Malaria

MALARIA
• 40% of the world’s population lives in endemic areas

• 3-500 million clinical cases per year
• 1.5-2.7 million deaths (90% Africa)
• increasing problem (re-emerging disease)
• resurgence in some areas
• drug resistance ( mortality)
• causative agent = Plasmodium species • P. falciparum

• protozoan parasite • P. vivax
• member of Apicomplexa
• P. malariae
• 4 species infecting humans
• transmitted by anopholine mosquitoes • P. ovale
Transmission
• sporozoites injected
with saliva
• enter circulation
• trapped by liver
(receptor-ligand)
Anopheles
Life Cycle
• sporozoites injected during
mosquito feeding
• invade liver cells
• exoerythrocytic schizogony
(merozoites)
• merozoites invade RBCs
• repeated erythrocytic
schizogony cycles
• gametocytes infective for
mosquito
• fusion of gametes in gut
• sporogony on gut wall in
hemocoel
• sporozoites invade salivary
glands
erythrocytic schizogony
• 48 hr in Pf, Pv, Po
• 72 hr in Pm
gametocytes
Clinical Features
• characterized by acute febrile attacks (malaria
paroxysms)
• periodic episodes of fever alternating with symptom-free
periods
• manifestations and severity depend on species and host
status
• immunity, general health, nutritional state, genetics
• recrudescences and relapses can occur over months or
years
• can develop severe complications (especially P.
falciparum)
How Malaria present Clinically
Stage 1
• Chills for 15 min to 1 hour
• Caused due to rupture from the host red
cells escape into Blood
• Preset with nausea, vomitting,headache
Stage 2
• Fever may reach upto 400c may last for
several hours starts invading newer red
cells.
Stage 3
• Patent starts sweating, concludes the
episode
• Cycles are frequently Asynchronous
• Paroxysms occur every 48 – 72 hours
• In P.malariae pyrexia may lost for 8 hours
or more and temperature my exceed 410c
Early symptoms
• The common first symptoms – fever, headache, chills
and vomiting – usually appear 10 to 15 days after a
person is infected. If not treated promptly with effective
medicines, malaria can cause severe illness and is often
fatal.
What are the characteristics of a
malaria attack
• Fever and shivering. The attack begins with

fever, with the temperature rising as high as
40ºC and falling again over a period of several
hours.
• A poor general condition, feeling unwell and
having headaches like influenza.
• Diarrhea, nausea and vomiting often occur as
well.
Diagnostic Tools
for Human Infections with
Malaria
• Blood film
examination
• Serology - IFA
• PCR
Blood collected with sterile
technique
Making the smears
Making of Thick smear
Thin and Thick smear
Appearance of Thick and Thin
Smears
Microscopy
• Malaria parasites can be identified by examining
under the microscope a drop of the patient's
blood, spread out as a "blood smear" on a
microscope slide. Prior to examination, the
specimen is stained (most often with the Giemsa
stain) to give to the parasites a distinctive
appearance. This technique remains the gold
standard for laboratory confirmation of malaria
How parasites appear
Antigen Detection Methods are
Rapid and Precise
Antigen Detection-
• Various test kits are available to detect antigens derived
from malaria parasites. Such immunologic
("immunochromatographic") tests most often use a
dipstick or cassette format, and provide results in 2-15
minutes. These "Rapid Diagnostic Tests" (RDTs) offer a
useful alternative to microscopy in situations where
reliable microscopic diagnosis is not available. Malaria
RDTs are currently used in some clinical settings
Serology
• Serology detects antibodies against malaria parasites,
using either indirect immunofluorescence (IFA) or
enzyme-linked immunosorbent assay (ELISA).
• Serology does not detect current infection but rather
measures past experience.
Newer Diagnostic methods
Molecular Diagnosis
• Parasite nucleic acids are detected using
polymerase chain reaction (PCR). This
technique is more accurate than microscopy.
However, it is expensive, and requires a
specialized laboratory (even though technical
advances will likely result in field-operated PCR
machines).
Treatment options in Malaria
• Most drugs used in treatment are active against the
parasite forms in the blood (the form that causes
disease) and include:
• Chloroquine
• Sulfadoxine-pyrimethamine (Fansidar®)
• Mefloquine (Lariam®)
• Atovaquone-proguanil (Malarone®)
• Quinine
• Doxycycline
• Artemisin derivatives (not licensed for use in the United
States, but often found overseas)

Malaria

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Malaria

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MALARIA

• 40% of the world’s population lives in endemic areas

• causative agent = Plasmodium species • P. falciparum

• Fever and shivering. The attack begins with

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