Download Presentation - The PPT/PDF document "MALARIA" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Presentation on theme: "MALARIA"— Presentation transcript:
Basic understanding of malaria
Malaria is a protozoan disease transmitted by the bite of
infected female Anopheles
Protozoan parasites of the genus
Severity of malaria
Severe may be fatal
Duration of intra
Average incubation period
up to 14 days
Man is the only important reservoir
Vector is female
Temperature: below 86º F, above 68º F
Rainfall: thrive in tropical areas
Altitude: rarely exist above 2000 meters
Terrain: coastal areas and lowlands with
lots of freshwater breeding sites
Transmission also possible through:
No absolute immunity
Partial immunity in areas of high
Immune complexes and mediators
After invading an erythrocyte, the growing malarial parasite progressively consumes and degrades intracellular proteins, principally hemoglobin.
The potentially toxic
is polymerized to biologically inert
, or malaria pigment.
The parasite also alters the RBC membrane by changing its transport properties, exposing cryptic surface antigens, and inserting new parasite-derived proteins.
The RBC becomes more irregular in shape, more antigenic, and less deformable.
infections, membrane protuberances appear on
the erythrocyte's surface toward the end of the first 24 h of the
asexual cycle. These “knobs” extrude a high-molecular-weight,
variant, strain-specific, adhesive protein
(PfEMP1) that mediates attachment to receptors on
capillary endothelium—an event termed
–infected RBCs may also adhere to uninfected
RBCs to form rosettes and to other parasitized erythrocytes
(agglutination). The processes of
agglutination are central to the pathogenesis of
malaria. They result in the sequestration of RBCs containing
mature forms of the parasite in vital organs (particularly the
brain), where they interfere with microcirculatory flow and metabolism.
, and P.
show a marked predilection
for either young RBCs (P.
) or old cells (P.
) and produce a level of
seldom >2%, P.
can invade erythrocytes of all ages and may be
associated with very high levels of
The specific immune response to malaria eventually controls the infection and, with exposure to sufficient strains, confers protection from high-level
and disease but not from infection.
As a result of this state of infection without illness (
is common among adults and older children living in regions with stable and intense transmission (i.e.,
Immunity is mainly specific for both the species and the strain of infecting malarial parasite. Both
immunity and cellular immunity are necessary for protection, but the mechanisms of each are incompletely understood
Most severe and prevalent
40-60% of cases
Widespread CHLOROQUINE resistance
Infects RBCs of all ages—Heavy
30-40% of cases
INFECTS YOUNG RBCs: LESS SEVERE THAN FALCIPARUM
INFECTS YOUNG RBCs
Can persist SUBCLINICALLY for extended periods of time
INFECTS OLD RBCs
Muscle Pain 60%
Palpable liver 33%
Palpable Spleen 28%
Nausea or vomiting 23%
Hypoglycemia: (<60 mg/dl)
Severe anemia (
< 21% or rapidly falling
High output vomiting or diarrhea
Gold standard: Multiple thick and thin smears
Dip stick tests
CHLOROQUINE sensitive infections:
CHLOROQUINE 600 mg (2 tabs) P.O. initially
300 mg (1 tab) in 6 hrs
300 mg (1 tab) QD for 2 days
Uncomplicated CHLOROQUINE-resistant infections:
Quinine 650 mg PO TID x 3 days and DOXYCYCLINE 100 mg PO bid x 7 days,
MEFLOQUINE 1000-1500 mg PO once
Complicated or severe
I.V. QUINIDINE or quinine
therapy should include
15mg PO QD x 14 days
CDC now recommends:
30mg PO QD x 14 days
WHO Guidelines For Malaria 2006
Treatment of uncomplicated malaria:
600mg ( 10mg/kg) followed by 300mg ( 5mg/kg) after 8 hours and then for next 2 days.( total dose 25mg/kg over 3 days)+
15mg (0.25mg/kg) daily for 14 days.
(2)Quinine 600mg (10mg/kg) 8 hourly for 7
100mg daily for 7
45mg(0.75mg/kg) single dose
0.75mg/kg single dose
(1)A75mg single dose
100mg BD for 3
750mg (15mg/kg) on 2
day and 500mg (10mg/kg) on 3
480mg twice daily for 3 days.
or Quinine 600mg (10mg/kg) 8 hourly for 7 days +
100mg daily for 7 days
100mg BD for 3
Treatment of severe and complicated
2.4mg/kg iv or
followed by 2.4mg/kg after 12 and 24 hours and then once daily for 7 days
day followed by 1.6mg/kg daily for 7 days
Or quinine loading dose: 20mg/kg and maintain 10mg/kg