malaria for 12 cbse

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Malaria

• Lajina ghimire
• BSC nurse/researcher

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Introduction

• Malaria is a mosquito borne-disease caused by
  plasmodium, which is transmitted by the bite of
  infected female anopheles mosquito.
• The term malaria originates from Italian
  word mala aria  "bad air"
• The disease is widespread in tropical and subtropi
  cal regions that are present in a broad band
  around the equator.2 This includes much
  of Sub-Saharan Africa, Asia, and Latin America.
  The World Health Organization estimates that in
  2012, there were 207 million cases of malaria.

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History

• Malaria or the associated disease have been noted
  4000 years ago.
• References to the unique periodic fevers of
  malaria are found throughout recorded history,
  beginning in 2700 BC in China.
• Malaria may have contributed to the decline of
  the Roman Empire, and was so pervasive in Rome
  that it was known as the "Roman fever".

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History

• Scientific studies on malaria made their first
  significant advance in 1880, when Charles Louis
  Alphonse Laverana French army doctor working in
  the military hospital of Constantine in Algeriaob
  served parasites inside the red blood cells of
  infected people for the first time. For this and
  later discoveries, he was awarded the 1907 Nobel
  Prize for Physiology or Medicine.
•  Scottish physician Sir Ronald Ross who proved
  that the mosquito was the vector for malaria for
  this he was awarded the Nobel prize in 1902.

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History

• The first effective treatment for malaria came
  from the bark of cinchona tree, which
  contains quinine.

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Malaria patient in Nepal
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Epidemiology

• The WHO estimates that in 2010 there were 219
  million cases of malaria resulting in 660,000
  deaths.
•  Others have estimated the number of cases at
  between 350 and 550 million for falciparum
  malaria and deaths in 2010 at 1.24 million up
  from 1.0 million deaths in 1990.
• The majority of cases (65) occur in children
  under 15 years old.
•  About 125 million pregnant women are at risk of
  infection each year in Sub-Saharan Africa,
  maternal malaria is associated with up to 200,000
  estimated infant deaths yearly.

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Epidemiology

• P. vivax is the most common cause of malaria and
  is found in subtropical and temperate areas of
  the world.
• P. vivax and P. ovale causes relapsing malaria.
• P. falciparum is found in the tropical region and
  causes the most severe and fatal disease.
• P. ovale is the least common malarial species and
  is endemic in Africa.

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Malaria prevalence in Nepal
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Aetiology

• Malaria parasites belong to the
  genus Plasmodium (phylum Apicomplexa).
• In humans, malaria is caused by P. falciparum, P. 
  malariae, P. ovale, P. vivax and P. knowlesi.
• Among those infected, P. falciparum is the most
  common species identified (75) followed
  by P. vivax (20).
•  Although P. falciparum traditionally accounts
  for the majority of deaths, recent evidence
  suggests that P. vivax malaria is associated with
  potentially life-threatening conditions about as
  often as with a diagnosis of P.
  falciparum infection.
• P. vivax proportionally is more common outside of
  Africa

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Life cycle of malarial parasite
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Lifecycle

• The lifecycle of malaria parasite consists of
  following phases
• sexual cycle in female anopheles mosquito,
  definitive host.
• Asexual cycle in human, as intermediate host.
• Sporozoites are the sexual form of the parasite.
• When the infected female anopheles mosquito bites
  the human then the sporozoites enter the human
  along with the saliva of the mosquito.
• Within 30 min they enter the parenchymal cells of
  the liver, where, during next 10-14 days, they
  undergo pre-erythrocytic stage of development and
  multipication.

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Lifecycle

• Following mitotic replication of its nucleus, the
  parasite is termed as schizont.
• At last the parasite rupture the liver cell and
  merozoites are released.
• The merozoites from the liver cell then bind to
  or enter the red blood cells and further develops
  into trophozoites.
• The multipication here results to Erythrocytic
  schizont.
• Some merozoites of erythrocytic schizony develop
  into male and female gametocytes known as
  microgamates and macrogamates res.
• They are sexual form and are found in peripheral
  blood.

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Lifecycle

• Some of the sporozoites also, on entering into
  the liver cells, do not undergo asexual
  multiplication but enter into a resting phase
  called hypnozoite.
• The sexual cycle of malarial parasite actually
  starts in the human host by the formation of
  gametocytes which are then transferred to
  mosquito for further development.
• In the midgut of the mosquito, one
  microgametocyte develops into 4 to 8 thread like
  filamentous structures named microgamates.

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Lifecycle

• From one macrogamate only one microgamate is
  formed.
• The fertilization occurs, and the gamate is known
  as zygote.
• The zygotes matures into an ookinete and it
  further develops into an oocyst.
• An oocyst mature and it increases in size and a
  large number of sporozoites develop inside it.
• The oocyst rupture and releases sporozoites in
  the body cavity of mosquito.
• The sporozoites are distributed to different
  organs of the mosquito and they have a special
  predilection for salivary glands.
• The mosquito is now capable of transmitting the
  infection to man.

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Symptoms of malaria

• Physical findings may include
• Elevated temperature
• Perspiration
• Weakness
• Enlarged spleen
• Mild jaundice
• Enlargement of liver
• Increased respiration rate.

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Symptoms of malaria

• Other symptoms of malaria are
• Dry (nonproductive) cough.
• Muscle or back pain or both.
• Enlarged spleen.
• In rare cases, malaria can lead to impaired
  function of the brain or spinal cord, seizures,
  or loss of consciousness.
• Infection with the P. falciparum parasite is
  usually more serious and may become life-threateni
  ng.
• Symptoms may appear in cycles. The time between
  episodes of fever and other symptoms varies with
  the specific parasite. Episodes of symptoms may
  occur
• Every 48 hours if you are infected with P.
  vivax or P. ovale.
• Every 72 hours if you are infected with P.
  malariae. Other common symptoms of malaria
  include

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Pathogenesis

• Incubation period 10-14 days in P. vivax, P.
  falciparum and P. ovale but it is 28-30 days in
  P. malariae.
• The typical clinical features consists of febrile
  paroxysm, anaemia and spleenomegaly.

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Stages of disease

• Cold stage
• Hot stage
• Sweating stage

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Cold stage
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Hot stage
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Sweating stage
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Diagnosis

• Laboratory - thin, thick smears, antigen capture
  EIA, PCR etc.
• Clinical - platelets, regularly intermittent
  fever
• Other tests
• CBC
• Lukopenia, Thrombocytobenia, Esinophilia,
  monocytosis, Quntitative buffy coat techniqe,
  Urinalysis,Increase ESR

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Medical intervention

• .

Examine blood under microscope (geimsa stain)
chest x-ray helpful if respiratory symptoms are
present
CT scan to evaluate evidence of cerebral edema
or hemorrhage
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.
Polymerase chain reaction (PCR) -determine the
species of plasmodium

• .

Dipstick test - not as effective when parasite
levels are below 100 parasites/mL of blood
Blood examination Thick and thin blood film
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Thick and thin smear
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Treatment
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Malaria control protocal
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Prevention
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Insecticides impregnated sites
Insecticides coil and spray
Protective clothing
Fishes
Screened windows doors
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Malaria project in Nepal

• The initiation of Malaria control project was
  first started in Nepal in 1954 with an objective
  to study malaria in Terai belt of central Nepal.
• Currently malaria control activities are carried
  out in 65 districts at risk of malaria.