Blood Protozoa malaria

What is malaria

Parasitosis due to hematozoa of the genus Plasmodium

What is the parasite that causes malaria called

Plasmodium

Is it a metazoa or a Protozoa

Protozoa

How many reservoirs does it have

One reservoir

Human

What type of immunity we have and dont have agasint it

No natural immunity

Acquired immunity

How is this acquired immunity

Premonition

Build up over 5 years disappears in 1 to 2 years

What is the vector

Female anopheles

What does it need for fécondation

One blood meal

What plasmodium leads to malignant tertian fever 48h

Plasmodium falciparum

What is special about falciparum

It's the most widespread and dangerous, if untreated can lead to cerebral malaria

What can cause mild tertian fever

Plasmodium vivax

Plasmodium ovale

What can cause mild quartan fever 72h

Plasmodium malaria

What causes daily fever 24h

Plasmodium knowlesi

What type of Parasitosis is plasmodium knowlesi

Anthropozoonosis

How long is it's incubation

5 days

What fever does it cause

Daily fever 24h

What access doe this parasite like

Severe access of pulmonary tropism

All malaria from southeast Asia

Should be sent to a reference center

Why

Bc knowlesi is mainly in SE

How is the activity of the vector

Nocturnal

What are the two species of anopheles in Morocco

Anopheles labranchiae

Anopheles sergenti

How is the life cycle of plasmodium

Indirect or heteroxenous

How is the life cycle in humans

Asexual

Exo-erythrocytes cycle: Liver

Erythrocytes:RBC

How is the life cycle in the anopheles

Sexual (sporogonic)

How do you diagnose someone with malaria

Epidemiological guidance

Biological guidance

Clinical signs and symptoms

What to ask when you are assessing the epidemiological guidance

Travel in endemic areas

Length of stay

Type of stay

Origin of the patient

Place of stay

What are biological elements?

CBC

Thrombocytopenia++++

Hemolytic anemia

What are the clinical signs and symptoms?

We have alterations between fever, sweat, and chills

What are the two manifestations of malaria

Simple malaria access (acute disease)

Pernicious access/cerebral malaria

What is the simple malaria access also called

Primo-invasion access

What are the symptoms seen in simple malaria?

We have fever+++++

Chills and sweats

Headaches, myalgia, arthralgia

Digestive disorders : abdominal pain, nausea, +- vomiting,+-diarrhea

When do we think of acute malaria?

Any fever in a patient returning from an endemic area

Any fever must search for the notion of travel

How is the evolution in P falciparum?

Risk immediate pernicious malignant malaria

But no relapse more than two months after return

How is the evolution in other species?

Risk of revival access to subsequent periodic fever for 2 to 5 years

How is malignant cerebral malaria in children?

Brutal start

What about in adult?

It's progressive

What is pernicious malaria ?

It is a life-threatening complication and acute falciparum malaria

What is the manifestation of cerebral malaria

Fever and signs of severity in a subject with asexual forms of falciparum on blood examination

What is a severe complication caused by falciparum

Cyto-adherence

Slowdown of flow

What happens in cerebral malaria?

Infected RBCs with schhzonts aggregate in the capillaries of the brain and other internal organs

What is the result of the red blood cells infection

The infected red blood cells obstruct the blood vessels in the brain lead to local hypoxia, and the relief of toxic cellular products. Other vital organs can also be damaged often leading to the death of the patient.

What is severe malaria defined as?

Severe malaria is defined as a symptomatic malaria in a patient with falciparum with one or more of the complications

What are these complications?

Cerebral malaria: coma

Hypoglycemia

Acute renal failure (Blackwater fever)

Hemorrhagic syndrome, DIC

Acute pulmonary edema and adult respiratory distress syndrome

Parasitemia>4% of parasitized RBCs

For the biological test, what do we do?

CBC

Coagulation test

Blood ionogram

Creatinine

Urea

Blood glucose

Liver test

LDH

Etc.

How severe is severe malaria

It's a diagnostic and therapeutic emergency

What is the international recommendation for biological diagnosis of malaria?

Results should be returned within a maximum of two hours by contacting the clinician

What are the requirements for laboratory Diagnosis of malaria? 4

Is there plasmodium in the blood?

If yes, which species, and which parasitic stage

Is asexual stage what parasitic load

What is the deadline for the result?

Example of the steps

..

Is there a plasmodium in the blood?

Asexual forms of plasmodium in the blood

If yes, which species, and which parasitic stage

Throphozoites or schizonts of the p falciparum

If a sexual stage, what parasitic load?

Parasitemia>4%

What is the deadline for the result?

Less than two hours

What are the diagnostic tools used?

Drop thickness

Thin blood smear (species diagnosis)

Malaria antigen detection

QBC malaria

Gene amplification (PCR)

What is the one gold standard of laboratory diagnosis?

Microscopic examination on thin blood smear (FSM) and drop thickness (GE)

What tube do we use for blood collection

EDTA tube

This gold standard what is it used for for?

Parasite density

Species diagnosis

Monitoring response to treatment

How long does it take to realize the fast thick drop?

Less than 10 minutes

How long does it take to get the results?

Less than two hours

What is a good about it?

Better appearance of parasite

Fewer artifacts

Higher your measured Parasitemia

Inexperienced staff

What do we use to visualize the blood smear?

Optical microscopy

What does that allow to do?

Appreciate the appearance of the smear

The the infected red blood cells

The parasite

What are the three developmental stages seen in blood films?

Trophozoite

Schizont

Gametocyte

How is the shape of the infected RBC in knowlesi and falciparum

It's oval

How is the size of the infected RBC in knowlesi and RBC

It stays the same

Remember, we have normocytic anemia

What do you see in the cytoplasm of infected RBC in falciparum

Taches de Maurer

How does the parasite look after staining with_____?

The stain is GIEMSA

The cytoplasm looks blue

And we see one or more red nuclei

Brown pigments

How different are the stages

The size and arrangement of chromatin and cytoplasm and etcs

What is the RDT?

Malaria antigen detection

It's a rapid diagnostic test

What does it detect?

HRP2 in falciparum

Aldolase (common)

LDH parasitic (common9

Why is the RDT used?

Simple, easy to read

Mobile

No need for power supplies

What are the steps of this RDT 5 steps

We put 15 microliters gently distributed over the purple area

Then we deposit two drops of reagents A

We have migration of the motile phase

Deposit of four drops of reagent agents A for rinsing

Folding/Rinsing

When we have only falciparum +

Low Parasitemia <150/microliters

Parasitemia>150/microliters

When we have only falciparum + or confection with falciparum

Parasitemia > 150 microliters

When we have + at plasmodium other than falciparum

Parasitemia >150 microliter

In what parameters does RDTs detection antigen HRP2 meet the requirements of malaria diagnosis

Species diagnosis yes, +++some situations

Result in 15 mins <2h

In what parameters RDTs detection antigen HRP2 doesn't meet the requirements of malaria diagnosis

In performances< GE but better than FSM

For parasitic stages , no. But coupled with FSM yes

Parasitemia no, but if coupled with FSM yes

Price GEx30

What does this tell us

Never to be used alone

What else do we use in molecular biology?

PCR

What does PCR assess?

Species, diagnosis, and diagnosis of mixed infection

Correction of species identification

HRP2/GE antigen mismatch

Good exclusion test

What is PCR good for?

It's excellent for ruling out malaria

What are its limitations

No differentiation of parasitic stages

No quantification and no post therapeutic follow up

In what parameters does rt-PCR meet the requirements of malaria diagnosis

Performance>GE

Species diagnosis YESS +++ certain situations

Parasitemia yes in quantitative PCR

In what parameters dRT-PCR oesn't meet the requirements of malaria diagnosis

Parasitic stage, no can't detect gametocytes

Results>2h

Expensive

Monitoring of therapeutic efficacy and the rest better seen on slides

Are serological techniques useful for diagnosis

Not used

What treatment do we use for simple malaria access of falciparum

Artemether-lumefantrine and primaquine

What abt in cerebral malaria

Hospitalization in intensive care unit

Artesunate iv OR quinine iv

Monitoring of therapeutic efficacy: CBC and Parasitemia

What chemophylaxis use for short stay in endemic areas

Atovaquone-proguanil / follow 7 days after retour

What chemophylaxis use for low budget patients

Doxycyline for 4 weeks after retour

What chemophylaxis use for prolonged stay in endemic areas

Mefloquine for 3 weeks after retour

Rest in slides