Oral presentation by Matthieu Ravelomanantsoa Yaniss Ouamri

1) Introduction 2) Parasites - Vector - Cycle 3) Epidemiology 4) Diagnosis & Prevention 5) Conclusion

Paludism : from latin paludis « marsh »latin Malaria : from italian mal'aria « bad air »italian Infectious disease  Hemolytic anemia Parasites : Plasmodiums Propagation : Anopheles (mosquitos) punctures World’s most important parasitosis

Human Pathogen for years  Sickle-cell anemia, G6PDH deficiency, thalassemia Toutankhamon DNA’s analysis : died of paludism. Hippocrates : described paludism’s different fevers. Christopher Colombus : had paludism symptoms : Laveran discovers the cause in Algeria : plasmodiums in red blood cells  Nobel Prize in 1907.

- P. Falciparum P. Vivax - P. Ovale - P. Malariae - P. Knowlesi (simian origin) 5 kinds of plasmodiums affect humans : Zoonosis : -Intermediate host : Man -Final host : anophele Protozoa parasites : -1 or 2 µm Coloration  MGG : -Blue cytoplasm -Red nucleus

One vector : Anopheles Latin : anôphelês « useless » Pools some species of mosquitos Final host of plasmodiums Bite only by night Only the females do bite : hematophagus specie. Attracted by : CO2, lactic acid, sebum, heat, perspiration. Paludism’s prevalence : directly related to its distribution.

Anophele’s cycle : sexual Bite  Gametocytes ♂ + ♀ from human’s blood : fecundation  oocyste in anophele’s stomach. Each oocyste contains many Sporozoa Final location : Salivary glands. Next bite : transmission of sporozoa.

Man’s cycle : asexual Cycle’s duration depends on the plasmodium specie and is relatated To the kind of fever (24h : quotidian, 48h : tertian, 72h : quartan) Bite  sporozoa in man’s blood  hepatocytes Hepatocytes burst : Merozoa release  2 future locations : Red cells :- for all plasmodium species - responsible for red cells burst  Anemia Liver :- Only for P. Vivax / Ovale / Malariae -  Hypnozoa : quiescent parasites - Responsible for relapses of the disease.

Related to anophele’s distribution Alarming statistics, each year : 2 Billions : exposed persons 100 Millions : persons with cinical signs of paludism 1 to 3 Millions : death from paludism most of the death : children under 5 years old. Each 30 seconds : 1 death.

WHO : Divides world map in 4 categories Group 0 : No paludismGroup 2 : Paludism and resistance to treatment Group 1 : Paludism but no resistanceGroup 3 : Paludisme, and Multi-resistance

Group O cases : - Imported cases after visiting risky countries - Cases after blood-transfusion - Airport paludism phenomenon

Symptoms : Asthenia Anorexia Giddinesses Cephalgias Digestive disorders : nauseas, vomiting, abdominal pain Diarrhoea Myalgias. Signs : Periodic Fever Anemia Thrombopenia Intermittent tremors Hemoglobinuria  Icterus Convulsions Splenomegaly Hepatomegaly

Paludism is a medical emergency : Results of exams : 2 hours. 1) Smear  from blood  MGG 2) Thick-Smear  from blood  MGG 3) Detecting circulating Antigenes After treatment : control.  research of hematozoa.

Treatment : No vaccine available ACT (Artemisinin-based combination therapy)  The only one to be really efficient. Problems : - Very expensive - False drugs

Prevention : Prophylaxis Fight against anophele’s developement Chemical Repellents Mosquito nets For occidental tourists : Chloroquine  Depending on the destination  Treatment before contamination  France : bad observance  7000 Paludism cases a year.

 Mechanism and physiopathology are perfectly known  Treatment available  Still a massive killer in the third world country