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1
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• ??????? ???????? ?????? ????? ???? ???.
• ?????? 500 ? 300 ?????? ??? ?? ?? ????? ?? ????
  (80 ???? ?? ??????? ????????)
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  ????? ?? ?? ?? ??? ?? ???? (80 ???? ??? ??? ??? 5
  ???).

2

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• ???????? ????????? ?? ??????? ? ?? ???? ?????
  ???? ??? ?????? ?????.

3
???? ?????
4
(No Transcript)
5

• ?????????? ?????????? ???????? ????? ???? ?? ???
  (?????????) ?? ????? ?? ??? ? ???? 40? 10 ?????
  ??? ???? ?? ????? ?? ???.
• ?????????? ?????? ? ?????????? ?????? ?????? ????
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  ??????????? ???? ?? ?? ?? ?? ??? ????? ?? ???.

6

• ?????????? ?????? ???? ???? ???? ?????????? ??
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• ??? ???? ???? ?????????? ??????? ???? ??
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7

• ??? ?????? ?????????? ?????? ? ????? ??????? ????
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  ???? ???? ???? ????? ? ??? ??? ??? ?? ???? ??
  ????? .
• ????? ???? ? ???? ?????????? ??? ?????.

8

• ?? ???????? ???? ?? ?????????? ??????? ?? ?? ????
  ????? ???? ??? ???? ?? ????? ?? ?? ????? 30 ? 25
  ??? ?? ??? ????? ???? ?????.
• ??? ?? ???? ?????? ????? ???????? ???? ??
  ?????????? ?????? ?? ?? 4? 3 ??? ?? ??? ?? ????

9

• ?????????? ?????? ?? ???? ???? ???? ?? ???? ??
  ????? ?? ????? ????? ? ????? ?? ?????????? ??????
  ????? ?????.
• ???? ?????? ????????? ???? ??? ???? ?? ?????? ??
  ?????????? ????????? ?? ???? ?? ???? ???? ?????
  ??? ??? ??? ??? ????? ???? ????? ???? ? ????? ??
  ???.

10

• ???? ? ?????????? ?? ??? 17? 10 ??? ??? ?? ???.
• ?????? ??????? ?? ?????? ???? ???? ?????? ????
  ???? ????? ? ?? ?? ???? ??? ??? ???? ?? ????.
• ???? ????? ???????? ???? ?? ?????? ??? ?? ?????
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• ??? ?? ?????? ???? ?????? ???????? ????? ????????
  ??? ?? ???? ??? ???? ???? ???? ?? ????? ???.

11

• ???? ? ????? ? ?????? ?? ?????? ?? 30 ? 9 ???
  ?????? ??? ???? ????? ??? ?? ??? ?? ??????.
• ???? ?? ?????? ?????????? ?????? ?? ???? ?????
  ????????? ? ???? ? ????? ?? ?? ???? 10 ??? ?????.
• ??? ???? ???? ?? ?????????? ?????? ? ???? 10 ??
  17 ???? ?? ?????????? ??????? 18 ?? 40 ??? ? ??
  ?????????? ?????????? 11 ? 8 ??? ???.

12

• ?????? ?? ?????? ????? ????? ??? ????? ????? ???
  ????? ?????? ???? ????? ? ????? ?????? ????
  ???????? ? ?????? ????? ??? ? ?? ?? ?? ??? ????
  ?? ???.

13

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  ?????????? ??????? 72 ???? ???.

14

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  ??????? ????? ? ??????? ?? ????? 5/5? 8? 9 ? 15
  ???
• ??? ???? ?????????? ?? ????? 14? 12 ??? ??
  ??????????? 12 ? 8 ??? ?? ?????? ? 35 ??? ??
  ??????? ?? ????.

15

• ?? ??? ???? ???????? ?????? ?? ?? ??? ???
• ?????????? ?? ?? ?????
• ???????? ???? ?? ?????????? ??????? ???? ??
  ?????? ?? ???.

16

• ?? ????? ???? ?????? ??????? ?? ???? ?? ?????
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• ????? ???? ????? ??????? ? ????? ??????? ???? ??
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• ???? ????? ?? ??? ?? ???? ???????? ???? ?????
  ??????? ??

17

• ???????? ???? (????? ????? ????? ???? ???????
  ????) ? ?????? ???????? (?????? ??? ?????? ??? ?
  ?????? ?????? ??? ??????? ??? ??? ? ????).

18

• ?? ???? ???? ?
• ??????? ???? (???? ???? ?? ??????)?
• ??? ???? (???? ???? ???? ?? ????? ?????)?
• ???? ??? ??? ?
• ???????? ??? ( ???? ???? ???? ???? ???? ????
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• ?????? ????? ???? ????? (DIC)
• (??????? ???? ?? ??? ??? ???? ? ?????? ?????)?
• ?? ????? ???? (?????? ?? ??? ?????? ???
  ????????? ?? ?????) ?
• ????? ????.

19
?????

• ????? ???? ??????? ?? ??????? ?????????? ???? ??
  ????? ???? ???? ?? ????.
• ???????? ???? ??? ????? ???? ??? ?? ??? ????? ??
  ??? ???? ????? ????? ??? ???????? ??????????
  ?????????? ?? 10 ??? ?? ?? ???? ????? ??? ??????
  ???? ??? ???.

20

• ????? ???? ??? ????? ???? 15 ????? ???? ?????
  ???? ????? ?? ???? ?? ?????? 5 ????? ?? ?????
  ????? ?? ???? ???? ????? ?? ?? ???? ????? ???.
• ????? ???? ???????? ??? ?????? ???? ??????? ???.

21
Types of Serological Assays Malaria

• Antibody Detection
• Indirect Fluorescent Antibody
• Enzyme immunoassays
• Antigen Detection
• Immunochromatographic

22
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23
Indirect Fluorescent Antibody (IFA)
24
Quantitative Buffy Coat (QBC )

• Useful for screening large numbers of samples
• Quick, saves time
• In the QBC technique, approximately, 50
  microlitres of whole blood was taken into a
  capillary tube coated with acridine orange and
  fitted with a cap.

25

• A plastic float was inserted inside the tube and
  then spun in the QBC microhaematocrit centrifuge
  at 12000 rpm for 5 minutes
• Due to acridine orange, the malarial parasite
  stains green (DNA nucleus) and orange (RNA
  cytoplasm).

26
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27
Malaria Antigen Detection

• Immunologic assays to detect specific antigens
• Commercial kits now available as
• immunochromatographic rapid diagnostic tests
  (RDTs), used with blood
• P. falciparum histidine-rich protein 2 (PfHRP-2)
• parasite LDH (pLDH)

28
Malaria Antigen Detection

• Immunologic assays to detect specific antigens
• Commercial kits now available as
• immunochromatographic rapid diagnostic tests
  (RDTs), used with blood
• P. falciparum histidine-rich protein 2 (PfHRP-2)
• parasite LDH (pLDH)

29

• Monoclonal and polyclonal antibodies used in
  antigen (Ag) capture test
• Species- and pan-specific Ab
• Cannot detect mixed infections
• Cross reactivity with rheumatoid factor
  reportedly corrected

30
Detection of Plasmodium antigens pLDH (parasite
lactate dehydrogenase)
31
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32
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33
Polymerase Chain Reaction (PCR)

• Molecular technique to identify parasite genetic
  material
• Uses whole blood collected in anticoagulated tube
  (200 µl) or directly onto filter paper (5 µl)
• 100 DNA is extracted
• 10 blood volume used in PCR reaction

34
Polymerase Chain Reaction (PCR)

• Threshold of detection
• 0.1 parasite/µl if whole blood in tube
• 2 parasites/µl if using filter paper
• Definitive species-specific diagnosis now
  possible
• Can identify mutations try to correlate to drug
  resistance
• Parasitemia not quantifiable
• May have use in epidemiologic studies
• Requires specialized equipment, reagents, and
  training

35
Sensitivity of Tools forDiagnosis of Malarial
Infection

• Most sensitive
• Antibody detection
• PCR
• Blood film examination

36
Diagnosis of Untreated Acute Malaria

• Blood film examination
• PCR

37
Diagnosis of Treated Recent Malaria

• Serology
• Blood film examination
• PCR

38
Other tests

• Rapid reduction in level of hemoglobin is seen in
  falciparum malaria and less than 7 g/ dl should
  be a warning.
• Leukocytosis is vary from low to high, and
  neutrophilic leukocytosis is common in severe
  malaria with or without associated bacterial
  infection.
• Leukopenia is seen in severe malaria with
  septicemia, and chronic hypersplenism.

39

• Thrombocytopenia is common in P. falciparum and
  P. vivax malaria
• Hypoglycemia is a common problem encountered in
  malaria
• Hyperbilirubinemia is common in malaria,
  particularly due to hemolysis
• Serum albumin levels may be reduced, some times
  markedly.

40

• Hyponatremia is common and needs careful
  management.
• Prothrombin time and partial thromboplastin time
  are elevated in 20 of patients with cerebral
  malaria

41
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• ????? ????? ???? ???? ???????? ???? ?? ???? ???
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  ???? ?????? ??????? ????? ?????? ??? ?? ?? ?????
  4? ???????????? ?? ????.

42

• ?? ????????? ???? ???? ?? ???? ??? ???? ?? ?????
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  ??????? ?????? ???? ??? ????? ??????? ????????
  ????? ???? ????.
• ???? ??????? ?? ?????? ???? ?? ?????????? ??????
  ? ?????? ?? ????? ???? ?? ?? ???????? ????? ?? ??
  8 ? ???????????? ?? ???? ???? ???
• ??? ???? ?????????? ??? ???? ?????????? ?????? ?
  ???? ?? ?? ??? ???? ? ???? ??? ?????? ?? ?? ????.

43

• ???? ????? ?????????? ?????????? ????? ?? ???????
  ???? ????? ?????? ????? ???? ???? ???.
• ?? ????? ?????? ?? ??????? 3 ??? ???????? ??
  ???? ?? ?? ????? ?? ???.
• ??? ???? ?????? ?? ????????? ? ??????????? ??
  ????.
• ?? ???? ????? ???? ???? ?? ???????? ?? ?????
  ????? ?????? ?? ?????????? ?? ????? ? ?? ????
  ???? ????? ?? ??????? ???? ?? ?????????? ???????
  ?? ???.
• ?????? ???????? ??????? ? ??????? ??????? ??????
  ?? ???? ? ???????? ?? ?????.

44
?????? ??????

• RI ???? ???? ??? ??????? ?? ??? ??? ????? ? ????
  ?? ??? ? ??? ?????? ?? ?? ??? ?? ??? ?? ?? ????
  ????? ???? ?? ???.
• RII ?????? ???? ????? ???? ?? ??? ?? ?? ????
  ????? ??? ??? ??? ??? ??? ? ?????? ???? ?????
  ???? ???.

45

• ?? RIII? ???????? ??? ?????? ? ?? ?? ????? ?????
  ?????? ?? ??? ?? ???? ????? ???? ??? ??? ????
  ?????? ?? ???? ?? ???.
• ?? ?????? ??? RI ?? ???? ??????? ?? ????? ?????
  ???.
• ?? ???? ???? ?????? ?? ???? ?? ??????? ????
  ?????? ??? ???????? ??????? ???.

46
??? ??? ?????

• ???? ????? ???? ???? ?????? ??? 9? 2 ???? ? ?????
  ???? ???? ???.
• ???? ????? ?? ????? ????? ?? ???? ????? 9? 2 ????
  ?? ??? ?? ?? ?? ????? ???? ??? ???? ??????????
  ???? ???.
• ?????? ?? ???? ????? ????? ?? ?? ?? ????? ?????
  ??????? ???? ????? ????? ??????? ???? ??
  ????????? ???? ?? ????.

47

• ?? ????? 2 ????? ???? ??????? ???? ????
• ????? ???? ???? ?????? ????? ? ????? ???? ??.
• ?? ????? ???? ?? ?? ?????? ?????? ??? 1950
  ??????? ????? ???? ? ?????? ???? ???? ???? ???
  ???? ? ?? ????? ?? ???? ????? ?? ??? ?????? ????
  ?????? ?? ????.

48

• ???? ????? ??????? ?? ??? ????? ????? ?? ????????
  ?? ???? ?? ?? ???? ???? ?? ??? ??? ???? ??? ???.
• ????? ??? ????? ?? ????? ???? ??? ??? ?? ? ???
  ?????? ?? ???? ?? ?? ? ??? ???? ??? ???? ???????
  ? ??????? ?? ??? ???? ????? ??????? ?? ???? ?????
  ?????.

49

• ?? ????? ???? ????? ??????? ?? ? ?????? ??????
  ??? ?? ?? ???? ?? ??? ?????? ???? ??? ?????? ?
  ?????? ????( ??? ?? 12? 10) ???? ? ?????? ??????
  ? ??? ??????? ? ??????? ? ??????? ????? ??? ???
  ??? ??? ?? ??????? ?? ??????? ???? ??? ???? ????
  ????.

50

• ?? ??? ???? ???? ?? ???????? ?? ??? ?????? ????
  ??????? ????? ??? ??? ??? ?? ????? ???? ???? ????
  ????? ?????? ? ????????? ??? ????? ??????? ? ????
  ????? ????? (????? ? ?????) ???? ???? ???????
  ???? ????.

51

• ?? ????? 15 ???? ????? ?? ??? ????? ???? ???? ??
  7 ???? ???? ???? ?? ?????? ?????? ??????? ??
  ?????????
• ????? ??????? ??? ???? ???? ?? ????? ????? ?????
  ?? ????.
• ????? ????? ?????? ??????? ??????? ?????? ???? ?
  ??? 50 ?? 100 ???? ???.
• ?? ???? ???? ????? ?? ???? ????? ????? ?? ?? ???
  ?????????? (???? ?? 10 ????)? ????????? (11 ?? 50
  ????) ? ??????????75-50 ?? ?? ???? ???? ???.

52
???????

• ??????? ???? ????
• ??? ???? ??????? ? ???? ????? ???????? ??? ??
  ??? ????? ????? ?? ?? ??? ? ??? ????? ????????.
• ?????? ?????????
• ??? ??? ??? ???? ??? ? ??????? ???? ?? ??????? ?
  ??? ???????? ??? ????? ?? ??? ?? ??? ??????
  ??????? ?? ???.

53

• ?????? ?????? ?????
• ???? ??????? ?? ???? ???????? ?? ???? ?? ???????
  ?? ?? ????? ????? ??? ????? ??? ???? ?????? ??
  ??? ?? ???? ???? ?? ??? ??????? ??? ???? ?? ???.
• ???? ?????? ?? ??? ??????? ???????? ??? ????? ??
  ??? ?? ??? ??? ??????? ?? ???.
• ?????? ?? ??? ????
• ?? ???? ?? ?? ??? ???? ?? ????.

54

• ?? ???? ?????? ????? ??????
• ?? ?? ???? 2 ?? 6 ??? ?? ? ???? ???? ?? ???? ?
  ?? ????? ????? ?? ???? ????? ? ?????? ??????? ??
  ???.
• ?? ???? ????? ????? ???? ????.
• ?? ????? ????? ???????? ???? ?? ?????? ?? ????
  ???? ???? DDT(?? ???? ?? ???? ??? ???? ????)?
  ???????? ? ??????? ?????? ???? ???? ???.

55

• ?????? ??????? ?? ??????? ???? ??? ???????? ?? ??
  ????? ???? ?? ???? ??? ?? ?????? ???? ?? ???? ???
  ??? ??????? ????? ???? ????.
• ??????? ?? ??? ???
• ??????? ?????? ?? ??? ??? ?? ???? ?????? ?? ??
  ?? ????????? ????? ???? ?? ??????? ???????? ?????
  ???? ???.

56
(No Transcript)
57
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58
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59
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60
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61
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62
(No Transcript)
63
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64
(No Transcript)
65
(No Transcript)
66
(No Transcript)