MalariaMalaria

Dept. of Infectious Disease

Shengjing Hospital

CMU

DefinitionDefinitionMalaria is a parasitosis caused by plasmodia.

It is transmitted to human by the mosquito.

Clinical feature: cyclic chill, high fever & profus

e sweating. In chronic illness, there are anemia

& splenomegaly.

EtiologyEtiology

Causative organism: Plasmodia P. Vivax: tertian malaria P. Malariae: quartan malaria P. Falciparum: malignant malaria P. Ovale: tertian malaria

Pathogenicity: merozoite, malarial pigment & products of metabolism

EtiologyEtiology

TachysporozoiteBradysporozoiteMerozoiteSporozoiteParasitemia

EtiologyEtiologyTwo periods:

human - whole asexual reproduction mosquito - sexual parasitic stage

Two hosts: human - intermediate host mosquito - final host

notes: clinical symptoms: erythrocytic stage relapse: exerythrocytic stage infectivity: sporozoite

Life cycle of the malaria parasite

mosquitomicrogametocyte

zygoteoocystsporozoite

Blood stream

tachysporozoite

merozoite

mature rupture

Bradysporozoite

Blood stream

reenter

phagocyte

merozoite

trophzoite

shizontmaturerelease

merozoite

gametocyte

Erythrocytic phaseExoerythrocytic stage

human

EpidemiologyEpidemiologySource of infection

Patient, parasite carrierRoute of transmission

female mosquito biting person blood transfusion

Susceptibility: universal susceptibility no-cross-immunity re-infection

Epidemic features: sporadic or endemic, tropic or subtropic

PathogenesisPathogenesisMechanism of attack merozoite RBC rupture malaria pigment products of metabolism blood stream allergy

P. Faciparam: produce microvascular diseasemagnitude of the parasitemia & age of patientno specific Ab or cell -mediated response

PathologyPathologyAnemia:

P. Vivax - retiform RBC P. Malariae - mature RBC P. Falciparum - every RBC

Prolifeation of mononuclear phagocyte hepatomegaly splenomegaly

Cerebral edema & congestion

Clinical manifestationClinical manifestation

Incubation period: quartan malaria: 24-30 day

tertian malaria: 13~15 day

malignant malaria: 7~12 day

Clinical manifestationClinical manifestation

Typical attack Chill: abrupt onset, shivering, pale face,cyanosis.

Last 10 min or 1~2hr. High fever: T rise to 40oC with malaise, myalgia, t

hirsty. Last 2~6 hr. Sweating: profuse sweating with restlessness regular 48 hr. or 72 hr. Cycle

Clinical manifestationClinical manifestation

Singsanemia splenomegalyhepatomegaly, ALT elevate

Clinical manifestationClinical manifestation

Pernicious attack: caused by P. Falciparum

cerebral malaria high fever, headache, vomiting, convulsion deliriu

m, respiratory failure

hyperpyrexia type T> 420C, convulsion, deliriumRelapse: early relapse - <3m, later relapse - >6m

Clinical manifestationClinical manifestation

Malaria caused by transfusion incubation period: 7~10 day no exoerythrogenic phase, no relapse

ComplicationsComplications

Black- water- fever: cause:1/inadequate G-6-PD 2/The toxin release by malarial parasite 3/Allergic reaction to anti-malarial drugs feature:1/chill & fever 2/dark red or black urine 3/severe hemolytic anemia

Acute glomerulonephritis

Laboratory FindingsLaboratory Findings

Blood picture: decrease in RBC & Hb blood film for parasiteserological examination

ELISA for P. antigen DNA hybridization

DiagnosisDiagnosisEpidemiological data

endemic zone blood transfusion

Clinical manifestationLaboratory findingsDiagnostic treatment:

chloroqunine for 3 days

Differential DiagnosisDifferential DiagnosisTyphoid feverSepticemiaLeptospirosisEncephalitis B

TreatmentTreatmentAnti-malarial drugs Chloroquine-susceptable infection

chloroquine : 1g /d, for 3 day, p.o. primaquine: for 8day, p.o.

Chloroquine-resistant infection mefloguine: artemisinine

TreatmentTreatmentPernicious attack

Chloroquine: 10mg/kg iv drop in 4 hr. Then 5mg/kg, iv drop in 2 hr.

Quinine: 500mg iv drop in 4 hr.

Radical therapy

Chloroquine (3 day) + primaquine ( 8 day )

PreventionPrevention

Drug prophylaxis chloroquine: 0.3g once a week doxycycline

Kill mosquitoVaccination