Name means “bad air”- A life-threatening parasitic disease

1. Name means “bad air”- • A life-threatening parasitic disease • 40% of the world’s population is at risk • 90% of the deaths due to Malaria occur in Sub-Sahara Africa, mostly among young children. • 5 million of people are affected every year . • At least 1.5 million deaths annually. • It is one of the major public health concerns

2. How is malaria transmitted? Malaria parasites are transmitted from one person to another by the bite of a female anopheles mosquito. The female mosquito bites during dusk and dawn and needs a blood meal to feed her eggs. Male mosquitoes do not transmit malaria as they feed on plant juices and not blood. There are about 380 species of anopheles mosquito but only about 60 are able to transmit malaria.

3. Transmission Female Anopheline mosquito bite Mother to child Blood transfusion

4. What is malaria ? One of the red blood cell & a vector – borne infectious diseaseMalaria is a disease caused by the protozoan parasites of the genus Plasmodium. The 4 species that commonly infect man are:

5. Plasmodium falciparum Malignant tertian M. (Cerebral Ma. Or renal failure) (48hr.) Plasmodium vivax(48hr.) Benign tertian M. relapsing M. Plasmodium ovale - Ovale tertian M. relapsing M.(48hr.) Plasmodium malariae Quartan M. (72 hr.) remain for one decade , no dominant(relapsing) stage (7%) Common & Severe Rare & Mild Species Infecting Humans

6. The Hosts Human: _ intermediate host. _ victim. _ asexual cycle (schizogony cycle). Female Anopheles mosquitos : _ final hosts. _ vector. _ sexual cycle(sporogony cycle).

7. Plasmodium 1 2 Sporozoites undergo schizogony in liver cell; merozoites are produced 2000-40,000 Mer.(6-16)days. Infected mosquito bites human; sporozoites migrate through bloodstream toliver of human Sporozoites in salivary gland 10,000 sp. 9 Resulting sporozoites migrate to salivary glands of mosquito 3 Merozoites released into bloodsteam from liver may infect new red blood cells Sexualreproduction Asexual reproduction 8 In mosquito’s digestive tract, gametocytes unite to form zygote Zygote Intermediate host Female gametocyte 4 Merozoite develops into ring stage in red blood cell Male gametocyte.gut Ring stage 5 Ring stage grows and divides, producing merozoites (6-24)M. Definitive host 7 Another mosquito bites infected humnan and ingests gametocytes .skin 6 Merozoites are released when red blood cell ruptures; some merozoites infect new red blood cells, and some develop into male and female gametocytes Merozoites

8. Oocyst Sporozoites Mosquito Salivary Gland Zygote Hypnozoites (for P. vivax and P. ovale) Gametocytes Erythrocytic Cycle Malaria Life Cycle Sporogony Sexualfinal host Exo- erythrocytic (hepatic) cycle 6-16 days Asexual cycleIntermediate host Red Blood cell Schizont Schizogony Liver cell Schizont

9. Hypnozoites(relapsing) Hypnozoites: - Are liver-trophozoite stages -Responsible for recurrence of malarial symptoms. Plasmodium vivax &Plasmodium ovale HYPNOZOITES Illness May Relapse 3 To 5 Years After Original Infection

10. Days 1, 3, 5, 7, 9,………. 48 hrs. Tertian malaria Days 1, 4, 7, 10,………. 72 hrs. Malarial Paroxysm • Days 1 and 3 for: • Plasmodiumvivax • Plasmodiumovale • andPlasmodiumfalciparum • Usually persistent fever or daily paroxyms for Plasmodium falciparum. • Days 1 and 4 forPlasmodiummalariae Quartian malaria

11. Malarial Paroxysm • Cold stage • Hot stage • Sweating stage

13. The clinical course of P. • Asymptomatic parasitaemia (“clinical immunity”) • Acute, uncomplicated malaria • Severe malaria

14. A. Asymptomatic parasitaemia This is usually seen in older children and adults who have acquired natural immunity to clinical disease as a consequence of living in areas with high malaria endemicity. There are malaria parasites in the peripheral blood but no symptoms. These individuals may be important reservoirs for disease transmission. Some individuals may even develop anti-parasite immunity so that they do not develop parasitaemia following infection.

15. B. Simple, uncomplicated malaria This can occur at any age but it is more likely to be seen in individuals with some degree of immunity to malaria. The affected person, though ill, does not manifest life-threatening disease. Fever is the most constant symptom of malaria. It may occur in paroxysms fever, chills and rigors (uncontrollable shivering). Children with malaria waiting to be seen at a malaria clinic in the south western part of Nigeria. Identifying children with severe malaria, and giving them prompt treatment, is a major challenge when large numbers attend clinics.

16. Other features of simple, uncomplicated malaria include: Vomiting, Diarrhoea,Convulsions, Jaundice Malaria is a multisystem disease. Other common clinical features are: Anorexia, Cough, Headache, Malaise, Muscle aches, Splenomegaly, hepatomegaly These clinical features occur in “mild” malaria. However, the infection requires urgent diagnosis and management to prevent progression to severe disease.

17. C. Severe and complicated malaria Cerebral malaria Severe malaria anaemia Hypoglycaemia Metabolic acidosis Acute renal failure Pulmonary oedema Circulatory collapse, shock or “algid malaria” Blackwater fever Nearly all severe disease and the estimated >1 million deaths from malaria are due to P. falciparum. Although severe malaria is both preventable and treatable, it is frequently a fatal disease. The following are 8 important severe manifestations of malaria: Note: It is common for an individual patient to have more than one severe manifestation of malaria!

18. Hyperendemic areas. • Fever ,sweat, chills, headache & muscle pain Malaria Diagnosis • Clinical Diagnosis • Malaria Blood Smear • Serology (ELISA)(IFAT) . • Polymerase Chain Reaction B.F.F.M.=Blood Film For Malaria Blood SmearPrepare smears as soon as possible after collecting venous blood to avoid any Changes in parasite morphology. the“gold standard”for diagnosis of malaria..

19. Plasmodium falciparum Infected erythrocytes: ***normal size(Maurer’s dots) 4 2 1 Gametocytes: mature (2)and immature (1) forms (1is rarely seen in peripheral blood) Rings: double chromatin dots multiple infections in same red cell 1 3 Schizonts: 8-24 merozoites *(rarely seen in peripheral blood) 2 Trophozoites: compact *(rarely seen in peripheral blood)

20. Plasmodium vivax Infected erythrocytes: enlarged up to 2X**deformed; (Schüffner’s dots) 1 2 Ringsone chromatin dots Trophozoites: ameboid; deforms the erythrocyte Schizonts: 12-24 merozoites Gametocytes: round 4 3

21. Plasmodium ovale Infected erythrocytes: enlarged (1 1/4 X); **fimbriated; oval; (Schüffner’s dots) 1 2 Trophozoites: compact Rings Gametocytes: round-oval Schizonts: 6-14 merozoites; dark pigment; (“rosettes”) 3 4

22. Plasmodium malariae • Infected erythrocytes: **normal size 1 2 3 4 Trophozoite: typical band form Schizont: 6-12 merozoites; coarse, dark pigment Gametocyte: round; coarse, dark pigment Ring: compact

23. Prevention • Using insecticide to kill a larval stage of mesquite. • Recovering all ponds and water source with oil. • Using a mesquite net. • Using prophylaxis when travel to area with malaria are endemic. • Breeding a special type of fish which feeding on larval stage of Anopheles.