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Clinical Features
characterized by acute febrile attacks
(malaria paroxysms)
periodic episodes of fever alternating with
symptom-free periods
Malaria Transmission
natural (sporozoites/Anopheles)
blood transfusions
shorter incubation period
fatality risk (P. falciparum)
no relapses possible (vivax/ovale)
syringe sharing
congenital
relatively rare although placenta is
heavily infected
Prodromal Symptoms
end of incubation period
2-3 days before 1st paroxysm
includes: malaise, fatigue, lassitude,
headache, muscle pain, nausea, anorexia
(i.e., flu-like symptoms)
can range from none to mild to severe
cold stage
feeling of intense cold
vigorous shivering, rigor
lasts 15-60 min
hot stage
intense heat
dry burning skin
throbbing headache
lasts 2-6 hours
sweating stage
profuse sweating
declining temperature
exhausted, weak sleep
lasts 2-4 hours
Malaria Paroxysm
paroxysms associated
with synchrony of
merozoite release
between paroxysms
temperature is normal
and patient feels well
falciparum may not exhibit classic paroxysms
continuous fever
24 hr periodicity
tertian malaria
quartan malaria
sweating
rigor
Immunity
slow to develop
short lived
premunition
non-sterilizing
lower parasitemia
less symptoms
Anti-Parasite Immunity
immune response prevents
merozoite invasion, eliminates
infected erythrocytes, etc.
Anti-Disease Immunity
eg., neutralization of exoantigens or toxic effects
Distribution of Malaria
P. falciparum
primarily tropics and subtropics
P. malariae
similar range as P. falciparum, but less
common and patchy distribution
P. ovale
occurs primarily in tropical west Africa
Malaria Epidemiology
Stable or Endemic Malaria
~constant incidence over several
years
Endemicity
Levels:
includes seasonal transmission
holo immunity and disease tolerance
hypercorrelates with level of endemicity
meso(especially adults)
hypo-
% Incidence
(smear/PCR)*
13% (2/8)
19% (4/11)
24% (8/11)
19% (0/14)
} 33% reported
symptoms
} no symptomatic
cases
Mosquito
Transmission
susceptibility of
anopheline species
feeding habits
density
longevity
climatic factors
temperature, humidity,
rainfall, wind, etc
Anopheles
Malaria Control
Reduce Human-Mosquito Contact
impregnated bed nets
repellants, protective clothing
screens, house spraying
Reduce Vector
environmental modification
larvacides/insecticides
biological control