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BLOOD PARASITES PLASMODIA/ BABESIA

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Presentation on theme: "BLOOD PARASITES PLASMODIA/ BABESIA"— Presentation transcript:

1 BLOOD PARASITES PLASMODIA/ BABESIA
WINIFREDA U. DE LEON

2 SPECIES PLASMODIUM FALCIPARUM PLASMODIUM VIVAX PASMODIUM MALARIAE
PLASMODIUM OVALE PLASMODIUM KNOWLESI

3 ARTHROPOD -BORNE ANOPHELES MOSQUITOES A. MINIMUS FLAVIROSTRIS HABITAT IN MAN – RBC HIGH OXYGEN TENSION COMPONENTS: NUCLEUS (CHROMATIN) CYTOPLASM

4 ON THE MOSQUITO VECTOR SLOW FLOWING CLEAN STREAMS FOOTHILLS EXOPHAGIC
NIGHT BITER SLOW FLOWING CLEAN STREAMS FOOTHILLS EXOPHAGIC ZOOPHILIC

5 FORESTED AREAS- CLEAN SLOW FLOWING STREAMS

6 LIFE CYCLE SCHIZOGONY ASEXUAL MULTIPLICATION
END PRODUCTS – SCHIZONTS (MEROZOITES) OCCURS IN MAN GAMETOGONY GAMETOCYTES SPOROGONY SEXUAL MULTIPLICATION END PRODUCTS – OOCYSTS (SPOROZOITES) OCCURS IN MOSQUITOES

7 ASEXUAL STAGES TROPHOZOITES YOUNGEST - RINGFORMS DEVELOPING MATURE
SCHIZONTS EARLY MATURE - MEROZOITES

8 TROPHOZOITES

9 SCHIZONTS

10 RED CELL DEFENSES CELL MEMBRANE DUFFY Ag NULL – RESISTANCE TO P. VIVAX
HEMOGLOBIN -HEMOGLOBIN S (SICKLE TRAIT) HELPS IN THE SURVIVAL OF PATIENTS FROM P. FALCIPARUM PRIMARY ACUTE ATTACK -B-THALLASEMIA- IMBALANCED GLOBIN CHAIN PROD’N OXIDATION BY HEMICHROMES (REACTIVE O2) G6PD PREVENTS OXIDATION OF THE HEME GROUP DEFICIENCY – GENERATION OF REACTIVE O2 ACCUMULATES IN THE RBC DAMAGES P. FALCIPARUM

11 VIRULENCE FACTORS RUPTURE OF SCHIZONTS RELEASE OF MEROZOITES:
MONOCYTES – TNF (PYROGENIC) OTHER CYTOKINES GLYCOSYLPHOSPHATIDYL INOSITOL (GPI) KNOBS – CYTOADHESION (PfEMP) HISTIDINE RICH PROTEIN (HRP)

12 MULTI-ORGAN INVOLVEMENT
GASTRO-INTESTINAL DIARRHEA, ABD PAIN, NAUSEA, VOMITING, ANOREXIA RESPIRATORY DYSPNEA NON PRODUCTIVE COUGH

13 FEVER PERIODICITY COINCIDES WITH RUPTURE OF SCHIZONTS
INITIAL INFECTION – ASYNCHRONOUS AFTER 5- 7 D - SYNCHRONOUS PF – EVERY 40 HOURS PV & PO - EVERY 48 HOURS PM - EVERY 72 HOURS

14 PATHO-PHYSIOLOGY DESTRUCTION OF RED BLOOD CELL (INFECTED/ UNINFECTED)
PRODUCTION OF CYTOKINES - TUMOR NECROTIC FACTOR (TNF) FEVER, HYPOGLYCEMIA, ARDS SEQUESTRATION IN DEEP VASCULATURE OF INTERNAL ORGANS (RBC RECEPTORS) - INTRACELLULAR ADHESION - VASCULAR ADHESION

15 HEMATOLOGIC CHANGES ANEMIA LEUKOPENIA THROMBOCYTOPENIA
SUPPRESSED HEMATOPOIESIS RETICULOCYTES REDUCED SERUM IRON DEFECTIVE BLOOD CELL MATURATION

16 PATHO-PHYSIOLOGY SEVERE MALARIA
HYPOGLYCEMIA LOW SERUM SODIUM MALABSORPTION (FATS, XYLOSE, VIT B 12 PULMONARY EDEMA CNS DYSFUNCTION ( COMA) ELEVATED BUN, CREATININE, PROTEINURIA

17 MALARIA OCCURS IN TROPICAL/ SUBTROPICAL COUNTRIES
M CASES ANNUALLY M DEATHS 10 LEADING CAUSES OF MORTALITY

18 MALARIA FIRST FEW DAYS: STEADY LOW GRADE FEVER HEADACHE PHOTOPHOBIA
MYALGIA ANOREXIA NAUSEA/ VOMITING

19 REGULAR CYCLE CLASSIC: CHILLS FEVER SWEATING SPLENOMEGALY ANEMIA
JAUNDICE

20 CAUSES OF ANEMIA HEMOLYSIS SPENIC REMOVAL OF RBC FROM CIRCULATION
AUTO-IMMUNE LYSIS DECRASED INCORPORATION OF IRON INTO HEME BONE MARROW DEPRESSION

21 MALARIA - PHILIPPINES 65-70% P. FALCIPARUM – MALIGNANT
30% P. VIVAX – BENIGN TERTIAN 1% P. MALARIAE - QUARTAN

22 FALCIPARUM MALARIA INVADES ALL AGES OF RBC
SEQUESTRATION IN INTERNALORGANS ISCHEMIA LIVER – ABDOMINAL PAINS JAUNDICE LUNGS – PULMONARY EDEMA KIDNEYS - BLACKWATER FEVER- HEMOGLOBINURIA CEREBRAL INVOLVEMENT

23 COMPLICATED COMA CONVULSIONS HYPOGLYCEMIA ACIDOSIS
RESPIRATORY DISTRESS ALGID (CIRCULATORY COLLAPSE, SHOCK & SEPTICEMIA) HYPER-PARASITEMIA

24 CEREBRAL MALARIA

25 VIVAX MALARIA LESS SEVERE RELAPSES OCCUR AFTER WEEKS OR MONTHS
INVADES ONLY RETICULOCYTES LOW ALBUMIN/ ELEVATED GLOBULIN INCREASED SERUM POTASSIUM

26 MALARIAE MALARIA INVADES OLDER RBC LONGER INCUBATION PERIOD
NEPHROTIC SYNDROME – DEPOSITION OF IMMUNE COMPLEXES LATENT INFECTION FOR MANY YEARS

27 WHO ARE AT RISK? THOSE IN ENDEMIC PLACES CHILDREN PREGNANT WOMEN
SPONTANEOUS ABORTION CONGENITAL INFECTIONS LOW BIRTH WEIGHT PRE-TERM DELIVERY PERI-NATAL DEATH TRAVELERS BLOOD RECIPIENTS- TRANSFUSION

28 PHILIPPINES 14.8% AT RISK SOLDIERS FARMERS INDIGENOUS CULTURAL GROUPS
MINERS FOREST WORKERS 65/ 79 PROVINCES 8TH LEADING CAUSE OF MORBIDITY

29 SOLDIERS/ FORESTERS SCOUT RANGERS LOGGERS

30 MALARIA FREE AKLAN GUIMARAS BILIRAN ILOILO BOHOL LEYTE
CAMIGUIN LEYTE DEL SUR CAPIZ N/ SAMAR CATANDUANES SIQUIJOR CEBU

31 HIGHLY ENDEMIC PLACES PALAWAN KALINGA-APAYAO IFUGAO AGUSAN DEL SUR

32 DIAGNOSIS CLINICAL – MIMIC DISEASE GASTROENTERITIS PNEUMONIA
MENINGITIS HEPATITIS ENCEPHALITIS DENGUE TYPHOID TRAVEL Hx

33 LABORATORY Dx BLOOD SMEARS THICK/ THIN STAIN WITH WRIGHT’S OR GIEMSA
FLOURESCENT STAINING (QBC) SEROLOGY: ANTIBODY DETECTION: IFAT ELISA ANTIGEN DETECTION : RAPID DIAGNOSTIC TESTS (RDT’S) HRP II LDH PCR

34 BLOOD SMEARS THICK/ THIN

35 TREATMENT NON FALCAPARUM: CHLOROQUINE ORAL UNCOMPLICATED FALCIPARUM
QUININE ORAL FANSIDAR (SULFADOXINE PYREMETHAMINE) PRIMAQUINE – HYPNOZOITES/ GAMETOCYTES CHECK FOR G6PD DEFICIENCY ARTEMISININ (QINGHAOSU) CO-ARTEM COMPLICATED MALARIA – HOSPITALIZE (IV MEDICATION) PROPHYLAXIS – CHLOROQUINE PROGUANIL

36 P. FALCIPARUM P.VIVAX P.MALARIAE ASEXUAL 36-40 HRS 48 HRS 72 HRS
DISEASE INCUBATION MALIGNANT DAYS BENIGN 10-17 DAYS QUARTAN 18-40 DAYS INFECTED RBC NORMAL & ENLARGED SIZE ENLARGED NORMAL SIZE PIGMENTS MAURER’S CLEFTS SCHUFFNER’S DOTS ZIEMANN’S DOTS

37 P. FALCIPARUM P. VIVAX P.MALARIAE RINGS 1/5 1/3 TROPHOZOITES NOT IN THE CIRCULATION AMEBOID CYTOPLASM BAND/BASKET OR BIB FORMS SCHIZONTS (NO. OF MEROZOITES) 12- 36 AVE-24 12-24 AVE 16 6-12 AVE -8 GAMETOCYTES BANANA SAUSAGE CRESCENT SPHERICAL

38 PLASMODIUM FALCIPARUM RINGS

39 PLASMODIUM FALCIPARUM GAMETOCYTES

40 PLASMODIUM VIVAX

41 PLASMODIUM VIVAX RINGS

42 PLASMODIUM VIVAX DEVELOPING TROPHOZOITES

43 PLASMODIUM VIVAX SCHIZONTS

44 PLASMODIUM MALARIAE

45 PLASMODIUM MALARIAE BANDFORM

46 PLASMODIUM MALARIAE SCHIZONTS

47 PREVENTION Mosquito nets Clean clothing

48 CONTROL

49 BABESIA- PIROPLASMA BLOOD PARASITES THAT CAUSES HEMOLYSIS
B. MICROTI USA B. DIVERGENS - EUROPE TICK-BORNE – IXODES spp LYME DISEASE BLOOD TRANSFUSION

50 BABESIOSIS -PIROPLASMOSIS
MANIFESTATIONS IRREGULAR FEVERS CHILLS SWEATING PAIN/ MALAISE LETHARGY SEVERE CASES HEMOLYTIC ANEMIA JAUNDICE SHORTNESS OF BREATH HEMOGLOBINURIA

51 HIGH RISK IMMUNO-SUPPRESSED ELDERLY CO-INFECTION WITH LYME DISEASE
COMPLICATIONS ACUTE RESPIRATORY FAILURE CONGESTIVE HEART FAILURE PULMONARY EDEMA RENAL FAILURE

52 DIAGNOSIS BLOOD SMEAR EXAMINATION IFAT ANIMAL INOCULATION - GERBILS

53 TREATMENT CLINDAMYCIN ORAL/ IV WITH QUININE ATOVAQUONE - ORAL
AZITHROMYCIN - ORAL


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