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發冷發熱的張小姐

Host and Defence (#B03)林雅玲

May, 2008

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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

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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

http://www.who.int/malaria/

http://www.rbm.who.int/worldmalariaday/background.html

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Transmission of malaria

• Mosquito bite- Anopheles• Blood transfusion• Contaminated syringe• Congenital infection

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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)

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Life cycle in human

Sporozoite (Pre-erthrocytic stage)

schizont

merozoite

ring form

(Erthrocytic stage)

gametocyte

hypnozoite(Exo-erthrocytic stage)

RBC

liver schizont

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Clinical features and pathology I

1. General symptoms Headache, Lassitude2. Fever

Cold stage 1~2 hrs Chillness, temperature mounts rapidlyHot stage 8~12 hrs 39-41oC, rapid pulse, flushSweating stage 2~4 hrsSweating, temperature falls rapidly

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Clinical features and pathology II

3. Parasitemia4. Hemolyic anemia 5. Jaundice6. Tropical splenomegaly syndrome 7. Recrudescence

Anemia can be more severe with chronic malaria.

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Severe Plasmodium falciparum infection Circulation failure

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Severe Plasmodium falciparum infection I

1. Cerebral malaria 2. Convulsion3. Circulation failure4. Renal failure5. Abnormal liver function6. Pulmonary edema

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Severe Plasmodium falciparum infection II

7. Hyperparasitemia 8. Severe anemia9. High fever10. Tropical splenomegaly syndrom

e12. Hemorrhage in many organs13. Hemolysis (Blackwater fever)14. Electrolyte imbalance 15. Hypogylcemia

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臨床診斷1. History taking

2. Blood smear

Thin film

Thick film

3.Immunodiagnosis

4. Molecular diagnosis

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抗瘧藥物1. Quinine

2. Chloroquine

3. Mefloquine

4. Doxycycline

5. Pyrimethamine

6. Primaquine

7. Proguanil

8. Artemisinin

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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

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其他議題

• 非洲醫療團• 面對病人死亡• 老年喪女