case 3.2 (malaria)

case 3.2 (malaria)Presenter: Arwa Hussain Al-Onayzan.ID: 215007943.Serial number: 66.

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Our caseA 17-year-old women admitted to hospital after returning from vacation in Malawi.She didnt take preventing measures regarding malaria.3 days after returning she had cold shiver, headache, dry cough, lost weight and her stools became loose.Upon admission, she was ill, pale and slightly confused.Her lab test showed she had P. falciparum infection.She was treated with artemether and lumefantrine.

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Learning objectives:Definition of malaria and types of malaria parasites.Epidemiology of malaria.Risk factor of malaria.Life cycle of malaria.Incubation period of the parasite.Pathophysiology of malaria.Signs and symptoms of malaria.Laboratory diagnosis of malaria.Treatment and prevention of malaria.Complication of malaria.

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Definition of Malaria and type of malaria parasite Is an infection of liver and RBCs caused by protozoan parasites of the genus plasmodium.

Malaria is caused by 5 species of plasmodium:P. falciparum (the most common and dangerous).P. vivax.P. ovale.P. malaria. P. knowlesi.

Malaria Is febrile dieases that mean having or showing the symptom of a fever.4

Epidemiology of malariaMalaria is widely distributed in tropics and subtropics of Africa, Asia and Latin America.Malaria affecting 400 million people word-wide.Malaria causing 2 million death each year.

speciesDistributionP. falciparumWest, East and central Africa, Middle East, Far East, South America.P. vivaxIndia, North and East Africa, Far East, South America P. ovaleTropical Africa, India, Far EastP. malariaTropical Africa.

In spite of intensive control measures, malaria remains widely distributed in tropics and subtropics of Africa, Asia and Latin America.

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What do you think about the risk factor of malaria?

Risk factors of malaria Living or traveling in a region where malaria is present.

Traveling to area where malaria is common:

- Without taking medicine to prevent malaria.- Being outdoors, especially in rural areas.- Not taking steps toprotect yourself from mosquito bites.

Pregnant women. Children under 5 years of age. Patients with HIV/AIDS.

#Pregnant womenare more likely than nonpregnant women to get severe malaria, because the immune system is suppressed duringpregnancy.#People who have lowered immunity. Patients with HIV/AIDS.

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Life cycle of malaria

Microbiology 3th book by Richard A. Harvey.

In P. ovate and P. vivax infection, some sporzites remain dormant as Hypnozoites in the parechymal cells, only starting the process of schizogony.8

Life cycle of malaria

Incubation period of the parasitespeciesIncubation period (Liver cycle)P. falciparum7-14 daysP. vivax12-17 days ( with relapse up to 3 years)P. ovale 9-18 days ( with relapse up to 20 years)P. malaria13-40 days.

Malaria is an acute febrile illness with an incubation period of 7 days or longer. Thus, a febrile illness developing less than 1 week after the first possible exposure is not malaria.The incubatin period of P.falciparum is the shortest of all the plasmodia, ranging from 7 to 10 daysthe incubatin period of P.malariae is the longest of the plasmodia, usually 18 to 40 days

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ConThe time between the fever episodes can be characteristics of the infecting plasmodium species.

speciesDuration of fever (erythrocytic cycle)P. falciparum36-48 h, Malignant tertian malaria.P. vivax48h, Benign tertian malaria.P. ovale48h, Ovale tertian malaria.P. malaria72h, Quartan malaria.

Pathophysiology of malariaShowers of new merozoites are released from the RBCs at intervals of approximately 48h for P.vivax, P.ovale and P.falciparum and 72h for P.malaria. The episodic shaking, chills, and fever coincide with this release.

The parasites destroy large numbers of infected RBC, thereby causing a hemolytic anemia.

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Pathophysiology of malariaA characteristic brown malaria pigment derived from hemoglobin, called hematin is released from ruptured RBCs and produces discoloration of the spleen, liver, lymph nodes and bone marrow.

Activation of defense mechanisms in the host leads to a marked hyperplasia of mononuclear phagocytes, producing massive splenomegaly and occasional hepatomegaly.

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What do you think about the signs and the symptoms of malaria?

Signs and symptoms of malariaCycles of shaking chills followed by fever and profuse sweating.Hemolytic anemia. Jaundice.Dark pigmented urine (blackwater fever)Stools became increasingly loose. Hepatomegaly.Splenomegaly.Headache. Dry cough. Lost weight.

The liver and spleen enlarge as fixed the fixed phagocytic cells which pick up large amount of debris from the destroyed RBCs# Dark pigmented urine (blackwater fever) from erythrocyte destruction.#Aneamia and jaundice due to erythrocyte destruction.#Cycles of shaking chills followed by fever and profuse sweating.

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Diagnosis of malaria1) Medical history.2) Physical examination.3) Laboratory diagnosis:

MicroscopyImmunological techniquesMolecular techniques

1- Films of blood (Thick and thin blood smear study).

2- Quantitative Buffy Coat (QBC) test.1- Antibody-based techniques(serologic tests):Indirect fluorescent antibody test (IFAT)Enzyme- linked immunosorbent assay (ELISA)2- Antigen-based techniquesRapid Diagnostic Tests (RDTs)Polymerase Chain Reaction (PCR)

1) Medical history: in order to make a malaria diagnosis, the doctor may ask a number of questions concerning: 1 Current symptoms 2 Medical conditions 3 Family medical history 4. Current medications 5. Recent travel history.# Amalaria diagnosis can be difficult to make, especially in areas where malaria is not very common. A number of other conditions share similar symptoms with malaria. Some of these conditions the healthcare provider will consider before diagnosing malaria include: The flu(influenza) Common cold Meningitis Typhoid fever Dengue fever Acute schistosomiasis(disease caused by worms Bacteremia/septicemia(infection in blood) Hepatitis Viral gastroenteritis(stomach flu) Yellow fever(disease typically transmitted by mosquitoe).2) Physical examination: will based on the symptos of the malaria. The doctor may chick the eye. Palpate the lever and spleen. 3) Laboraty diagnosis:

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P. FalciparumP. VivaxP. Malaria P. OvateQuinine, Mefloquin, Sulfadoxine and Pyrimethamine. Chloroquine With primaquine.

Treatment of malariaTo treat Malaria we most understand 2 concept:

The geographic pattern of susceptibility of P. Falciparum to antimalarial drugs.The type of plasmodium species causing the infection.

Chloroquine-sensetive areasChloroquine-resistant areas Chloroquine.

# with other types we used primaquine to kill the parasite in the liver and to prevent relapse.# we used chloroqine to kill the malaria.17

Prevention of malaria1- Prevent mosquito bite by:Covering the limbs.Using insects repellents.Sleeping under mosquito nets.Stagnant water should be avoided.

2- Chemical prophylaxis for travelers:When you traveling to area:Without chloroquine resistance: chloroquine is used.With chloroquine resistance: melfloquine or doxycycline may be used.

Complication of malariaspeciesMajor complicationP. falciparumCerebral malaria, haemolytic anaemia (blackwater fever), jaundice, hypoglycaemiaP. vivaxRelapse due to liver hypnozoites.P. malariaNephrotic syndromeP. OvateRelapse due to liver hypnozoites

Cerebral malaria; the high level of parasitaemia lead to the schizont-containing erythrocytes blocking brain capillires. The resulting hypoxia causes confusion, coma and death.

Cerebral malaria.If parasite-filled blood cells block small blood vessels to your brain (cerebral malaria), swelling of your brain or brain damage may occur. Cerebral malaria may cause coma.Breathing problems.Accumulated fluid in your lungs (pulmonary edema) can make it difficult to breathe.Organ failure.Malaria can cause your kidneys or liver to fail, or your spleen to rupture. Any of these conditions can be life-threatening.Severe anemia.Malaria damages red blood cells, which can result in severe anemia.Low blood sugar.Severe forms of malaria itself can cause low blood sugar, as can quinine one of the most common medications used to combat malaria. Very low blood sugar can result in coma or death.

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CNSCerebral malaria(coma, convulsions)Renal* Hemoglobinuria (black water fever)*Oliguria*Acute renal failure

Blood*Severe hemolytic anemia.*DIC(Disseminated intravascular coagulation).*ARDS

Metabolic*Hypoglycemia.*Metabolic acidosis

Gastrointestinal /liver*Diarrhea.*Jaundice.*Splenic rupture.Other*Shock-hypotention.*Hyperpyrexia.Complication of malaria

Disseminated intravascular coagulation(DICAcute respiratory distress syndrome(ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs)20

SummaryMalaria is an infection of liver and RBCs.

Caused by 5 different species of plasmodium.

Malaria is one of the most serious problems.

Symptoms: Fever( which may be periodic), chills, sweeting, hemolytic anemia and splenomegaly.

Diagnosis is by seeing plasmodium in a peripheral blood smear.

Treatment and prophylaxis depend on the species and drug sensitivity.

Any Question?

ReferenceThe Merck Manual of Diagnosis & Therapy, page 1540.Medical Microbiology book Murray 7th, page 765.Clinical Microbiology made ridiculously simple book 3th ( p.240-244).Medical Microbiology made memorable (p.80).Microbiology Lippincott's Third Edition (P.221-222)