmune process) Hypersplenism Bone marrow depression Increase RBC fragility

Tissue anoxia Congestion Reduced blood flow Stasis of blood Thrombi Obstruction of small blood vessels Petechial hemorhages Anoxia of the affected organ

Complications Cerebral malaria Hyperpyrexia Gastrointestinal Algid malaria Black water fever Renal complications Tropical spleenomegaly

Cerebral malaria Hyperpyrexia Gastrointestinal complications Algid malaria Parasitemia is high > 5% Multiple infection in the RBC is common Trophozoits &schizonts appear in the peripheral blood

Epidemiology Prevalence: Reservoir Transmission Endemicity study

Transmission Bite of female anophiline mosquito Blood transfusion,Contaminated syringes Across the placenta(placental defect)

Endemicity study Statistical data for morbidity &mortality Splenic index Parasite index Mosquito density & infection rate Environmental factors affect the transmission

Splenic index Holo endemic Hyper endemic Mesoendemic Hypoendemic

Environmental factors Climate Socio-economic state of the population

Immunity Innate resistance(natural immunity: Black people immune to P vivax Sickle Hb Trait immune to P falciparum G6 PD deficiency of RBC limits parasitemia especially to P falciparum

Acquired immunity Stimulated by erythrocytic parasites Immunity is specific for spices & strain

Premunition

Diagnosis History Clinical signs Blood films: Thick film Thin film Sero-dignosis

Treatment General measures Chemotherapy

Drugs acting on asexual erythrocytic parasites (Schizontocides) Quinine 4 aminoquinolene: Chloroquine Nivaquine Amodiaquine Mefloquine Mepacrin Proguanil Pyrimethamine Sulphonamide & sulphones(in combination with other drugs

Drugs acting on tissue forms Proguanil & pyrimethamin 8 aminoquinolene( primaquine),has gametocidal activity

Treatment of all uncomplicated attacks except resistant P falciparum Chloroquine phosphate orally: day one : 1 Gm 0.5 Gm after 6 hours day two ; 0.5 Gm day three; 0. 5 Gm In P falciparum If no response = Drug Resistance In P vivax & Ovale: destroy hypnozoites in the liver Primaquine phosphate(15 mg /orally /day for 14 day

Treatment of severe illness except resistant P falciparum Chloroquine hydrochloride I.M until oral therapy is possible

Treatment of P falciparum resistant to Chloroquine Combined therapy: Quinine sulphate Pyrimethamine Sulfadiazine