MALARIA

Contributors to the
research
Number

Name

1205

Melissa Nourhan Kurkdijan

1206

Nadeen El Shebiny

1207

Nada Ashraf

1208

Nada Khaled

1211

Nouran Ehab

1212

Nouran Mohammed AbdelRahman

1213

Nourhan Jamal AbdulAziz

1214

Hebatalla Maged Badrawy

1215

Hanadi Ahmed Salama

Malaria is a protozoan disease

caused in humans by four species of
the PLASMODIUM genus.
The parasites are spread to people
through the bites of infected
Anopheles mosquitoes, called
"malaria vectors", which bite mainly
between dusk and dawn.

Epidemiology

Malaria is endemic in parts of Asia, Africa,

Central and South America, Oceania, and
certain Caribbean islands.

Most deaths occur

among children living
in Africa.
Since 2000, mortality
rates amongst children
have reduced by 54%,
and in adults by 42%
globally.

The Plasmodium
Protozoon

Four species:
P. falciparum malignant malaria (dangerous!)
P. vivax benign tertian malaria (commonest)
P. ovale oval tertian malaria
P. malariae quartan malaria

The Anopheles
Mosquito

The vector of the plasmodium, the female

Anopheles mosquito transfers the protozoon
through its bites to humans.
The Plasmodium makes the smell of the
person attractive to mosquitoes.
The development of the parasite within the
mosquito depends on several factors such as
humidity and ambient temperatures.

Life Cycle

1.
2.
3.
4.

Infection by sporozoites
Exo-erythrocytic schizogony
Erythrocytic schizogony
Gametogony (or re-invasion)

1. Reduction Division of gametocytes

2. Copulation
3. Formation of sporocyst containing
sporozoites
4. Concentration in salivary glands ready to
infect another human

Mode of infection

Bite of infected Anopheles

mosquito
Transfusion malaria : blood
transfusion from infected
donors
Accidental malaria: use of
contaminated needles
Congenital malaria : from
mother to fetus through the
placenta or when the
umbilical cord is cut .

Infective
stages
Sporozoite

Erythrocytic
stages

Pathogenesi
s

6. HYPOGLYCEMIA
Due to increase
metabolic demands of
glucose and impaired
hepatic functions

Clinical Picture
Begin 825 days following infection
May occur later in those who have
taken anti-malarial medications as
prevention
Initial manifestations of the
disease similar to flu-like
symptoms and include headache,
vomiting, arthralgia.
Paroxysmal attacks of fever occur
every 3 days in P. vivax, ovale and
falciparum,but every 4 days in P.
malariae.

Complications

Acute respiratory distress syndrome (rare,

in young children with severe malaria)
Renal failure
Neurological manifestations (retinal
whitening, nystagmus, seizures, coma)
Splenomegaly
Hepatomegaly
Hypoglycemia
Anemia
Hemoglobinuria (with renal failure)
Complications may include spontaneous
intravascular bleeding and coagulopathy.
Shock

Recurrence

Malaria recurrence can be either due

reinfection or relapse.
Re- infection less than 14 days in endemic
areas
Relapse:
More than 14 days
True due to activation of hepnozoites in liver

hepatocytes; only in vivax and ovale

False (Recrudescence) due to either
inadequate treatment or antigenic variation

Diagnosis

Clinical diagnosis
is based on the patients' signs and symptoms,

and on physical findings at examination.

A clinical diagnosis of malaria is still
challenging because of the non-specific nature
of the signs and symptoms, which overlap
considerably with other common diseases.
The Integrated Management of Children
Illness (IMCI) has provided clinical algorithms
for moderately-trained physicians.
Lab Diagnosis

PBS:

QBC:

Using Giemsa, Wright or Field

stain
Gold standard Giemsastained thick (for detecting
parasite) and thin (for confirming
species) blood films
labor intensive, time
consuming, require considerable
expertise and trained healthcare
workers, underestimated
infection

a rapid and sensitive test for

diagnosing malaria in numerous
laboratories.
simple, reliable, and user-friendly
requires specialized instruments,
more costly than conventional light
microscopy, poor at determining
species and numbers of parasites

RDTs:
Detects proteins inside Plasmodium
species, mostly P. falciparum.

Serology:
IFA highly sensitive& specific; costly

PCR:
Recent molecular diagnosis method
Very effective in low parasitemia and
mixed infections.

Treatment

Blood schizonticidal drugs:

Chloroquine (also gametocidal; not used in P.

falciparum)
Quinine (used in falciparum-resistant strains)
Mefloquine (prophylaxis during travel; safe)

Tissue schizonticidal drugs:

Primaquine (also gametocidal; gives radical cure

and terminnal prophylaxis)

Anti-folate antimalarial drugs (pyrimethamine)

Combinational Therapy:
artemisinin + mefloquine ACT
atovaquone+proguanil kills both blood

and tissue
Artesunate+pyrimethamine+sulfadoxine=
FANSIDAR

Used in effective treatment

of chloroquine-resistant P.
falciparum

Prevention and Control

GOAL to reduce as much as possible the
health impact of malaria on an endemic
population, using the resources available, and
taking into account other health priorities.
Malaria control does not aim to eliminate
malaria totally. Complete elimination of the
malaria parasite (and thus the disease) would
constitute eradication an un-realistic goal for
most endemic countries.

The following interventions

are applied to malaria control:
Case Management treat patients
effectively within 24 hours (WHO recommendation)
Prevention of Infection Prophylaxis - intermittent
preventive treatment (IPT) to ladies during the
second and third trimesters of pregnancy, as well as
vulnerable patients (travel, immuno-suppression)
Vector control destruction of larval breeding sites,
insecticide spraying inside houses, insecticidetreated bed nets (ITNs), skin repellents (OFF)

References

http://scientistsagainstmalaria.net/about-malaria/key-facts-about-malaria
http://www.ncbi.nlm.nih.gov/mesh/68008288
Korenromp E, Williams B, de Vlas S, Gouws E, Gilks C, Ghys P, Nahlen B
(2005). "Malaria attributable to the HIV-1 epidemic, sub-Saharan Africa"
. Emerging Infectious Diseases 11 (9): 14109.doi:
10.3201/eid1109.050337. PMC 3310631.PMID 16229771.
Bartoloni A, Zammarchi L (2012).
"Clinical aspects of uncomplicated and severe malaria".Mediterranean
Journal of Hematology and Infectious Diseases 4 (1): e2012026.doi:
10.4084/MJHID.2012.026. PMC 3375727.PMID 22708041.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688806/
http://www.medicinenet.com/script/main/mobileart.asp?articlekey=44657
http://www.cdc.gov/malaria/travelers/drugs.html
https://www.niaid.nih.gov/topics/malaria/research/Pages/control.aspx
http://www.malaria.com/overview/malaria-prevention-control