بسم الله الرحمن الرحیم انگلهای مالاریا

 Phylum: Apicomplexa  Class: Sporozoea  Sub-class: Coccidia  Order: Eucoccidia  Sub-order: Haemosporina  Family: Plasmodidae  Genus: Plasmodium  Sub-genus: Plasmodium Laverania Vinckeia …....  Species: vivax falciparum berghei malariae malariae ovale ovale

Characteristic of Sub-genus  1- Plasmodium  2- Laverania  3- Vinckeia

Causal Agents:  There are approximately 156 named species of Plasmodium which infect various species of vertebrates.  There are approximately 156 named species of Plasmodium which infect various species of vertebrates.  Four are known to infect humans:  Blood parasites of the genus Plasmodium.  Blood parasites of the genus Plasmodium. P. falciparum, P. vivax, P. ovale and P. malariae. P. falciparum, P. vivax, P. ovale and P. malariae.

P. vivax most widespread, found in most endemic areas including some temperate zones P. falciparum primarily tropics and subtropics P. malariae similar range as P. falciparum, but less common and patchy distribution P. ovale occurs primarily in tropical west Africa Distribution of Malarial Parasites

Malaria types  Malignant Tertian Malaria  Agent: P. falciparum  Benign Tertian Malaria  Agent: P. vivax  Benign Quartan Malaria Agent: P. malariae  Benign Tertian Malaria  Agent: P. ovale

Anopheles mosqouite

Vectores in Iran An. stephenciمهمترین و پایدارترین ناقل در ایران An. superpictus فراگیرترین آنوفل در ایران An. dethaliکوچکترین آنوفل در جنوب شرق ایران An. culicifacies An. fluviatilisخطرناکترین ناقل فالسیپاروم An. maculipennisناقل اصلی درشمال و شمال غرب کشور An. sacharovi ناقل اصلی درشمال و شمال غرب کشور

 Life Cycle: Life Cycle

Geographic Distribution Geographic Distribution

شیوع مالاریا در جهان و ایران  Prevalence rate in the world: > 300,000,000 case  Incidence rate “ “ “ “” “ “ > 100,000,000 case  Mortality rate “ “ “ “ “ “ “ “ 1,000,000 case در سال 1351: 20 هزار مورد در کشور در سال 1362: 20 هزار مورد فقط در استان سیستان و بلوچستان در سال 1377: 40 هزار مورد در استان سیستان و بلوچستان

natural (sporozoites/Anopheles) blood transfusions shorter incubation period fatality risk (P. falciparum) no relapses possible (vivax/ovale) syringe sharing congenital relatively rare although placenta is heavily infected Malaria Transmission methods

Clinical features History of exposure: Paroxysm : Paroxysm : 1-Chills ( Cold stage) 1-Chills ( Cold stage) 2-Fever ( Hot stage) 2-Fever ( Hot stage) 3- Sweating stage Other clinical features: splenomegaly, anemia, thrombocytopenia, hypoglycemia, pulmonary or renal dysfunction, and neurologic changes.

cold stage feeling of intense cold vigorous shivering, rigor lasts min

hot stage intense heat dry burning skin throbbing headache lasts 2-6 hours

sweating stage profuse sweating declining temperature exhausted, weak  sleep lasts 2-4 hours

falciparum may not exhi- bit classic paroxysms continuous fever 24 hr periodicity Malaria Paroxysm tertian malaria quartan malaria

 Relapse  Hypnozoite (Resting stage)  Recrudescence  Induced malaria  Hemozoin توضیح واژه ها

Stippling dots  1) Schuffner’s dots  2) Maurer’s dots  3) Ziemann’s dots  4) Jame’s dots  Sticky phenomen( knobs)

Malignant Tertian Malaria 1-Cerebral malaria  2-Black water fever ( severe anemia)  3-Acute renal failure  4- Algid malaria  5- Respiratory distress syndrome (pneumonic malaria)  6- Gastro-intestinal mlaria  Complications of P. vivax malaria include splenomegaly (with, rarely, splenic rupture),  and those of P. malariae include nephrotic syndrome.

Karunaweera et al (1992) PNAS 89:3200 TNF = tumor necrosis factor-  (  ) proinflammatory cytokine (produced in response to malarial antigens?) rigor sweating

Immunity slow to develop short lived ‘premunition’ non-sterilizing lower parasitemia less symptoms Anti-Parasite Immunity immune response prevents merozoite invasion, eliminates infected erythrocytes, etc. Anti-Disease Immunity eg., neutralization of exo- antigens or toxic effects

Immunity in Malaria  A) Natural immunity  1-Innate immunity  2- Genetic immunity B) Acquired immunity  1-Exo-Erythrocytic stage  Premonition: prevents of super-infection no re-infection (stage specific). 2- Erythrocytic stage concomitant immunity (stage specific & strain specific ): - Ab mediated immunity - Ab dependent cell cytotoxicity (ADCC) - Ab dependent phagocytosis - Cellular immunity

Malaria laboratory diagnosis  1) Microscopic identification:  -preparing thick and thin biood smear  -comparison of plasmodium species  2- Quality Buffy Coat ( QBC)  3) Immunochromatographic methods  4)Antibody Detection  5) Molecular diagnosis techniques

Thin Blood Smear

Thick Blood Smear

Malaria antibody detection The IFA procedure can be used as a diagnostic tool to determine if a patient has been infected with Plasmodium. The IFA procedure can be used as a diagnostic tool to determine if a patient has been infected with Plasmodium. Blood stage Plasmodium species schizonts (meronts) are used as antigen Enzyme immunoassays have also been employed as a tool to screen blood donors, but are not recommended for clinical diagnosis due to limited sensitivity serologic testing is not practical for routine diagnosis of acute malaria. serologic testing is not practical for routine diagnosis of acute malaria.

Antibody detection may be useful for: 1- screening blood donors 2- testing a patient with a febrile illness who is suspected of having malaria and from whom repeated blood smears are negative ( Fever of Unknown Origin) 3- testing a patient who has been recently treated for malaria but in whom the diagnosis is questioned  Species-specific testing is available for the four human species: P. falciparum, P. vivax, P. malariae, and P. ovale.  Species-specific testing is available for the four human species: P. falciparum, P. vivax, P. malariae, and P. ovale.  Cross reactions often occur between Plasmodium species and Babesia species..

A: Positive IFA result with P. malariae schizont antigen. A

Rapid Diagnostic Tests(dipstickor test strip) (basedon the detection of antigens malaria parasites; Histiding- rich protein II)

Comparison of Plasmodium Species

Treatment Chloroquine Chloroquine Sulfadoxine-pyrimethamine (Fansidar) Sulfadoxine-pyrimethamine (Fansidar) Mefloquine (Lariam) Mefloquine (Lariam) Quinine Quinine Doxycycline Doxycycline Artemisin derivatives Artemisin derivatives

Malaria Control Reduce Human-Mosquito Contact impregnated bed nets repellants, protective clothing screens, house spraying Reduce Vector environmental modificaton larvacides/insecticides biological control Reduce Parasite Reservoir diagnosis and treatment chemoprophylaxis