THE MALARIAL PARASITES

PROTOZOA

First animals

inner (endoplasm) and outer later of cytoplasm (ectoplasm)

PROTOZOA Contains an

cytostomes

mouth like opening

• use to ingest food

sexually and asexually

PROTOZOA Reproduce

• trophozoite (active and motile form);

• cyst (resting stage)

PROTOZOA

• 2 forms:

  • active and motile form

  • resting stage

FEMALE Anopheles MOSQUITO

Plasmodium spp. Grows by sexual reproduction in the

• aghe

• intermitent fever

• marsh fever

• fever

MALARIA aka

malaria

Plasmodium spp. Causative agent of

female Anopheles mosquito

MALARIA It is transmitted by the

Plamodium vivax

Benign Tertian Malaria

Plasmodium falciparum

Malignant Tertian Malaria

Plasmodium malariae

Benign Quartan Malaria

Plasmodium ovale

Benign Tertian Malaria

P. vivax, P. ovale

infect young RBCs

P. malariae:

infects old RBs

P. falciparum:

infects all age groups

P. falciparum, P. ovale, and P. vivax

Cycle repeats every 48 hours in

P. malariae

Cycle repeats every 72 hours in

9-14 days

P. falciparum

• incubation period

8-17 days

P. vivax

• incubation period

16-18 days

P. ovale

• incubation period

18-40 days

P. Malariae

• Incubation Period

Schüffner dots

• Small red dots

Plasmodium vivax

• Blood Smear

• stippling

Plasmodium vivax

• Has the widest distribution, Preferentially penetrates reticulocytes , Ring stage is large, usually single, prominent thicker chromatin

12-24 irregular grape-like clusters

Plasmodium vivax

• Number of merozoite

spherical or globular

Plasmodium vivax

• Gametocytes

Maurer’s cleft

• Large red spots

Plasmodium falciparum

• Blood Smear

• stippling

Plasmodium falciparum

• Most severe form of malaria,

• Ring stage is delicate and small with double chromatin and multiple rings

• crescent

• banana shape

Plasmodium falciparum

• Gametocytes 

Plasmodium malariae

• Blood Smear

• stippling

Ziemann’s Stippling

• few tiny dots

Plasmodium malariae

• Ring stage is similar to P. vivax but thicker,

• Schizont nearly fills red cell

Plasmodium malariae

• Gametocytes

• spherical or globular

Plasmodium ovale

• Blood Smear

• stippling

James dots

• numerous small red dots

Plasmodium ovale

• Schizont fils three quarters,

• Merozoites 6-14 fills three quarters

• spherical or globular

Plasmodium ovale

• Gametocytes

• Febrile paroxysm

• Anemia

• Splenomegaly

CLINICAL FEATURES

• The typical picture of malaria consists of

lasts for 15-60 minutes (intense cold and shivering)

FEBRILE PAROXYSM 

• Cold Stage min.

lasts for 2-6 hours

FEBRILE PAROXYSM

• Hot stage hrs.

FEBRILE PAROXYSM 

• Sweating Stage

• fever ends by crisis accompanied by profuse sweating

ANEMIA

Causes of anemia in malaria

• Destruction of large number of RBCs by complement mediated and autoimmune hemolysis

• Suppression of erythropoiesis in the bone marrow

• Antimalarial therapy in glucose-6-phosphate dehydrogenase (G6PD) deficient patients.

SPLENOMEGALY

• Enlargement of SPLEEN

CEREBRAL MALARIA

• This is the most common cause of death in malignant tertian malaria

• It is manifested by headache, hyperpyrexia, coma or confusion, and paralysis

ALGID MALARIA

• It resemble surgical shock with cold clammy skin, peripheral circulatory failure and profound shock. Patient may also develop vomiting and diarrhea or dysentery.

SEPTICEMIC MALARIA

It is characterized by a high degree of prostration, there is high continuous fever with involvement of various organs.

BLACK WATER FEVER

Patients with G6PD deficiency may develop this condition after taking oxidant drugs, even in the absence of malaria.

blood smear

The most common diagnostic test for malaria is the??

Thick

Blood smear

• is used for detecting, most importantly in early cases where there are less parasites.

Thin

Blood smear

• is used for identifying which specific specie is the cause of the disease.

Thin Film

Thick Film

Chloroquine

OLD DRUG OF CHOICE

• Uncomplicated malaria P. falciparum 

• Atovaquone + Proguanil

• Arthemeter + Lumefrantine

OLD DRUG OF CHOICE

• With chloroquine resistance:

• Blood stage: Chloroquine

• Liver stage (hypnozoite): Primaquine

OLD DRUG OF CHOICE

P. vivax and P. ovale

• Blood stage: 

• Liver stage (hypnozoite): 

• Arthemeter + Lumefrantine

DOH Revised Guideline on the Tx of Malaria 2009

• First line for confirmed uncomplicated and severe P. falciparum

• Quinine + Tetracycline

• Doxycycline

• Clindamycin

DOH Revised Guideline on the Tx of Malaria 2009

• If ALL combination is not available, whether the patient is conscious or unconscious Treatment failure 2nd line Treatment

• Artesunate suppository

DOH Revised Guideline on the Tx of Malaria 2009

• Severe Malaria, Patient is unconscious Facility: no capacity to manage the px

• Artermisinin-based combination therapy

DOH Revised Guideline on the Tx of Malaria 2009

• For all Plasmodium species and mixed infections

Chloroquine

PROPYLAXIS

• ATORVAquine

• PROQUANIL

Chloroquine

• if not sensitive here we use

MEFLOQUINE

IF traveles 

• we give