1. Lecture originally from University of Warwick Medical Student website adapted by Siobhan Quenby Professor of Obstetrics

2. Yeasts vs Moulds Single cell Reproduce by budding Identify using biochemical tests tubular structures called hyphae grow by branching and longitudinal extension. …and dimorphic fungi

3. Yeasts: Candida sp.

4. Mucocutaneous candidiasis

5. Protozoa

6. Unicellular, simple eukaryote Broad range of diseases

7. Plasmodium sp. –Malaria Giardia sp. –Diarrhoea Leishmaniasis –Cutaneous and systemic infections Amoebiasis –Dysentery, liver abscess Trypanomonisasis –Sleeping sickness, Chagas disease

8. Leishmaniasis

9. Malaria

11. Malaria and pregnancy

12. WHO malaria in pregnancy

13. Malaria in pregnancy sulfadoxine-pyrimethamine (SP)

14. Insecticide treated nets

16. Arnold Mkandawire

17. Felix Simbeye

18. Lenard Gama

19. Malaria – Life Cycle Life Cycle of Plasmodium vivax

20. Malaria – Pathology : Sepsis Sepsis due to Malaria

21. Malaria – Pathology : Haemolysis Jaundice due to Malaria

22. Malaria – Pathology : Sequestration Erythrocyte Sequestration due to Falciparum Malaria

23. Malaria – Symptoms & Signs Benign + Falciparum Malaria : hot + cold sweatsheadache arthralgia + myalgiadiarrhoea + vomiting hepatosplenomegalyanaemia Falciparum Malaria only : hypoglycaemiacoagulopathy haemorrhageseptic + hypovolaemic shock renal failurerespiratory failure cerebral malaria = various CNS features that lead on to  consciousness / fits / coma / death

24. Malaria – Investigations (Blood Films) Thick & Thin Blood Films

25. Malaria – Investigations (Blood Films) Thick & Thin Blood Films

26. Malaria – Investigations (Blood Films) Malaria Parasites at Various Stages

27. Malaria – Investigations (Malaria Antigen Tests)

29. Negative Non-Falciparum Falciparum or Mixed

30. Malaria – Treatment Supportive treatment & management of sepsis … Benign Malaria chloroquine 600 mg then 300 mg after 8 hours then chloroquine 300 mg daily for another 2 days followed by primaquine 15 mg for 14 days to eradicate Falciparum Malaria quinine 600 mg (or 10 mg/kg if IV) every 8 hours for 7 days followed by doxycycline 200 mg daily for 7 days to eradicate alternatives are :malarone (4 tablets daily for 3 days) riamet (4 tablets at 0, 8, 24, 36, 48 & 60 hours)

31. Malaria – Supportive Management Complicated falciparum malaria should be treated in an ITU / HDU Monitor :Glasgow Coma Scale / AVPU score temperature heart rate blood pressure (invasive CVP monitoring) respiratory rate (urine output / fluid balance) blood glucose FBC (Hb + platelets) clotting tests renal function chest radiograph

32. Malaria – Supportive Management May also include : nasogastric tube ventilation if GCS < 8 treat seizures + continue anti-convulsants reduce temperature with tepid sponging + paracetamol optimise fluid balance (CVP +5 to +10) + maintain urine output treat pulmonary oedema → sit upright / high % oxygen / IV diuretic consider haemofiltration / venesection treat hypoglycaemia + continue 10% glucose infusion transfuse if Hb < 7 g/dl or haematocrit < 20% (with frusemide cover) transfuse if platelets < 20 x 10 9 / litre + signs of bleeding consider clotting factors (FFP) if DIC develops consider haemodialysis if ARF develops

33. Treatments Malaria –Quinine, artesunate, chloroquine Giardiasis –Metronidazole Leishmaniasis –Amphotericin B

34. Helminths

35. Most prevalent human infection Multicellular Usually life cycle involving more than one host with an egg, larval and adult stage

36. Helminths Round worms –Nematodes Tape worms –Cestodes Schistosomiasis –Trematodes

37. Roundworms : hookworm 10% worlds population Can cause iron deficiency anaemia

38. Roundworms: Enterobius

39. Tapeworms – Taenia sp.

40. Tapeworms: Taenia sp.

42. Neurocysticercosis

44. Schistomomiasis

45. Katayama fever

46. Schistosomiasis

48. Cutaneous larva migrans

50. Treatments Hookworms –Mebendazole –Albendazaole Schistosomiasis/ tapeworms –Priziquantel

51. Parasite resources http://dpd.cdc.gov/dpdx/html/Para_Health.h tmhttp://dpd.cdc.gov/dpdx/html/Para_Health.h tm