NATURAL

HISTORY

OF

MALARIA

Parasite
Plasmodium falciparum

Plasmodium vivax

Plasmodium malariae

D E A T H

Plasmodium ovale curtesi

Plasmodium knowlesi

Plasmodium ovale walliker

(Protozoan Infection)

Chronic Complications

Splenomegally

Anemia

Acute Complications

Splenic artery rupture

Neurological Symptoms:

Fatal nephrotic syndrome

Generalized seizure

Coma

Vectors
Anopheles minimus flavirostris

Anopheles litoralis

Anopheles dirus

Anopheles gambiae

Anopheles minimus

Host

- Decrease level of consciousness, Ataxia, Speech difficulties

All age group

Cerebral malaria:

At risk: pregnant women and lactating mothers, infants, young children, elderly
Genetics

- Seizure, Opisthothonus

Malaria paroxysms

Duffy blood group: (-) P. vivax & (+) P. ovale

Pulmonary Symptoms:

Cold stage (15-60 min)

Blood Transfusion

(hypothermia, mild shivering, feeling of apprehension, violent teeth chattering, vomiting, febrile convulsion in children

Acquired Immunity
Non-immune traveller
Clinical Horizon

Migration
Socioeconomic status: People living in remote area & Lacking access to medical services
Human activities:

Continuous erythrocytic schizogony

Going out at night, Night time occupation, Agricultural works, & Raising domestic animals
Immunosuppression

Environmental
Living in endemic area
People living in remote area
Lacking access to medical services
People living in tropical and sub-tropical regions
Shaded margins of clear fresh water stream
Foot hills and mountainous areas
Rainy season
Rural areas
Water resources development
Irrigations
Dams
Creeks

Malarial endotoxin

Parasite antigen

Macrophage

Pyrogenic cytokines

Entry to erythrocytic cycle and undergo asexual

multiplication

- Pulmonary edema, ARDS, Pneumonia

Cardiovascular Circulatory Symptoms
- Hyperparasetemia, Septicemia, Massive haemolysis,
Electron dense knobs and PfEMP-1, Cardiovascular collapse

Hot stage (2-6 hours)

( temperature to 41C, vasodilation, headache,
palpitation, tachypnea, epigastric pain, thirst,
nausea & vomiting, confusion & delirium,
flushed & hot skin)

Thrombocytopenia, Shock
Hypoglycemia:
- Decerebrate and Decorticate, Metabolic Acidosis
Urinary Symptoms:
- ARF, Hemoglobinuria (Blackwater disease)

TNF

Sweat stage (2-4 hours)

IL-6

IFN y

(defervescence and diaphoresis, lowering of

temperature, cessation of symptoms)

Hepato-billary Symptoms:
- Jaundice

Infects RBC via expression of Reticulocyte-binding protein homologue 5 that binds to CD147 of red blood cells

Entry to Exoerythrocytic cycle

Inoculation of sporozoite in
the blood stream

Carried to the liver

Infects liver cell

Development into schizont

Schizont produce daughter merozoite

Swelling of infected liver cell & bursting

Release of merozoite into the blood stream

P. ovale & P. vivax merozoites reinvade

Enters Ring stage and develops into trophozoite

Trophozoite further divides to form merozoites

Parasite feed on haemoglobin producing hematin

Schizont rupture and release merozoite

Some parasite differentiate into gametocytes

Recovery

hepatocytes and forms hypnozoites and

become dormant

Man bitten by infected anopheles mosquito: Injects Sporozoite

PREPATHOGENESIS PERIOD

HEALTH PROMOTION

Health education and public awareness

Good standard of environmental sanitation

Attention to behavior in the environment

S P E C I F I C

Genetics

Periodic selective examinations

Jaymee B. Quindara

EARLY DIAGNOSIS

Indoor residual spraying

Using insect repellants

Active case findingfebrile cases

Chemoprophylaxis

Passive case findingSurvey

Slide Positivity Rate

Mefloquine (250mg once a week for 4 weeks)

Doxycycline (100 mg daily for 4weeks)

Chloroquine (150 mg bid for 4 weeks )

Zooprophylaxis

Biological control (Larvivorous fish, Bacillus thorengensis &

sphaericus, Fungi)

Use of environmental sanitation

Protection against occupational hazards

Wearing of light-colored clothing

Covering most of the body

Avoidance of night-time activities

Niki Angeli I. Tabaniag

PROMPT TREATMENT

D I S A B I L I T Y

Case finding

AND

PRIMARY PREVENTION
Lindfonn Eunice F. Querubin

P R O T E C T I O N

Use of insecticide treated nets

Provision of adequate housing and protection

P E R I O D

First Line

Artemether/ Lumefantine (80 mg/day)

Gametocidal

SPR= Number of + / Number of Examined

Primaquine (15mg)

Microscopic exam of peripheral Blood smear

Quinine (10mg/kg tid for 7 days)

Spleen rate and infant parasite rate in endemic areas

Tetracycline(4 mg/kg qid for 7 days)

Chloroquine (initial: 600 mg/day then 300 mg/day)

Rapid Diagnostic Test

Serology

P R E V E N E T I O N

P A T H O G E N E S I S

L I M IT A T I O N

Schizontocides

R E H A B I L I T A T I O N

Special Cases:

Chloroquine (initial: 600 mg/day then 300 mg/day)

Quinine (600 mg tid)

Mefloquine (20 mg/ kg tid)

Hypnozonticidal (Anti-relapse)

PCR, ELISA, Immunoflourescent assay

S E C O N D A R Y

O F

Primaquine

Provision of proper referral system to appropriate facilities

Chloroquine (initial: 600 mg/day then 300 mg/day)

Education of the public and industry to utilize the rehabilitated

Pyrimethamine/Sulfadoxine (25/500 mg)

As full employment as possible

Trainings for Medical Technologist and other allied healthcare providers for proper detection of new cases

Improve microscopic detection of malarial parasite

For pregnant women

Multi-Drug Resistant

Artesunate-Mefloquine (25/50mg)

Artemether-Lumefrantine (80 mg/day)

Drug for Complicated cases

Quinine oral (200 mg)

Quinine parenteral (150 mg)

T E R T I A R Y

P R E V E N T I O N
Nelia P. Salazar Ph.D.