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Malaria Dept. of Infectious Disease Shengjing Hospital CMU 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. 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 Etiology Tachysporozoite Bradysporozoite Merozoite Sporozoite Parasitemia 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 Life cycle of the malaria parasite zygote oocyst sporozoite microgametocyte Blood stream gametocyte tachysporozoite Bradysporozoite mature mosquito rupture merozoite merozoite mature release reenter human shizont merozoite trophzoite Blood stream phagocyte Exoerythrocytic stage Erythrocytic phase 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 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 Pathology Anemia: P. Vivax - retiform RBC P. Malariae - mature RBC P. Falciparum - every RBC Prolifeation of mononuclear phagocyte hepatomegaly splenomegaly Cerebral edema & congestion Clinical manifestation Incubation period: quartan malaria: 24-30 day tertian malaria: 13~15 day malignant malaria: 7~12 day Clinical manifestation Typical attack Chill: abrupt onset, shivering, pale face,cyanosis. Last 10 min or 1~2hr. High fever: T rise to 40oC with malaise, myalgia, thirsty. Last 2~6 hr. Sweating: profuse sweating with restlessness regular 48 hr. or 72 hr. Cycle Clinical manifestation Sings anemia splenomegaly hepatomegaly, ALT elevate Clinical manifestation Pernicious attack: caused by P. Falciparum cerebral malaria high fever, headache, vomiting, delirium, respiratory failure hyperpyrexia type T> 420C, convulsion, delirium Relapse: early relapse - <3m, later relapse - >6m convulsion Clinical manifestation Malaria caused by transfusion incubation period: 7~10 day no exoerythrogenic phase, no relapse 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 Laboratory Findings Blood picture: decrease in RBC & Hb blood film for parasite serological examination ELISA for P. antigen DNA hybridization Diagnosis Epidemiological data endemic zone blood transfusion Clinical manifestation Laboratory findings Diagnostic treatment: chloroqunine for 3 days Differential Diagnosis Typhoid fever Septicemia Leptospirosis Encephalitis B 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 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 ) Prevention Drug prophylaxis chloroquine: 0.3g once a week doxycycline Kill mosquito Vaccination