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
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
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
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 )