BLOOD PARASITES PLASMODIA/ BABESIA

1. BLOOD PARASITESPLASMODIA/ BABESIA WINIFREDA U. DELEON

2. SPECIES PLASMODIUM FALCIPARUM PLASMODIUM VIVAX PASMODIUM MALARIAE PLASMODIUM OVALE PLASMODIUM KNOWLESI

3. ARTHROPOD -BORNE ANOPHELES MOSQUITOES A. MINIMUS FLAVIROSTRIS HABITAT IN MAN – RBC HIGH OXYGEN TENSION COMPONENTS: NUCLEUS (CHROMATIN) CYTOPLASM

4. ON THE MOSQUITO VECTOR NIGHT BITER SLOW FLOWING CLEAN STREAMS FOOTHILLS EXOPHAGIC ZOOPHILIC

5. FORESTED AREAS- CLEANSLOW FLOWING STREAMS

6. LIFE CYCLE SCHIZOGONY ASEXUAL MULTIPLICATION END PRODUCTS – SCHIZONTS (MEROZOITES) OCCURS IN MAN GAMETOGONY GAMETOCYTES OCCURS IN MAN SPOROGONY SEXUAL MULTIPLICATION END PRODUCTS – OOCYSTS (SPOROZOITES) OCCURS IN MOSQUITOES

7. ASEXUAL STAGES TROPHOZOITES YOUNGEST - RINGFORMS DEVELOPING MATURE SCHIZONTS EARLY DEVELOPING MATURE - MEROZOITES

8. TROPHOZOITES

9. SCHIZONTS

10. RED CELL DEFENSES CELL MEMBRANE DUFFY Ag NULL – RESISTANCE TO P. VIVAX HEMOGLOBIN -HEMOGLOBIN S (SICKLE TRAIT) HELPS IN THE SURVIVAL OF PATIENTS FROM P. FALCIPARUM PRIMARY ACUTE ATTACK -B-THALLASEMIA- IMBALANCED GLOBIN CHAIN PROD’N OXIDATION BY HEMICHROMES (REACTIVE O2) G6PD PREVENTS OXIDATION OF THE HEME GROUP DEFICIENCY – GENERATION OF REACTIVE O2 ACCUMULATES IN THE RBC DAMAGES P. FALCIPARUM

11. VIRULENCE FACTORS RUPTURE OF SCHIZONTS RELEASE OF MEROZOITES: MONOCYTES – TNF (PYROGENIC) OTHER CYTOKINES GLYCOSYLPHOSPHATIDYL INOSITOL (GPI) KNOBS – CYTOADHESION(PfEMP) HISTIDINE RICH PROTEIN (HRP)

12. MULTI-ORGAN INVOLVEMENT GASTRO-INTESTINAL DIARRHEA, ABD PAIN, NAUSEA, VOMITING, ANOREXIA RESPIRATORY DYSPNEA NON PRODUCTIVE COUGH

13. FEVER PERIODICITY COINCIDES WITH RUPTURE OF SCHIZONTS INITIAL INFECTION – ASYNCHRONOUS AFTER 5- 7 D - SYNCHRONOUS PF – EVERY 40 HOURS PV & PO - EVERY 48 HOURS PM - EVERY 72 HOURS

14. PATHO-PHYSIOLOGY DESTRUCTION OF RED BLOOD CELL (INFECTED/ UNINFECTED) PRODUCTION OF CYTOKINES - TUMOR NECROTIC FACTOR (TNF) FEVER, HYPOGLYCEMIA, ARDS SEQUESTRATION IN DEEP VASCULATURE OF INTERNAL ORGANS (RBC RECEPTORS) - INTRACELLULAR ADHESION - VASCULAR ADHESION

15. HEMATOLOGIC CHANGES ANEMIA LEUKOPENIA THROMBOCYTOPENIA SUPPRESSED HEMATOPOIESIS RETICULOCYTES REDUCED SERUM IRON DEFECTIVE BLOOD CELL MATURATION

16. PATHO-PHYSIOLOGYSEVERE MALARIA HYPOGLYCEMIA LOW SERUM SODIUM MALABSORPTION (FATS, XYLOSE, VIT B 12 PULMONARY EDEMA CNS DYSFUNCTION ( COMA) ELEVATED BUN, CREATININE, PROTEINURIA

17. MALARIA OCCURS IN TROPICAL/ SUBTROPICAL COUNTRIES 300-500 M CASES ANNUALLY 1.5.-2.7 M DEATHS 10 LEADING CAUSES OF MORTALITY

18. MALARIA FIRST FEW DAYS: STEADY LOW GRADE FEVER HEADACHE PHOTOPHOBIA MYALGIA ANOREXIA NAUSEA/ VOMITING

19. REGULAR CYCLE CLASSIC: CHILLS FEVER SWEATING SPLENOMEGALY ANEMIA JAUNDICE

20. CAUSES OF ANEMIA HEMOLYSIS SPENIC REMOVAL OF RBC FROM CIRCULATION AUTO-IMMUNE LYSIS DECRASED INCORPORATION OF IRON INTO HEME BONE MARROW DEPRESSION

21. MALARIA - PHILIPPINES 65-70% P. FALCIPARUM – MALIGNANT 30% P. VIVAX – BENIGN TERTIAN 1% P. MALARIAE - QUARTAN

22. FALCIPARUM MALARIA INVADES ALL AGES OF RBC SEQUESTRATION IN INTERNALORGANS ISCHEMIA LIVER – ABDOMINAL PAINS JAUNDICE LUNGS – PULMONARY EDEMA KIDNEYS - BLACKWATER FEVER- HEMOGLOBINURIA CEREBRAL INVOLVEMENT

23. COMPLICATED COMA CONVULSIONS HYPOGLYCEMIA ACIDOSIS RESPIRATORY DISTRESS ALGID (CIRCULATORY COLLAPSE, SHOCK & SEPTICEMIA) HYPER-PARASITEMIA

24. CEREBRAL MALARIA

25. VIVAX MALARIA LESS SEVERE RELAPSES OCCUR AFTER WEEKS OR MONTHS INVADES ONLY RETICULOCYTES LOW ALBUMIN/ ELEVATED GLOBULIN INCREASED SERUM POTASSIUM

26. MALARIAE MALARIA INVADES OLDER RBC LONGER INCUBATION PERIOD NEPHROTIC SYNDROME – DEPOSITION OF IMMUNE COMPLEXES LATENT INFECTION FOR MANY YEARS

27. WHO ARE AT RISK? THOSE IN ENDEMIC PLACES CHILDREN PREGNANT WOMEN SPONTANEOUS ABORTION CONGENITAL INFECTIONS LOW BIRTH WEIGHT PRE-TERM DELIVERY PERI-NATAL DEATH TRAVELERS BLOOD RECIPIENTS- TRANSFUSION

28. PHILIPPINES 14.8% AT RISK SOLDIERS FARMERS INDIGENOUS CULTURAL GROUPS MINERS FOREST WORKERS 65/ 79 PROVINCES 8TH LEADING CAUSE OF MORBIDITY

29. SOLDIERS/ FORESTERSSCOUT RANGERSLOGGERS

30. MALARIA FREE AKLAN GUIMARAS BILIRAN ILOILO BOHOL LEYTE CAMIGUIN LEYTE DEL SUR CAPIZ N/ SAMAR CATANDUANES SIQUIJOR CEBU

31. HIGHLY ENDEMIC PLACES PALAWAN KALINGA-APAYAO IFUGAO AGUSAN DEL SUR

32. DIAGNOSIS CLINICAL – MIMIC DISEASE GASTROENTERITIS PNEUMONIA MENINGITIS HEPATITIS ENCEPHALITIS DENGUE TYPHOID TRAVEL Hx

33. LABORATORY Dx BLOOD SMEARS THICK/ THIN STAIN WITH WRIGHT’S OR GIEMSA FLOURESCENT STAINING (QBC) SEROLOGY: ANTIBODY DETECTION: IFAT ELISA ANTIGEN DETECTION : RAPID DIAGNOSTIC TESTS (RDT’S) HRP II LDH PCR

34. BLOOD SMEARSTHICK/ THIN

35. TREATMENT NON FALCAPARUM: CHLOROQUINE ORAL UNCOMPLICATED FALCIPARUM CHLOROQUINE ORAL QUININE ORAL FANSIDAR (SULFADOXINE PYREMETHAMINE) PRIMAQUINE – HYPNOZOITES/ GAMETOCYTES CHECK FOR G6PD DEFICIENCY ARTEMISININ (QINGHAOSU) CO-ARTEM COMPLICATED MALARIA – HOSPITALIZE (IV MEDICATION) PROPHYLAXIS – CHLOROQUINE PROGUANIL

38. PLASMODIUM FALCIPARUMRINGS

39. PLASMODIUM FALCIPARUM GAMETOCYTES

40. PLASMODIUM VIVAX

41. PLASMODIUM VIVAX RINGS

42. PLASMODIUM VIVAX DEVELOPING TROPHOZOITES

43. PLASMODIUM VIVAX SCHIZONTS

44. PLASMODIUM MALARIAE

45. PLASMODIUM MALARIAE BANDFORM

46. PLASMODIUM MALARIAE SCHIZONTS

47. PREVENTION • Mosquito nets • Clean clothing

48. CONTROL

49. BABESIA- PIROPLASMA BLOOD PARASITES THAT CAUSES HEMOLYSIS B. MICROTI - USA B. DIVERGENS - EUROPE TICK-BORNE – IXODES spp LYME DISEASE BLOOD TRANSFUSION

50. BABESIOSIS -PIROPLASMOSIS MANIFESTATIONS IRREGULAR FEVERS CHILLS SWEATING PAIN/ MALAISE LETHARGY SEVERE CASES HEMOLYTIC ANEMIA JAUNDICE SHORTNESS OF BREATH HEMOGLOBINURIA