1. Name means “bad air”- A life-threatening parasitic disease 40% of the world’s population is at risk 90% of the deaths due to Malaria occur in Sub- Sahara Africa, mostly among young children. 5 million of people are affected every year. At least 1.5 million deaths annually. It is one of the major public health concerns

2. How is malaria transmitted? Malaria parasites are transmitted from one person to another by the bite of a female anopheles mosquito. The female mosquito bites during dusk and dawn and needs a blood meal to feed her eggs. Male mosquitoes do not transmit malaria as they feed on plant juices and not blood. There are about 380 species of anopheles mosquito but only about 60 are able to transmit malaria.

3. Female Anopheline mosquito bite Mother to child Blood transfusion Transmission

4. What is malaria ? One of the red blood cell & a vector – borne infectious disease Malaria is a disease caused by the protozoan parasites of the genus Plasmodium. The 4 species that commonly infect man are: SpeciesMajor features P. falciparum  The most important species as it is responsible for 50% of all malaria cases worldwide and nearly all morbidity and mortality from severe malaria  Found in the tropics & sub-tropics P. vivax  The malaria parasite with the widest geographical distribution  Seen in tropical and sub-tropical areas but rare in Africa  Estimated to cause 43% of all malaria cases in the world P. ovale  This species is relatively rarely encountered  Primarily seen in tropical Africa, especially, the west coast, but has been reported in South America and Asia P. malariae  Responsible for only 7% of malaria cases  Occurs mainly in sub-tropical climates

5. Species Infecting Humans Plasmodium falciparum –Malignant tertian M. (Cerebral Ma. Or renal failure) (48hr.)  Plasmodium vivax (48hr.) –Benign tertian M. relapsing M.  Plasmodium ovale - Ovale tertian M. relapsing M. (48hr.)  Plasmodium malariae –Quartan M. (72 hr.) remain for one decade, no dominant(relapsing) stage (7%) Common & Severe Rare & Mild

6. The Hosts Human: _ intermediate host. _ victim. _ asexual cycle (schizogony cycle). Female Anopheles mosquitos : _ final hosts. _ vector. _ sexual cycle (sporogony cycle).

7. Plasmodium Infected mosquito bites human; sporozoites migrate through bloodstream to liver of human Sporozoites undergo schizogony in liver cell; merozoites are produced 2000-40,000 Mer.(6-16)days. Merozoites released into bloodsteam from liver may infect new red blood cells Merozoites are released when red blood cell ruptures; some merozoites infect new red blood cells, and some develop into male and female gametocytes 1 2 3 4 6 Asexual reproduction Intermediate host Merozoite develops into ring stage in red blood cell Ring stage Merozoites Another mosquito bites infected humnan and ingests gametocytes.skin 7 5 Ring stage grows and divides, producing merozoites (6-24)M. Definitive host In mosquito’s digestive tract, gametocytes unite to form zygote 8 Male gametocyte.gut Female gametocyte Zygote Sexual reproduction Resulting sporozoites migrate to salivary glands of mosquito 9 Sporozoites in salivary gland 10,000 sp.

8. Exo- erythrocytic (hepatic) cycle 6-16 days Sporozoites Mosquito Salivary Gland Malaria Life Cycle Gametocytes Oocyst Erythrocytic Cycle Zygote Schizogony Sporogony Hypnozoites (for P. vivax and P. ovale) Red Blood cell Schizont Liver cell Schizont Asexual cycle Intermediate host Sexual final host

9. Plasmodium vivax &Plasmodium ovale HYPNOZOITES Illness May Relapse 3 To 5 Years After Original Infection Hypnozoites(relapsing) Hypnozoites: - Are liver-trophozoite stages -Responsible for recurrence of malarial symptoms.

10. Malarial Paroxysm –D–Days 1 and 3 for: –P–P lasmodium vivax –P–P lasmodium ovale –a–a nd Plasmodium falciparum –U–Usually persistent fever or daily paroxyms for Plasmodium falciparum. Tertian malaria Days 1, 3, 5, 7, 9,………. 48 hrs. Days 1, 4, 7, 10,………. 72 hrs. –D–Days 1 and 4 for Plasmodium malariae Quartian malaria

11. Malarial Paroxysm Cold stage Hot stage Sweating stage

13. The clinical course of P. Asymptomatic parasitaemia (“clinical immunity”) A. Acute, uncomplicated malaria B. Severe malaria

14. This is usually seen in older children and adults who have acquired natural immunity to clinical disease as a consequence of living in areas with high malaria endemicity. There are malaria parasites in the peripheral blood but no symptoms. These individuals may be important reservoirs for disease transmission. Some individuals may even develop anti-parasite immunity so that they do not develop parasitaemia following infection. A. Asymptomatic parasitaemia

15. B. Simple, uncomplicated malaria Children with malaria waiting to be seen at a malaria clinic in the south western part of Nigeria. Identifying children with severe malaria, and giving them prompt treatment, is a major challenge when large numbers attend clinics. This can occur at any age but it is more likely to be seen in individuals with some degree of immunity to malaria. The affected person, though ill, does not manifest life- threatening disease. Fever is the most constant symptom of malaria. It may occur in paroxysms fever, chills and rigors (uncontrollable shivering).

16. Other features of simple, uncomplicated malaria include: oVomiting, Diarrhoea,Convulsions, Jaundice oMalaria is a multisystem disease. Other common clinical features are: oAnorexia, Cough, Headache, Malaise, Muscle aches, Splenomegaly, hepatomegaly These clinical features occur in “mild” malaria. However, the infection requires urgent diagnosis and management to prevent progression to severe disease.

17. C. Severe and complicated malaria 1.Cerebral malariaCerebral malaria 2.Severe malaria anaemiaSevere malaria anaemia 3.HypoglycaemiaHypoglycaemia 4.Metabolic acidosisMetabolic acidosis 5.Acute renal failureAcute renal failure 6.Pulmonary oedemaPulmonary oedema 7.Circulatory collapse, shock or “algid malaria”Circulatory collapse, shock or “algid malaria” 8.Blackwater feverBlackwater fever Nearly all severe disease and the estimated >1 million deaths from malaria are due to P. falciparum. Although severe malaria is both preventable and treatable, it is frequently a fatal disease. The following are 8 important severe manifestations of malaria: Note: It is common for an individual patient to have more than one severe manifestation of malaria!

18. Malaria Diagnosis Clinical Diagnosis Malaria Blood Smear Serology ( ELISA )( IFAT ). Polymerase Chain Reaction Blood Smear P repare smears as soon as possible after collecting venous blood to avoid any Changes in parasite morphology. the “ ““ “gold standard” for diagnosis of malaria.. Hyperendemic areas. Fever,sweat, chills, headache & muscle pain B.F.F.M.= Blood Film For Malaria

19. Plasmodium falciparum Rings : double chromatin dots multiple infections in same red cell Gametocyte s: mature (2)and immature (1) forms (1is rarely seen in peripheral blood) Trophozoites : compact *(rarely seen in peripheral blood) Schizonts : 8-24 merozoites *(rarely seen in peripheral blood) Infected erythrocytes: ***normal size (Maurer’s dots) 2 1 1 2 3 4

20. Plasmodium vivax Trophozoites : ameboid; deforms the erythrocyte Gametocytes : round Schizonts : 12-24 merozoites Rings one chromatin dots Infected erythrocytes: enlarged up to 2X **deformed; (Schüffner’s dots) 2 1 3 4

21. Plasmodium ovale Infected erythrocytes: enlarged (1 1/4 X); ** fimbriated; oval; (Schüffner’s dots) Rings Trophozoites : compact Schizonts : 6-14 merozoites; dark pigment; (“rosettes”) Gametocytes : round-oval 1 3 4 2

22. Infected erythrocytes: **normal size Plasmodium malariae Ring: compact Trophozoite : typical band form Schizont : 6-12 merozoites; coarse, dark pigment Gametocyte : round; coarse, dark pigment 4 1 23

23. Prevention Using insecticide to kill a larval stage of mesquite. Recovering all ponds and water source with oil. Using a mesquite net. Using prophylaxis when travel to area with malaria are endemic. Breeding a special type of fish which feeding on larval stage of Anopheles.