1. ARULANANDAM TERENCE.T 403(A)
Malaria
ARULANANDAM TERENCE.T
403(A)

2. Topicality
The worldwide annual incidence of malaria is between 300 and 500 million cases, causing between 1 and 2 million deaths.
Areas with significant numbers of malaria cases include Africa, the Middle East, India, Southeast Asia, South America, Central America, and parts of the Caribbean.

3. Topicality
Greater than 90% of severe, life-threatening malaria occurs in children.

4. Etiology Protozoal microorganism: Plasmodium falciparum
Plasmodium vivax
Plasmodium malariae
Plasmodium ovale

5. Epidemiology
Mosquito transmission is the most common route of infection

7. Epidemiology
Transmission may result from intravenous drug abuse (shared needles) or blood transfusion. In these instances, only the erythrocytic cycle is established, because hepatocytes can be infected only by the sporozoite form of the parasite.

8. Life cycle Differences
Plasmodium falciparum:
All falciparum sporozoites that enter the liver remain active and develop into tissue schizonts that proceed to form thousands of merozoites
P. falciparum merozoites can infect red blood cells of all ages

9. Life cycle Differences
rapid asexual reproduction - rapid rise in the percentage of infected host red blood cells
formation of red blood cell membrane knobs

10. Life cycle Differences
P. vivax and P. ovale can form hypnozoites that can remain dormant within the liver for months
P. vivax and P. ovale merozoites bind only young red blood cells, having the highest affinity for reticulocytes

11. Life cycle Differences
P. malariae can persist as a low-level infection for up to 30 years
P. malariae tends to infect older red blood cells

12. Clinical symptoms The incubation period is generally 9 to 40 days
The hallmark of all forms of malaria is fever :
initial “cold stage” ,
“hot stage” ,
“sweating” stage

13. Clinical symptoms Signs of anemia Splenomegaly and mild hepatomegaly
Other symptoms associated with the fever (tachycardia, hypotension, cough, headache, back pain, nausea etc.)

14. Clinical symptoms Falciparum malaria:
severe damage, particularly to the kidneys, brain, and lungs
profound hemolysis
jaundice
blackwater fever
renal failure
CNS dysfunction up to coma
pulmonary edema

15. Dignosis Thick smears – detection.
Microscopic examination of a Giemsa-stained blood smear – identification.
ELISA
Immunoassay for species-specific parasite lactic dehydrogenase isoenzymes
PCR

16. Diagnosis Hemolysis: Anemia Elevated levels of lactic dehydrogenase
Increased reticulocytes
Elevated unconjugated bilirubin level without a significant increase in hepatic enzymes (severe cases).

17. Diagnosis Severe cases of P. falciparum : Elevated serum creatinine
Proteinuria
Hemoglobinuria
Hypoglycemia

18. Treatment
oral chloroquine 600 mg base (1000 mg chloroquine phosphate), followed 6 hours later by 300 mg base (500 mg phosphate), repeated on days 2 and 3
Then for P. vivax or P. ovale oral primaquine 15.3 mg phosphate base (26.5 mg phosphate salt) daily for 14 days

19. Treatment Chloroquine-resistant P. falciparum: Hospitalization
quinine 650 mg every 8 hours for 3–7 days plus doxycycline 100 mg twice daily for 7 days

20. Intravenous therapy
Quinidine gluconate salt 10 mg/kg loading dose (maximum 600 mg) in normal saline should be infused slowly over 1 to 2 hours, followed by a continuous infusion of 0.02 mg/kg every minute until the patient is able to take oral medication

21. Treatment Levels of parasitemia above 5% require intensive treatment
Levels of P. falciparum parasitemia above 10% to 15% - exchange transfusion
Monitoring of: volume status, renal function, serum glucose, cardiac function
Respirator support in cases of severe pulmonary edema

22. Chemoprophylaxis
In chloroquine-susceptible areas – chloroquine 300 mg base orally per week
In chloroquine-resistant areas - mefloquine 250 mg orally per week, or doxycycline 100 mg orally per day, or primaquine 0.5 ,mg/kg base per day