1. Malaria Dept. of Infectious Disease Shengjing Hospital CMU

2. Definition Definition  Malaria is a parasitosis caused by plasmodia.  It is transmitted to human by the mosquito.  Clinical feature: cyclic chill, high fever & profuse sweating. In chronic illness, there are anemia & splenomegaly.

3. Etiology Etiology  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

4. Etiology Etiology  Tachysporozoite  Bradysporozoite  Merozoite  Sporozoite  Parasitemia

5. Etiology Etiology  Two 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

6. Life cycle of the malaria parasite mosquito microgametocyte zygote oocyst sporozoite Blood stream tachysporozoite merozoite maturerupture Bradysporozoite Blood stream reenter phagocyte merozoite trophzoite shizont mature release merozoite gametocyte Erythrocytic phase Exoerythrocytic stage human

10. Epidemiology  Source of infection Patient, parasite carrier  Route of transmission  female mosquito biting person  blood transfusion  Susceptibility:  universal susceptibility  no-cross-immunity  re-infection  Epidemic features:  sporadic or endemic, tropic or subtropic

11. Pathogenesis Pathogenesis  Mechanism of attack  merozoite  RBC rupture malaria pigment  products of metabolism   blood stream allergy  P. Faciparam: produce microvascular disease  magnitude of the parasitemia & age of patient  no specific Ab or cell -mediated response

12. Pathology Pathology  Anemia:  P. Vivax - retiform RBC  P. Malariae - mature RBC  P. Falciparum - every RBC  Prolifeation of mononuclear phagocyte  hepatomegaly  splenomegaly  Cerebral edema & congestion

13. Clinical manifestation Clinical manifestation Incubation period: quartan malaria: 24-30 day tertian malaria: 13~15 day malignant malaria: 7~12 day

14. Clinical manifestation  Typical attack  Chill: abrupt onset, shivering, pale face,cyanosis. Last 10 min or 1~2hr.  High fever: T rise to 40 o C with malaise, myalgia, thirsty. Last 2~6 hr.  Sweating: profuse sweating with restlessness  regular 48 hr. or 72 hr. Cycle

15. Clinical manifestation  Sings  anemia  splenomegaly  hepatomegaly, ALT elevate

16. Clinical manifestation  Pernicious attack: caused by P. Falciparum  cerebral malaria  high fever, headache, vomiting, convulsion delirium, respiratory failure  hyperpyrexia type  T> 42 0 C, convulsion, delirium  Relapse: early relapse - <3m,  later relapse - >6m

17. Clinical manifestation  Malaria caused by transfusion  incubation period: 7~10 day  no exoerythrogenic phase, no relapse

18. Complications Complications  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

19. Laboratory Findings Laboratory Findings  Blood picture: decrease in RBC & Hb  blood film for parasite  serological examination  ELISA for P. antigen  DNA hybridization

20. Diagnosis Diagnosis  Epidemiological data  endemic zone  blood transfusion  Clinical manifestation  Laboratory findings  Diagnostic treatment:  chloroqunine for 3 days

21. Differential Diagnosis Differential Diagnosis  Typhoid fever  Septicemia  Leptospirosis  Encephalitis B

22. Treatment Treatment  Anti-malarial drugs  Chloroquine-susceptable infection  chloroquine : 1g /d, for 3 day, p.o.  primaquine: for 8day, p.o.  Chloroquine-resistant infection  mefloguine:  artemisinine

23. Treatment Treatment  Pernicious 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 )

24. Prevention Prevention  Drug prophylaxis  chloroquine: 0.3g once a week  doxycycline  Kill mosquito  Vaccination