2. MALARIA
▪ Infection of RBCs and liver with Plasmodium.
▪ P. falciparum
▪ P. vivax
▪ P. malariae
▪ P. ovale
▪ P. knowlesi
▪ Transmitted by the female Anopheles mosquito.
▪ Occurs primarily in the tropical areas of Asia, Africa,
and Latin America.
▪ RBCs rupture as a part of the Plasmodium life cycle,
resulting in intravascular hemolysis and cyclical fever.
▪ P. falciparum - daily fever
▪ P. vivax and P. ovale - fever every other day
3. MALARIA TRANSMISSION CYCLE
Malaria spreads when a mosquito becomes infected with the disease after biting an infected person, and the infected
mosquito then bites a noninfected person. The malaria parasites enter that person's bloodstream and travel to the
liver. When the parasites mature, they leave the liver and infect red blood cells.
4. PRESENTAION
▪ UNCOMPLICATED MALARIA (Lasts 6-10 h)
▪ Cold stage (sensation of cold, shivering)
▪ Hot stage (fever, headache, vomiting, seizure in young children)
▪ Sweating stage (sweats, return to normal temperature, tiredness)
▪ Other symptoms (mild jaundice, rapid breathing, diarrhea, dry cough,
muscle and/or Back pain, abdominal pain)
▪ COMPLICATED MALARIA (SEVERE)
▪ Hemolytic anemia → Splenomegaly, Hemoglobinuria, Jaundice
▪ Blood coagulation disturbances (↑ Clotting)
▪ Hepatomegaly
▪ Metabolic acidosis
▪ Cardiovascular collapse and shock
▪ Hyperparasitemia (> 5% of RBCs are infected)
COMPLICATIONS: Cerebral malaria, pulmonary edema, kidney or liver failure,
spleen rupture, anemia, hypoglycemia, coma
5. TRETMENT (ANTIMALARIALS)
Chloroquine (CQ)
Is the DOC
Primaquine
To eradicate liver phase in P. vivax
and P. ovale infections
Mefloquine or Quinine
For proven CQ-resistant cases
NON-FALCIPARUM INFECTION
Chloroquine (CQ)
Is the DOC
[Mefloquine or Quinine] +
[Doxycycline or Malarone or
Artemisinin]
[Pyrimethamine-Sulfadoxine]
(Fansidar®)
For proven CQ-resistant cases
FALCIPARUM INFECTION
In severe cases, use parenteral artesunate or quinidine.
6. PREVENTION
▪ Protecting yourself against mosquito bites. [IRS / ITNs]
▪ Preventive chemotherapies:
▪ Taking antimalarial medicines.
▪ Chloroquine
▪ If chloroquine resistance: malarone, mefloquine, or doxycycline
▪ Primaquine
▪ RTS,S/AS01 malaria vaccine
▪ Young children and pregnant women avoid travelling to areas where malaria
are common.
7. CASE
A 40-year-old woman was well until 2 days ago, when
she experienced the sudden onset of fever, shaking
chills, and profuse sweating. Today, she also
complains of headache and abdominal pain but no
nausea, vomiting, or diarrhea. She does not have a
stiff neck, rash, or altered mental status. Travel
history reveals she returned from an extended trip to
several countries in central Africa 1 week ago.
Diagnosis??
