S.- Malaria 1

ParasitologaMALARIA

Dr. Oswaldo Andrs Herrera CaveroJefe de la Ctedra de Parasitologa

Universidad Nacional Mayor de San Marcos Facultad de Farmacia y Bioqumica

PlasmodiumEs el gnero que produce el paludismo o malaria en sus diferentes expresiones clnicas.Existen 4 especies del gnero Plasmodium que parasitan al hombre:Plasmodium vivax.P. malariae.P. falciparum.P. ovale.

MorfologaCorresponden al grupo de los esporozoarios, porque tienen una esporogonia (reproduccin por esporozoos)En sus diferentes estados evulutivos existen caractersticas especficas que permiten su identificacin y diferenciacin con respecto a otras especies.Pasan por los siguientes estados evolutivos:Trofozoito anillado, trofozoito amiboide, esquizonte en formacin, esquizonte joven, esquizonte maduro, gametocitos, gemetos, cigote, esporoblasto, esporozoito.

Mostrando 2 eritrocitos parasitados por Plasmodium sp.

Caractersticas diferenciales de los Plasmodium que atacan al humano

Ciclo biolgicoPresentan varias etapas o fases:En el humano:Fase preeritroctica.- Antes de invadir hemates, pasan por los hepatocitos, hasta formar merozoitos.Fase eritroctica que comprende:Trofozoito anilladoTrofozoito amiboideEsquizonte en formacinEsquizonte joven o inmaduroEsquizonte maduroMerozoitosFase gametognica que comprende:GametoblastosMicrogametocitoMacrogametocito.

Ciclo biolgico (continuacin)En el vector:Face sexuada o Esporognia:ExflagelacinFecundacinOoquinetoEsporoquisteEsporozoitosEsporozoitos metacclios (FORMA INFECTANTE)

Ciclo biolgico (continuacin)En el vector mosquito Anopheles sp.En el humanoGametocitosMacro MicroExflagelacin y fecundacinEsporogoniaEsquizogoniaGametogoniaGlndulas salivales

Cuadro comparativo entre los estados evolutivos de Anofelinos y CulicinosAnofelinoCulicino

Diferencia estructural entre las cabezas de culicinos y anofelinos

Anopheles hembra en accin de absorber sangre de una persona

PatogenieAunque los signos y sntomas son los mismos, stos varan segn sea la especie que produzca la malaria.La diferencia se marca segn el tiempo que dura la esquizogania eritroctica del parsito:P. vivax = 48 horas= tercianaP. falciparum = 48 horas= tercianaP. Ovale = 48 horas= tercianaP. malariae = 72 horas= cuartanaLa terciana se manifiesta cada 3 das y la cuartana cada 4 das con fiebres escalofros, postracin y sudoracin abundante, es recomendable el tra-tamiento inmediato, ya que se ha demostrado que la alta reproduccin del parsito complica el cuadro clnico, produciendo anmia, hiperpla-sia medular, ictericia, hepatomegalia, splenomegalia y muerte.

P. vivaxP. FalciparumFUENTE: OGE/RENACE/MINSAPorcentual de casos de malaria por P. vivax y P. falciparumPer 1992 - 1999

casos de malaria Per

58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819

Datos de P.falciparum 1992

4

138

47

40

51

42

28

66

12

0

42

138

144

725

Datos P falciparum 1

19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

78.11746230870.712642911963.753704313560.463999650898.8046560707

21.88253769229.287357088136.246295686539.53600034921.1953439293

1996

1997

1998

1999*

1992

1996

Tabla Casos de 92-99

MALARIA

P vivaxP falciparumTotal% P. vivax% P. falciparum

19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458196040

725

6575

10003

25356

38738

52719

77056

18115

Hoja4


58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819


4

138

47

40

51

42

28

66

12

0

42

138

144

725


19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

70.712642911963.753704313560.463999650898.8046560707

29.287357088136.246295686539.53600034921.1953439293

1997

1998

1999*

1992

1997


MALARIA


19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458196040

725

6575

10003

25356

38738

52719

77056

18115

Hoja4


58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819


4

138

47

40

51

42

28

66

12

0

42

138

144

725


19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

63.753704313560.463999650898.8046560707

36.246295686539.53600034921.1953439293

1998

1999*

1992

1998


MALARIA


19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458196040

725

6575

10003

25356

38738

52719

77056

18115

Hoja4


58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819


4

138

47

40

51

42

28

66

12

0

42

138

144

725


19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

5398.8046560707

471.1953439293

1999*

1992

1999


MALARIA


19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458195347

725

6575

10003

25356

38738

52719

77056

18115

Hoja4


58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819


4

138

47

40

51

42

28

66

12

0

42

138

144

725


19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

98.8046560707

1.1953439293

1992

1992

99

1


MALARIA


19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458196040

725

6575

10003

25356

38738

52719

77056

18115

Hoja4


58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819


4

138

47

40

51

42

28

66

12

0

42

138

144

725


19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

93.528352215192.424380121585.772959870778.11746230870.712642911963.753704313560.463999650898.8046560707

6.47164778497.575619878514.227040129321.88253769229.287357088136.246295686539.53600034921.1953439293

1993

1994

1995

1996

1997

1998

1999*

1992

1993


MALARIA


19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458196040

725

6575

10003

25356

38738

52719

77056

18115

Hoja4


58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819


4

138

47

40

51

42

28

66

12

0

42

138

144

725


19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

92.424380121585.772959870778.11746230870.712642911963.753704313560.463999650898.8046560707

7.575619878514.227040129321.88253769229.287357088136.246295686539.53600034921.1953439293

1994

1995

1996

1997

1998

1999*

1992

1994


MALARIA


19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458196040

725

6575

10003

25356

38738

52719

77056

18115

Hoja4


58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819


4

138

47

40

51

42

28

66

12

0

42

138

144

725


19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

85.772959870778.11746230870.712642911963.753704313560.463999650898.8046560707

14.227040129321.88253769229.287357088136.246295686539.53600034921.1953439293

1995

1996

1997

1998

1999*

1992

1995


MALARIA


19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458196040

725

6575

10003

25356

38738

52719

77056

18115

Hoja4

Casos de Malaria por P. falciparum segn regiones 1997 - 1999Nmero de casosFuente: OGE/RENACE/METAXENICAS


58

44

57.5

39

41

41

80.5

59

46

40

32

20

19

19

20

17

16

10

11

10.5

5

3

3.2

2.8

2.5

2.4

2.5

2.4

2.5

3

2.4

8

4.5

4.2

12

12.5

12.5

15

19

34

20

18

16

16

20

29.4

36

37

38

40

36

37.5

30

60.657

101.597

132.042

178.224

177.027

180.006

212.59

45.819

Datos 1939 -1999

193958

194044

194157.5

194239

194341

194441

194580.5

194659

194746

194840

194932

195020

195119

195219

195320

195417

195516

195610

195711

195810.5

19595

19603

19613.2

19622.8

19632.5

19642.4

19652.5

19662.4

19672.5

19683

19692.4

19708

19714.5

19724.2

197312

197412.5

197512.5

197615

197719

197834

197920

198018

198116

198216

198320

198429.4

198536

198637

198738

198840

198936

199037.5

199130

199260.657

1993101.597

1994132.042

1995178.224

1996177.027

1997180.006

1998212.59

199945.819


4

138

47

40

51

42

28

66

12

0

42

138

144

725


19794

1980138

198147

198240

198351

198442

198528

198666

198712

19880

198942

1990138

1991144

1992725

G casos de falcipa

725

6575

10003

25356

38738

52719

77056

18115

Grfico4

93.528352215192.424380121585.772959870778.11746230870.712642911963.753704313560.463999650898.8046560707

6.47164778497.575619878514.227040129321.88253769229.287357088136.246295686539.53600034921.1953439293

1993

1994

1995

1996

1997

1998

1999*

1992


MALARIA


19925992772560652991

1993950226575101597946

199412203910003132042928

1995152868253561782248614

1996138289387381770277822

1997127287527191800067129

1998135534770562125906436

1999*2770418115458196040

725

6575

10003

25356

38738

52719

77056

18115

Gr regiones falcip

20102562

2386655

30102166

4696382

571143122

321168130

301335194

521044135

291037111

311123127

60980128

51829163

23523115

69886165

55907159

801171151

821122193

836890

1101157107

170157288

1681344129

158127795

1931369144

1841056112

2141306175

19912331

2091052125

2391037113

233903102

10890154

149795144

16282387

139770103

18968667

11647579

13449448

16046962

7959561

9335352

13441139

15640044

12531041

8032731

5926561

924144

9035829

15334431

11633049

6234142

13132112

16231445

35628738

47434674

58935845

72638382

60046354

56852376

44654586

441547109

46946693

53562076

47252061

56155090

53851970

78846383

722457104

113756199

1071589115

1243624100

2039797112

2444557138

2380644139

172963479

2380448103

2768641179

1624595131

106056694

161056777

2347485104

1335502102

175146774

101029364

161045753

94045512

102643269

82642356

45234940

78634735

64337728

64534326

51226312

5042716

59422119

58926013

71728522

70124427

71838219

69638330

62426432

56629445

55235541

38328523

28929612

3232909

65331121

742028

87927630

94518851

77018741

68217557

69615832

64118841

82317442

97313873

140413143

168912677

140516135

173021478

166725341

171229457

158715835

182213655

228920058

2556150358

2280195205

1984182339

174120874

167427767

1236245127

1165222120

104926266

111523656

812238153

66720079

775206101

1997

1998

1999

NORTE

SELVA

OTROS

Regiones 1998

Seleccin activa:diagnostic="084.0"

1999

SEMANADEPARTAMEN|12345678910111213141516

SUBREGION|12345678910111213141516171819202122232425262728293031323334353637383940414243444546474849505152Total-----------------+----------------------------------------------------------------------------------------------------------

-----------------+----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------AMAZONAS|3501817131871571055510129

Ancash|00000000002000000000000000000000100000000000000000003ANCASH|000201020102122013

Cajamarca|1388815363957936310149201994512802522270284120575123210797553333APURIMAC|00000000000000000

Callao|00001000000000000000000000000000100000000000000000002AYACUCHO|00000000000000000

Chachapoyas|520011012111310000132001000000000200000000000000000028CAJAMARCA|13181722134023252534185826481933432

Chota|2120111238502101124329391915102515611103824972104026343613601285CUSCO|00000000000000000

Jan|54347146588110287624775607596961048510111311366901349971677782665141259502822202211187818141622302112752787HUANCAVELICA|00000000000000000

Junn|00100000000000000001001000000000000000000100000000004HUANUCO|00000000000000000

La Libertad|0000211001001241020201102010000001052524112100010015240104ICA|00000000000000000

Lambayeque|6262919836238413244386871932272551682082752761541941761098578605850292219223727302431502919393239573128313529JUNIN|00000000000100001

Loreto|33134436345551253653445960050654050545344054556561278254062161143161358555455345747945427844044241840232532936833325026321124427923937937925628935528428828522316LA LIBERTAD|41311220119961140468

Luciano Castillo|12818222118020917216616123923919623129028539332576498345295057983891111410471146626066866365237333592672131821822452222822683232912492302472279712314253LAMBAYEQUE|00110001002000106

Madre de Dios|00000200000000000000000000100000000100001010000000006LIMA|00000000000000000

Piura|33840349540733526225328624319934528345238566892410601177132615291422147915501199779105184788062152150052036134021719816612910311312514817918420213114510512087638625941LORETO|31102761881871751581881741381311261612144412933161

San Martn|119208116127191391491715241215172323162891114252312151713142124179101389165534850185662MADRE DE DIOS|00000000000000000

Tumbes|2241113101214171012203226292839185765891131041401142512762323833513822962502191802051632421991781981872062201742341981921133697836726PASCO|00000000000000000

Ucayali|450001101110101000000101102010000000000000000000000022PIURA|32049847451045041941842551553974287348491483110989510

-----------------+----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------0SAN MARTIN|149710163534128141088

Total|8949921191111711671077109710281231105312011127133412831797177519672948313931632442293135882350172022542936193922921367212014071527130584111681048101478778183486210249721119110992090594869159762277001TUMBES|22523630039265127721211331041954594993709834154696

UCAYALI|000000024130010011

-----------------+----------------------------------------------------------------------------------------------------------0

NORTE|12345678910111213141516171819202122232425262728293031323334353637383940414243444546474849505152TotalTotal|8777621080114174377868077586485411111536117915762296186318115

-----------------+----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

La Libertad|0000211001001241020201102010000001052524112100010015240104

Lambayeque|6262919836238413244386871932272551682082752761541941761098578605850292219223727302431502919393239573128313529NORTEMEN|12345678910111213141516

Luciano Castillo|12818222118020917216616123923919623129028539332576498345295057983891111410471146626066866365237333592672131821822452222822683232912492302472279712314253-----------------+----------------------------------------------------------------------------------------------------------

Piura|33840349540733526225328624319934528345238566892410601177132615291422147915501199779105184788062152150052036134021719816612910311312514817918420213114510512087638625941LA LIBERTAD|41311220119961140468

Tumbes|2241113101214171012203226292839185765891131041401142512762323833513822962502191802051632421991781981872062201742341981921133697836726LAMBAYEQUE|00110001002000106

-----------------+----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------0PIURA|32049847451045041941842551553974287348491483110989510

Total Norte47458972660056844644146953547256153878872211371071124320392444238017292380276816241060161023471335175110101610940102682645278664364551250459458971770171869662456655238328932350553TUMBES|22523630039265127721211331041954594993709834154696

-----------------+----------------------------------------------------------------------------------------------------------0

Total Pais|8949921191111711671077109710281231105312011127133412831797177519672948313931632442293135882350172022542936193922921367212014071527130584111681048101478778183486210249721119110992090594869159762277001Total Norte5497357789045165484925476496629481338984129818151517

Total|8777621080114174377868077586485411111536117915762296186318115

SELVA|12345678910111213141516171819202122232425262728293031323334353637383940414243444546474849505152Total

-----------------+----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Loreto|33134436345551253653445960050654050545344054556561278254062161143161358555455345747945427844044241840232532936833325026321124427923937937925628935528428828522316SELVAMEN|12345678910111213141516

Madre de Dios|00000200000000000000000000100000000100001010000000006-----------------+----------------------------------------------------------------------------------------------------------

San Martn|119208116127191391491715241215172323162891114252312151713142124179101389165534850185662LORETO|31102761881871751581881741381311261612144412933161

Ucayali|450001101110101000000101102010000000000000000000000022MADRE DE DIOS|00000000000000000

-----------------+----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------0SAN MARTIN|149710163534128141088

Total Selva34635838346352354554746662052055051946345756158962479755764463444864159556656748550246729345745543242334934737734326327122126028524438238326429435528529629023006UCAYALI|000000024130010011

-----------------+----------------------------------------------------------------------------------------------------------0

Total Pais|8949921191111711671077109710281231105312011127133412831797177519672948313931632442293135882350172022542936193922921367212014071527130584111681048101478778183486210249721119110992090594869159762277001Total Selva3124285195197176164193183142138127163223455303

Total|8777621080114174377868077586485411111536117915762296186318115

OTROS|12345678910111213141516171819202122232425262728293031323334353637383940414243444546474849505152Total

-----------------+----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Ancash|00000000002000000000000000000000100000000000000000003DEPARTAMEN|12345678910111213141516

Cajamarca|1388815363957936310149201994512802522270284120575123210797553333-----------------+----------------------------------------------------------------------------------------------------------

Callao|00001000000000000000000000000000100000000000000000002AMAZONAS|3501817131871571055510129

Chachapoyas|520011012111310000132001000000000200000000000000000028ANCASH|000201020102122013

Chota|2120111238502101124329391915102515611103824972104026343613601285APURIMAC|00000000000000000

Jan|54347146588110287624775607596961048510111311366901349971677782665141259502822202211187818141622302112752787AYACUCHO|00000000000000000

Junn|00100000000000000001001000000000000000000100000000004CAJAMARCA|13181722134023252534185826481933432

-----------------+----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------0CUSCO|00000000000000000

Total Otros7445825476861099376619070831049911510011213813979103179131947710410274645312695640352826126191322271930324541231293442HUANCAVELICA|00000000000000000

HUANUCO|00000000000000000

Total Pais|8949921191111711671077109710281231105312011127133412831797177519672948313931632442293135882350172022542936193922921367212014071527130584111681048101478778183486210249721119110992090594869159762277001ICA|00000000000000000

JUNIN|00000000000100001

12345678910111213141516171819202122232425262728293031323334353637383940414243444546474849505152LIMA|00000000000000000

Total Norte474589726600568446441469535472561538788722113710711243203924442380172923802768162410601610234713351751101016109401026826452786643645512504594589717701718696624566552383289323PASCO|00000000000000000

Total Selva346358383463523545547466620520550519463457561589624797557644634448641595566567485502467293457455432423349347377343263271221260285244382383264294355285296290-----------------+----------------------------------------------------------------------------------------------------------0

Total Otros744582547686109937661907083104991151001121381397910317913194771041027464531269564035282612619132227193032454123129Total Otros16231742305424353250257132552643

Total|8777621080114174377868077586485411111536117915762296186318115

120102562

22386655Total Norte5497357789045165484925476496629481338984129818151517

330102166Total Selva3124285195197176164193183142138127163223455303

44696382Total Otros16231742305424353250257132552643

5571143122

6321168130

7301335194

8521044135

9291037111

10311123127

1160980128

1251829163

1323523115

1469886165

1555907159

16801171151

17821122193

18836890

191101157107

20170157288

211681344129

22158127795

231931369144

241841056112

252141306175

2619912331

272091052125

282391037113

29233903102

3010890154

31149795144

3216282387

33139770103

3418968667

3511647579

3613449448

3716046962

387959561

399335352

4013441139

4115640044

4212531041

438032731

445926561

45924144

469035829

4715334431

4811633049

496234142

5013132112

5116231445

5235628738

147434674

258935845

372638382

460046354

556852376

644654586

7441547109

846946693

953562076

1047252061

1156155090

1253851970

1378846383

14722457104

15113756199

161071589115

171243624100

182039797112

192444557138

202380644139

21172963479

222380448103

232768641179

241624595131

25106056694

26161056777

272347485104

281335502102

29175146774

30101029364

31161045753

3294045512

33102643269

3482642356

3545234940

3678634735

3764337728

3864534326

3951226312

405042716

4159422119

4258926013

4371728522

4470124427

4571838219

4669638330

4762426432

4856629445

4955235541

5038328523

5128929612

523232909

165331121

2742028

387927630

494518851

577018741

668217557

769615832

864118841

982317442

1097313873

11140413143

12168912677

13140516135

14173021478

15166725341

16171229457

17158715835

18182213655

19228920058

202556150358

212280195205

221984182339

23174120874

24167427767

251236245127

261165222120

27104926266

28111523656

29812238153

3066720079

31775206101

Tratamiento diferencial

Esquizonticidas tisulares(aminoquinolinas, primaquinas)

Esquizonticidas Hematicos(cloroquinas y derivados)

Gametocidas(destruyen los gametocitos y parsitos tisulares, como la primaquina)

Preventiva.Contra los esporozoitos (profilaxis como la cloroquina)

FACTORES A TOMAR EN CUENTA PARA EL TRATAMIENTO

Urgencia en el tratamiento para P. falciparumEspecie de plasmodio InfectanteDosis, asociaciones y contraindicacionesTipo de tratamiento(supresivo, radical, o preventivo)Antecedentes epidemiolgicos de las especies prevalentes en la zona y la resistencia a las drogaAsesoria

1ra. Lnea (Cloroquina-Primaquina) para el tratamiento de la malaria no complicada frmaco sensible por P. vivax y P. falciparum.

2da. Lnea (Sulfadoxina-Pirimetamina) para el tratamiento de la malaria por P. falciparum no complicada resistente a Cloroquina.

3ra. Lnea (Quinina/Clindamicina-Quinina/Tetraciclina) para el tratamiento de la malaria por P. falciparum no complicada y complicada resistente a Sulfadoxina-Pirimetamina.

MGametociticidaEsquizonticidaEl ciclo biolgico y los medicamentos antimalricosMALARIA

Principales esquizonticidasCloroquinaSulfadoxinaPirimetaminaMefloquinaProguanil

QuininaQinhaosuTetraciclinas ClindamicinasAtovaquone

CloroquinaModo de accin4 amino-quinolenaInhibicin de proteasas que separan la hemoglobina

Sulfadoxina y PirimetamidaModo de accincido para-aminobenzoico(PABA) +dihidropteridineAcido dihydroflico(cido flico)Acido tetradihydroflico(cido folnico)Purinas PirimidinaNucleoproteinasNcleo del parsitoSintetasa delcido dihidroflicoReductasa delcido dihidroflicoAntiflicosSulfadoxinaAntifolnicosPirimetamina

MefloquinaDesde 1974Va oralToma nicaVida media 15 a 25 dasProblemas psiquitricosMecanismo de accin : bloquea la divisin del trofozoito hacia esquizonte. QuininaAlcaloide de la quinquina (derivado de la corteza de la quina)Va oral y parenteralVida media de 11 18 horasEleccin en malaria malignaAministracin lenta por cinchonismoMecanismo de accin igual que mefloquina

QinghaosuArtemisa annua (nombre cientfico)Medicina tradicional chinaArtemisinina y derivados: principales artesunato y artemeterVa oral y parenteralUltima esperanzaMecanismo de accin en discusin

Resistencia a los antimalricosMalaria por P. Vivax, no hay resistenciaEl problema es P. FalciparumDesde 1960 aparicin de resistencia En Per aparicin de resistencia primero a Cloroquina; luego fansidarEvaluacin se realiza con estudio in vivo30% de resistencia no se debe usar la droga

Zonas sin ResistenciaPrimera LneaCloroquinaDosis es 10 mg/Kg/da durante 2 das; el tercer da 5 mg/Kg/da Adultos 4 tabletas durante dos das; el tercer da 2 tabletasCloroquina baseSegunda LneaFansidarTableta 500 mg de sulfadoxina y 25 mg de pirimetamidaAdultos 3 tabletas dosis nicaNios en base a Sulfadoxina 25mg/Kg

Resistencia a FansidarPrimera LneaMefloquina + Artemisinina

Segunda LneaQuinina + Tetraciclina o Clindamicina

Resistencia a CloroquinaPrimera lneaFansidar

Segunda lneaAsociacin de drogasMefloquina 25 mg/Kg dosis nicaArtemisinina 10 mg/Kg/dia por 3 dasTercera lneaQuinina + Tetraciclina o ClindamicinaQuinina 10 mg/Kg/c 8hsTetra o clinda 10 mg/Kg/c 6-12 horasDurante 7 das

EpidemiologaEnfermedad tropical, en el Per se le encuentra en zonas tropicales y sub-tropicales: Tumbes, Piura, Amazonas, San Martn, Loreto, Ucayali, Selva del Cusco, de Apurimac, de Junn, de Hunuco y de Cajamarca.El mosquito Anpheles tiene varias especies en dichas zonas: A. macutipennis, A. oswaldoi, A. maculata, A. verticilata, etc.El vector se reproduce en lugares pantanosos o de aguas tranquilas, sombreadas y ventiladas.

Factores que favorecen su diseminacinEstablecimiento de los vectores en pantanos, aguas estancadas o riveras de aguas tranquilas.Presencia de vectores y reservorios.Clima, humedad y temperatura tropical.Poblacin en riesgo.Falta de educacin sanitaria especfica.Falta de fumigacin intradomiciliaria con insecticidas residualesPersonas portadoras en la poblacin.

ProfilaxisEliminar al vector.Usar mosquiteros y mallas en puertas y ventanas.Tratamiento de asintomticos u casos crnicos.Fumigacin intradomiciliaria cada 180 das.Educacin sanitaria especfica a la poblacin en riesgo.Si viaja a zonas endmicas, tomar medicamentos especficos cada 7 das (Aralen).

http://www.ncgr.org/microbe/pfalciparum.htmlhttp://www.sangre.ac.uk/Projects/P_falciparum/http://www.tigr.org/tdb/edb/pfdb/pfdb.htmlhttp://sequence-www.stanford.edu/group/malaria/index.htmlhttp://www.med-diagnostics.com/Consulte en Internet a:

Gracias por su gentil atencin

Documents

S.- Malaria 1