1 發冷發熱的張小姐 Host and Defence (#B03) 林雅玲 May, 2008

2 瘧原蟲種類 Plasmodium vivax 間日瘧 Plasmodium falciparum 惡性瘧 Plasmodium malariae 三日瘧 Plasmodium ovale 卵圓瘧

3 Epidemiology 全球約五億人口感染瘧疾 每年約一百萬人死於瘧疾 每年超過 500,000 非洲兒童得到腦性瘧疾 在非洲每天大約有 3000 名的兒童因瘧疾而死亡 每 30 秒左右就有一名兒童喪生

4 Transmission of malaria Mosquito bite- Anopheles Blood transfusion Contaminated syringe Congenital infection

5 Life cycle in Anopheles minimus ( 微小瘧蚊 ) 當雌瘧蚊叮咬人時 合子 (zygote) 卵動體 (ookinete) 卵囊體 (oocyst) 孢子小體 (sporozoite) 配子體 (gametocyte)

6 Life cycle in human Sporozoite (Pre-erthrocytic stage) schizont merozoite ring form (Erthrocytic stage) gametocyte hypnozoite (Exo-erthrocytic stage) RBC liver schizont

7 Clinical features and pathology I 1.General symptoms Headache, Lassitude 2. Fever Cold stage 1~2 hrs Chillness, temperature mounts rapidly Hot stage 8~12 hrs o C, rapid pulse, flush Sweating stage 2~4 hrsSweating, temperature falls rapidly

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9 Clinical features and pathology II 3. Parasitemia 4. Hemolyic anemia 5. Jaundice 6. Tropical splenomegaly syndrome 7. Recrudescence  Anemia can be more severe with chronic malaria.

10 Severe Plasmodium falciparum infection Circulation failure

11 Severe Plasmodium falciparum infection I 1.Cerebral malaria 2.Convulsion 3.Circulation failure 4.Renal failure 5. Abnormal liver function 6.Pulmonary edema

12 Severe Plasmodium falciparum infection II 7. Hyperparasitemia 8. Severe anemia 9. High fever 10. Tropical splenomegaly syndrome 12. Hemorrhage in many organs 13. Hemolysis (Blackwater fever) 14. Electrolyte imbalance 15. Hypogylcemia

13 臨床診斷 1. History taking 2. Blood smear Thin film Thick film 3.Immunodiagnosis 4. Molecular diagnosis

14 抗瘧藥物 1.Quinine 2.Chloroquine 3.Mefloquine 4.Doxycycline 5.Pyrimethamine 6.Primaquine 7.Proguanil 8.Artemisinin

15 預防 避免蚊蟲叮咬 避免因輸血而感染 出國前詢問相關資訊

16 其他議題 非洲醫療團 面對病人死亡 老年喪女