MALARIA

PRESENTOR:
NURDEZA N PUNTUKAN
JAY G. CAYA
BSMT-4A

reference
The Diagnosis of Malaria by_Norman Moore,

PhD_Director of Medical Affairs (ppt)

wikipedia

OBJECTIVES
To be able to know what is:

Malaria
2. Diagnostic test in determining malaria.
3. Treatment
4. Prevention
1.

TABLE OF CONTENTS
Malaria
Vector
Classification of malaria
Signs and symptoms
Diagnosis

Malaria
Is a mosquito-borne infectious disease of human

and other animals caused by parasitic protozoan's

belonging to the genus plasmodium.
Malaria is one of the major causes of preventable
death in the world today. It affects more than 500
million people worldwide and causes 1 to 2 million
deaths every year.

Vector
The disease transmitted most commonly by an

infected female anopheles mosquito.

The mosquito bite introduces the parasites from the
mosquito saliva into a person blood.
The parasites travel to the liver where they mature
and reproduce .Five species of plasmodium can
infect and be spread by humans.

Classification of Malaria
Most deaths are caused by P.falciparum because

P. vivax, P. ovale and P. malariae cause

generally cause a milder form of malaria and the
P.knowlesi rarely causes disease in humans.

Signs and symptoms

Diagnosis
The diagnosis of malaria may in fact into two ways :
Direct diagnosis: direct demonstration of the
parasite whole cell or of parasites nucleic acid or
products in the blood
Indirect Diagnosis: the demonstration of the
patients immune response to the infection
(immunodiagnosis).

(A) Light microscopic observation

- Sample preparation
1- thin film observation of malaria parasites is optimal when
parasites are fixed and observed in their natural location within red
blood cells after appropriate staining. This is best accomplished with
the thin film preparation technique. Unfortunately, thin film has a low
sensitivity and is thus inadequate for low parasitaemic infection.

2- thick film An adequate parasite concentration method is

obtained by osmotic lysis of the red blood cells releasing the parasites,
as is the case with the thick film preparation technique, the sensitivity
is more than thin film.

- Fixation
Its may be achieved by heat and alcoholic solutions
for 10-20 seconds . Methanol (methyl alcohol) is the
most widely used fixative for malaria thin films.
- staining
1- Giemsa staining procedure
Is the most commonly used method for both thin and
thick films all over the world for the quality of the stain and,
of greater importance, because its stability in tropical
climates.

2- Field staining procedure

3- Leishman staining procedure

Blood smear stained with Giemsa, showing a white blood cell (on left side) and several red blood
cells, two of which are infected with Plasmodium falciparum (on right sideBlood smear
stained with Giemsa, showing a white blood

- Field staining procedure. Field staining is a

good method to stain thick films but is not suitable for
thin films. However, it has the remarkable advantage
to be extremely quick (the smear may be stained in 1
minute).

- Leishman staining procedure. Since

Leishman staining solution uses methanol as a
solvent, this method is only useful to stain thin films.

(B ) Quantitative Buffy Coat (QBC )

and the direct acridine orange staining
Is a sensitive microscopic test based on the ability
of acridine orange to stain nucleic acid containing
cells
A direct acridine orange (fluorochrome)
staining This method recently proposed of thin and
thick film to provide an economically convenient
alternative to the QBC technique for use in the field
by using specially designed interference filters that
may be connected to conventional light (even
sunlight) microscopes

(C) DNA probes and Polymerase Chain

Reaction
The initial studies in nucleic acid-based malaria
diagnosis used the parasites repetitive DNA found
throughout the Plasmodium genome as the diagnostic
target . Therefore, after the sequencing of two small
subunits (18S) rRNA genes from P. falciparum and P.
vivax , species-specific regions of the rRNA genes
have been exploited in developing a sensitive and
specific

(D) Detection of P. falciparum antigen

The production of histidine rich protein II (HRPII) antigen by blood stages of Plasmodium falciparum
forms the basis for the development of ELISA antigen
test and more recently, of the dipstick Becton Dickinson
ParaSight -F test,

( E) Other direct diagnostic methods

The determination of blood levels of parasite-specific
lactate dehydrogenase (pLDH) has been evaluated as
indirect method of quantifying parasitaemia and also
drug resistance

(D) Detection of P. falciparum antigen

The production of histidine rich protein II (HRPII) antigen by blood stages of Plasmodium falciparum
forms the basis for the development of ELISA antigen
test and more recently, of the dipstick Becton Dickinson
ParaSight -F test,

( E) Other direct diagnostic methods

The determination of blood levels of parasite-specific
lactate dehydrogenase (pLDH) has been evaluated as
indirect method of quantifying parasitaemia and also
drug resistance

2- Indirect diagnosis (immunodiagnosis)

Detection of Plasmodia specific
antibodies by:
1-Immunofluorescene (IFAT) The first
serological test to be used for malaria antibodies was
immunofluorescence (IFAT), which may give
quantitative results for both G and M specific
immunoglobulins. Its specificity and sensitivity
largely rely on the laboratory technicians expertise.

2-

Indirect haemoagglutination test (IHA)

: Is

simple and suitable for field studies, but its sensitivity and
specificity are poor

Radioimmunoassay (RIA) :

is sometimes
used but needs well equipped research laboratories and
personnel.
3-

Signs and symptoms

The sign and symptoms of malaria typically begin 8-

25 days following infection, however symptoms may

occur later in those who have taken antimalarial
medication as prevention.

Treatment
Malaria is treated with antimalarial drugs and measures to control symptoms,

including medications to control fever, antiseizure medications when needed,

fluids and electrolytes. The type of medications that are used to treat malaria
depends on the severity of the disease and the likelihood of chloroquine
resistance. The drugs available to treat malaria include:
Chloroquine
Quinine
Hydroxychloroquine (Plaquenil)
Artemether and lumefantrine (Coartem)
Hydroxychloroquine (Plaquenil)
Atovaquone (Mepron)
Proguanil (sold as a generic)
Mefloquine
Clindamycin (Cleocin)
Doxycycline.

PREVENTION
One way to prevent malaria is to avoid mosquito bites with the

following strategies:
As much as possible, stay indoors in well-screened areas,
especially at night when mosquitoes are most active.
Use mosquito nets and bed nets. It's best to treat the nets with
the insect repellant permethrin.
Wear clothing that covers most of your body.
Use an insect repellent that contains DEET or picaridin. These
repellents are applied directly to your skin, except around your
mouth and eyes. If you choose a picaridin-based repellant, you
will need to reapply it every several hours.
Apply permethrin to clothing.

Evaluation
1.
2.
3.
4.
5.

what is the vector of malaria?

What are the classification of malaria?
What are the signs of malaria?
What is the treatment of malaria?
Prevention of malaria